Procedure No. 5290P

Return To Work, Light Duty

The following procedures will be implemented when an employee has sustained a work related injury and is able to perform light duty work.

An accident injuring a district employee occurs during the performance of district related work duties:

• The injured employee reports the injury to their supervisor.
• The supervisor immediately reports a work related injury to human resources and the return-to-work (RTW) coordinator.
• The site completes the employer section of the “physicians’ work status report” form. The form is then given to the injured employee to take to their doctor. The form should be completed at the doctor’s appointment and returned to human resources within 24 hours of the appointment.
• The RTW coordinator tracks the process of the “physicians’ work status report” form.
• The district will fax a copy of the completed “physicians’ work status report” form to ESD 112 Workers’ Compensation Trust.
• Each time an injured employee attends a doctor’s appointment relating to their work related injury, they will request a “physicians’ work status report” form from human resources or their supervisor to provide to their doctor. The form should be completed at the doctor’s appointment and returned to human resources within 24 hours of the appointment.

Physician releases injured employee to return to work for light duty:

• The district will determine and modify the job description of a light duty position to meet the requirements listed on the physician’s form.
• The RTW coordinator will fax a modified job description along with a “light duty DR notice” to the attending physician’s office.
• After the “light duty DR notice” has been returned to the district, the RTW coordinator will schedule a meeting with the employee to review and sign the “light duty EE notice-A” form with job description.  If the employee can’t be reached, the “light duty EE notice-B” with job description will be mailed to the employee’s known home address.

Employee agrees to return to work to the light duty job(s) made available by the district:

• The RTW coordinator will send copies of the signed notice along with the job description to the attending physician, ESD 112 Workers’ Compensation Trust, and the employee’s supervisor.
• The RTW coordinator confirms with the supervisor that the employee has returned to work on the scheduled day. This information will also be sent to ESD 112 Workers’ Compensation Trust.
• The work site will enter the hours the employee works into substitute-on-line on a daily basis. Also, the work site will notify the RTW coordinator immediately of any absence by the employee.
• The RTW coordinator will maintain a weekly time card for the employee.  It will be faxed to ESD 112 Workers’ Compensation Trust each week.

Employee declines to return to work to the light duty job(s) made available by the district:

• The RTW coordinator will send copies of the signed notice along with the job description to the attending physician, ESD 112 Workers’ Compensation Trust and the employee’s supervisor.
• Declining may affect the employment status of the employee with the district.

Legal Reference:

Adopted: March 8, 2010