return to work light duty letter sample

• Specifies the employee's condition and the limitations it imposes.
• Details the types of tasks the employee can safely perform.
• Outlines any activities the employee should avoid.
• Provides a timeline for when the employee can expect to return to full duty.

1. Patient Information: Name, date of birth, etc.
2. Diagnosis: A brief explanation of the medical condition.
3. Work Restrictions: This is the core of the letter and can be presented in various ways:

   Activity	Restriction
   Lifting	Max 10 lbs
   Standing	Max 2 hours at a time
   Repetitive Motions	Avoid

4. Recommendations: Any additional advice, like needing frequent breaks or modified equipment.
5. Doctor's Contact Information: For any follow-up questions.

Return to Work Light Duty Letter Sample: Post-Surgery Recovery

• No heavy lifting for 6 weeks.
• Limited standing to 30 minutes per hour.
• Avoid bending at the waist.
• No repetitive arm movements.
• Can sit for extended periods.
• Minimal computer work initially.
• Requires frequent short breaks.
• No driving company vehicles.
• Avoid prolonged standing in one spot.
• Can perform light office tasks.
• Limited reaching overhead.
• No pushing or pulling heavy objects.
• Can answer phones and respond to emails.
• Avoid exposure to extreme temperatures.
• Can walk for short distances.
• Needs a comfortable chair with back support.
• Avoid prolonged sitting without movement.
• Can participate in light meetings.
• Gradual increase in standing tolerance.
• Return to full duty expected in 8 weeks.

Return to Work Light Duty Letter Sample: Back Injury

1. Maximum lifting weight: 15 lbs.
2. Avoid bending or twisting.
3. Limit sitting duration to 1 hour without a break.
4. Encourage regular stretching.
5. No prolonged standing.
6. Can perform sedentary tasks.
7. Avoid kneeling or squatting.
8. Can use a stool if standing is required.
9. No repetitive bending.
10. Can operate basic machinery with supervision.
11. Avoid carrying heavy loads.
12. Can perform light filing.
13. Limit driving to short distances.
14. Avoid sudden movements.
15. Can walk for up to 20 minutes at a time.
16. Needs a supportive brace if recommended.
17. Can participate in team discussions.
18. Avoid prolonged reaching.
19. Gradual increase in physical activity as tolerated.
20. Follow-up appointment in 2 weeks.

Return to Work Light Duty Letter Sample: Repetitive Strain Injury

• Avoid repetitive motions of the affected limb.
• Alternate tasks frequently.
• Use ergonomic equipment as needed.
• Take micro-breaks every 15-20 minutes.
• Limit typing to 30 minutes at a time.
• Avoid prolonged gripping.
• Can perform tasks requiring minimal hand or arm use.
• No lifting over 5 lbs.
• Can use voice-to-text software.
• Avoid forceful movements.
• Can participate in administrative duties.
• Limit duration of data entry.
• Avoid prolonged holding of objects.
• Can perform tasks requiring one hand only.
• Requires a break to shake out the limb.
• Can operate light machinery with caution.
• Avoid prolonged computer mouse use.
• Can perform tasks with short bursts of activity.
• Gradual increase in repetitive task duration.
• See therapist weekly.

Return to Work Light Duty Letter Sample: Foot or Ankle Injury

1. Limit standing to 1 hour total per day.
2. Avoid prolonged walking.
3. Can perform seated tasks.
4. Use an elevated footrest if sitting.
5. No running or jumping.
6. Can drive if the foot is not in a cast.
7. Avoid climbing stairs frequently.
8. Can perform light tasks that do not require significant foot movement.
9. Wear supportive footwear.
10. Avoid standing for more than 10 minutes continuously.
11. Can participate in meetings if seating is available.
12. No carrying heavy objects.
13. Can perform tasks that involve minimal movement.
14. Avoid prolonged standing on hard surfaces.
15. Requires a break to elevate the foot.
16. Can perform tasks requiring short walks.
17. Avoid prolonged standing in one place.
18. Gradual increase in walking tolerance.
19. Use crutches or a walker as needed.
20. Follow-up with physical therapist.

Return to Work Light Duty Letter Sample: Shoulder Injury

• No lifting over 5 lbs with the affected arm.
• Avoid overhead reaching.
• Limit repetitive arm movements.
• No pushing or pulling with the affected arm.
• Can perform tasks requiring two hands if one is not involved in lifting.
• Avoid sleeping on the affected side.
• Can use a keyboard with the affected arm resting.
• No forceful arm movements.
• Can participate in meetings if seating is comfortable.
• Limit duration of reaching forward.
• Avoid carrying heavy items.
• Can perform tasks that involve minimal arm use.
• Requires a break to rest the affected arm.
• Can operate light machinery with caution.
• Avoid prolonged holding of objects.
• Can perform tasks with short bursts of arm activity.
• Gradual increase in arm movement as tolerated.
• See doctor for re-evaluation in 3 weeks.
• Can use adaptive equipment for tasks.
• Avoid sudden jerking motions.