January 7, 2016
Dear Treating Practitioner:
The WSIB and the OMA both support timely return to work programs as a means of assisting with the rehabilitation of a recovering individual and encourage employers to seek recommendations from treating practitioners regarding specific capabilities, as they relate to an employee’s ability to perform work activities. 
Our company is committed to providing meaningful work to employees recovering from an occupational injury or illness through the use of a fair Return to Work Program.  We are committed to assisting our employees with work-related injuries or health problems, by offering modified duties, in keeping with the individual’s capabilities and precautions. 
The modified duties program is a phased program of productive work (generally duties are carved out from the employee’s regular occupation.).  The program may be available for up to eight weeks.
We are requesting that you provide us with information about the employee’s ability to return to productive work, on either modified employment or to the full and regular duties of their regular position.  The employee will not be permitted to work more than 44 hours a week, while on modified work.
A Functional Abilities Form is enclosed with this letter for your completion.
If any additional information is required by you to make your determination, please feel free to contact the office. 
Your co-operation is greatly appreciated,
Name of your company
Operations Manager