SOP 104.23-att-3: Transitional Employment Plan
Summary
Key Topics
- transitional employment
- modified duty
- work restrictions
- employee accommodation
- job modifications
- return to work
- modified hours
- work progression
- activity analysis
- restricted duty
- light duty
Full Text
SOP 104.23
Attachment 3
10/8/19
# Department of Corrections Transitional Employment Plan
|Employee Name:|Job Title:|Col3|
|---|---|---|
|Manager/Supervisor:
|Work Location:|Work Location:|
|Conditions/Restrictions:|Conditions/Restrictions:|Conditions/Restrictions:|
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|Date Restrictions Began:|Next Review Date:|Next Review Date:|
|Plan Specifications[NOTE: Refer to the Activity Analysis (AA) for description of job duties.]|Plan Specifications[NOTE: Refer to the Activity Analysis (AA) for description of job duties.]|Plan Specifications[NOTE: Refer to the Activity Analysis (AA) for description of job duties.]|
|Start Date:|End Date:|End Date:|
|Describe modified duties:|Describe modified duties:|Describe modified duties:|
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|Describe modified hours/day and days/week, including progression schedule:|Describe modified hours/day and days/week, including progression schedule:|Describe modified hours/day and days/week, including progression schedule:|
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|Special considerations:|Special considerations:|Special considerations:|
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|This Transitional Employment Plan has been reviewed and discussed with me to clarify any questions I may have. I have been provided
with a copy of this plan and I understand my supervisor will retain a copy. Should I experience any difficulties while performing transitional
work, I will immediately contact my supervisor.|This Transitional Employment Plan has been reviewed and discussed with me to clarify any questions I may have. I have been provided
with a copy of this plan and I understand my supervisor will retain a copy. Should I experience any difficulties while performing transitional
work, I will immediately contact my supervisor.|This Transitional Employment Plan has been reviewed and discussed with me to clarify any questions I may have. I have been provided
with a copy of this plan and I understand my supervisor will retain a copy. Should I experience any difficulties while performing transitional
work, I will immediately contact my supervisor.|
|Employee Signature:
|Employee Signature:
|Date:|
|I have reviewed and discussed this Transitional Employment Plan with the employee. In addition, I have provided a copy of the plan to
the employee.|I have reviewed and discussed this Transitional Employment Plan with the employee. In addition, I have provided a copy of the plan to
the employee.|I have reviewed and discussed this Transitional Employment Plan with the employee. In addition, I have provided a copy of the plan to
the employee.|
|Manager/Supervisor Signature:|Manager/Supervisor Signature:|Date:
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Record Retention: Upon completion, this form shall be retained permanently in the local medical file.