SOP_NUMBER: 104.23-att-3 TITLE: Transitional Employment Plan REFERENCE_CODE: IVO04-0003 DIVISION: Administrative & Finance TOPIC_AREA: 104 Policy-HR Programs/Support/Assistance EFFECTIVE_DATE: 2019-10-08 WORD_COUNT: 388 POWERDMS_URL: https://public.powerdms.com/GADOC/documents/206542 URL: https://gps.press/sop-data/104.23-att-3/ SUMMARY: This form is used to document a modified work plan for GDC employees who have work restrictions or limitations due to medical conditions, injuries, or other circumstances. The plan specifies modified job duties, work hours, and a progression schedule to help employees gradually return to full duty. Both the employee and supervisor must review, discuss, and sign the plan, with copies provided to the employee and retained in the local medical file. 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 ATTACHMENTS: 1. WC-240a Job Analysis Form URL: https://gps.press/sop-data/104.23-att-1/ 2. Activity Analysis Form URL: https://gps.press/sop-data/104.23-att-2/ 3. Transitional Employment Plan URL: https://gps.press/sop-data/104.23-att-3/ 4. Transitional Employment Tracking Form URL: https://gps.press/sop-data/104.23-att-4/ ======================================================================== 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:**| |||| |||| |||| |||| |||| |**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:**| |||| |||| |||| |||| |||| |||| |||| |||| |**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:**| |||| |||| |||| |||| |||| |**Special considerations:**|**Special considerations:**|**Special considerations:**| |||| |||| |||| |||| |||| |||| |**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:**
| Record Retention: Upon completion, this form shall be retained permanently in the local medical file.