Having the right tools is key to a successful return to work program. On this page we have provided some samples of the tools we recommend to help build or further develop your return to work program.
If you have questions or want advice about how to use any of these documents, please contact the Return to Work Program Services Team at RTWProgramServices@wcb.mb.ca or 204-954-4662.
- Return to Work Policy Statement - Sample
- Return to Work Policy - Sample
- Return to Work Program Procedures - Sample
- Notice of Injury to Employer (aka Green Card)
- Sample Incident Report Form
- Injured Worker Package Acknowledgement - Sample
- Sample Functional Abilities Forms
- Guidelines for Modified and Alternate Work - Standard Abilities
- Sample Return to Work Offer
- Return to Work Journal - Sample
- Physical Demands Description Form
The Return to Work Program Services team offers free consultations* for your existing return to work program. The team is available to go over all of the above tools in person with you and your leadership team. Should you be interested in either of these services, please contact us as indicated above.
*Our free, full return to work program consultation service is available to employers who meet certain criteria – please contact the Return to Work Program Services team to discuss.
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