Enabling Access Blog


After posting my last blog on Challenging the Validity of a Doctor's Note and providing recommendations for employers, I had many discussions with corporate clients about how they deal with Employees who bring in a note saying "light duties only" or something equally as vague.


The best practise solution came from one of my manufacturing clients who shared with me a simple tool that helps them sort through what to do with the doctor's note that provides no details of what the employee can actually do. When an employee brings in any doctor's note about limitations in ability to work at full capacity, they immediately provide the employee with a Medical Evaluation Report Form, which is a one page form including specifics on Employee abilities/limitations, that they are to bring to their physician to fill out.


Unfortunately the form was not as specific as I would like, if I were the employer who has to accommodate the injured employee. I took a look online to compare this form with other Medical Forms and decided to create a form based on relevant information from a few of these. My revised form makes it easier for the physician to give the employer the qualitative information they require when accommodating the injured worker.


The first part of the form asks the physician to fill in complaint/prognosis information and asks them to check boxes as they apply, regarding specifics about modified duties, how long they will not be fit for regular duties, etc. There are 6 scenarios the doc can choose from. Here are two of those statements that require action:


"This employee is able to return to MODIFIED DUTIES for ____days and then: ____return to regular duties OR ____reassess."

"This employee is not fit to return to any work activity for a period of ____days."


The main chunk of the form deals with specifics regarding employee abilities and includes lifting, positional demands, category of work (sedentary, light, medium, heavy), and manual dexterity including these statements, that require a check if they apply:


___Can lift up to shoulder height ___

___Can lift up to ____lbs from waist to shoulders

___Able to Work extended hours


The last section outlines clear restrictions regarding lifting, position demands and repetitive activities, so there is no room for interpretation and includes statements like: 


___No kneeling ___No bending

___Limited reaching ___Limited pushing


Finally the physician AND employee need to sign the form and return to the employer. As a clinician, this form filled out would give me all the information I would need to effectively put the modified duties or return to work plan in action. It also provides me with great information, should a Functional Capacity Evaluation be required.


If your workplace is using a strong Medical Evaluation Report and you would like to share it with me, I will collect them and make revisions to the form I am working on and then I will post the update revised Medical Report Form as a resource for employers dealing with this issue. It is time we share best practices strategies to ensure the safety of the employees and to guide HR decision making.



Marnie Courage, OT Reg.(MB)

Managing Director

Enabling Access