LETTER 1 – REQUEST FOR DOCTOR’S CERTIFICATE THIS

INSERT DATE OF LETTER] [INSERT SCHOOL DISTRICT NAME AND
INSERT EXTRA LINES APPROPRIATE FOR YOUR LETTERHEAD & DELETE
LETTER TO TIER 2 FAMILIES INSERT SPONSORING ORGANIZATION

LETTER TO TIER 2 FAMILIES – INSERT SPONSORING ORGANIZATION
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PRINT ON CLUB LETTERHEAD OR TYPE IN CLUB NAME

LETTER 1 (bcgeu) – Request for Doctor's Certificate (ST02)

LETTER 1 – REQUEST FOR DOCTOR’S CERTIFICATE

This letter is used to request a Doctor’s Certificate Form in situations where you as manager/supervisor have determined that one is required.


PLEASE NOTE

The language in this DRAFT letter is intended for use only as a model. Each case is unique and specific language will be required in every instance. Any italicized and bolded text or any text between these two symbols < > needs to be removed or replaced appropriately for each case. Your own ministry letterhead must be used. Your Disability Case Specialist is available to provide advice.


<Date>


<Employee’s name>

<Employee’s address>


Dear <Employee>:


Re: Doctor’s Certificate Form
BCGEU Main Agreement, Appendix 4, 1.4

The Ministry is committed to the Early Intervention and Return to Work program and I would like to work with you and your physician to explore how we might be able assist you in an early return to work, in a modified capacity, if possible.


This may include options such as a gradual or full return to work trial with modified or full duties. A trial period would provide you, your doctors and Occupational Health & Rehabilitation with an opportunity to ensure your recovery continues while you readjust to your work tasks. Occupational Health & Rehabilitation supports us, as needed, by working with you and your doctors to review treatment, rehabilitation and return to work opportunities.


In accordance with the collective agreement, have your doctor complete the enclosed Doctor’s Certificate Form and return the supervisor’s portion to me by <date>. The information provided on the form is will assist with return-to-work planning; identifying modified duties; and determining your eligibility for payment of benefits under the Short Term Illness and Injury Plan (STIIP).


<OPTIONAL: in situations where the payment of STIIP benefits has already been approved, but there is difficulty in obtaining medical documentation, this letter can be modified to include a statement such as:

You continue to be absent from the workplace due to illness or injury, therefore further medical information is required by <date> to determine eligibility for the continued payment of benefits under STIIP and to support return-to-work planning. Please note that failure to provide the form as previously requested may result in the suspension of benefits.>


I will contact you to discuss completion of your Time and Leave Management System entries. You will need to advise me whether you wish to supplement STIIP or not.


As you may be aware, the Main Agreement states that an employee does not earn vacation credits unless they receive at least 10 days pay at regular straight-time rates for each calendar month. Therefore, your vacation entitlement for the year may be decreased accordingly while on STIIP.


<OPTIONAL: for part time employees, delete the above paragraph and replace it with the following: As a part-time employee, any periods of sick leave will result in adjustments to your vacation entitlement.>


<OPTIONAL: - for safety sensitive positions, e.g. positions in environments where heavy equipment is used; positions required to carry firearms; positions required to restrain or apprehend individuals:

The employer may require confirmation of a clearance to return to work through specific testing or an Occupational Health and Rehabilitation examination for your position.>


<Name>, if you have any questions, please feel free to call me at <phone #>.


Yours truly,




<Supervisor’s name>

<Title>


Enclosure(s)



TITLE ALL LETTERS IN CAPITAL 18 PT MAX 75
WHERE ASSIGNOR IS FIRST PURCHASER FROM DEVELOPER [SOLICITORS LETTERHEAD]
COMPANY LETTERHEAD (MUST BE ISSUED BY THE


Tags: certificate -------------------------------------------, doctor’s certificate, certificate, request, doctor’s, letter