Modified-Duty Offer Template
A clear modified-duty offer helps employers communicate temporary work, schedule, restrictions, follow-up dates, and reporting instructions without changing clinician-issued limitations.
Resource Snapshot
A fillable local-only template for preparing a temporary modified-duty offer aligned to clinician restrictions.
- Format: Interactive template
- Audience: HR, Supervisors, Safety managers
- Time: 10-15 minutes
Who Should Use This
- Employers offering temporary modified duty
- HR teams coordinating restrictions
- Supervisors assigning safe temporary tasks
When To Use It
- After a treating clinician issues work restrictions
- Before assigning temporary tasks
- When follow-up or reevaluation dates need to be communicated
What It Includes
- Employer and employee details
- Temporary assignment details
- Restriction alignment
- Modified tasks and excluded tasks
- Acknowledgment fields
Common Mistakes And Cautions
- Do not create or change medical restrictions.
- Do not imply legal conclusions or guarantee acceptance.
- Have counsel review employment-law questions.
Resource Preview
Fill locally, print a completed version, or print a blank copy for supervisors.
Castellan Health Employer Resource
Modified-Duty Offer Template
A fillable local-only template for preparing a temporary modified-duty offer aligned to clinician restrictions.
Disclaimer: This template does not determine restrictions, require employee acceptance, or provide legal advice. Align duties with current clinician restrictions, company policy, and applicable law.
This resource uses 35 local fields or checklist items. Values stay in your browser session and are not stored by Castellan Health.
Use These With This Resource
Modified-Duty Offer FAQs
What is modified duty?
Modified duty is temporary work adjusted to match clinician-provided restrictions while an employee recovers or awaits reevaluation.
Who determines work restrictions?
Restrictions should come from the treating clinician or qualified occupational health provider, not from the employer template.
What should a modified-duty offer include?
Include the temporary role, schedule, restrictions, tasks offered, tasks excluded, supervisor, reporting instructions, and follow-up or reevaluation date.
Can an employer change medical restrictions?
No. Employers should align available duties to the current restrictions rather than altering medical limitations.
How long should modified duty last?
Modified duty usually lasts until the next clinical reevaluation or until restrictions are changed or removed.
Need help turning this into an employer workflow?
Castellan Health can help employers coordinate injury care, drug testing, OSHA documentation, return-to-work communication, and occupational medicine services.