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Staff Human Resources
« Worker's Compensation


How to Complete a TRTW Agreement
  1. Check if the claim is not worker's compensation.
  2. The date you are completing the agreement.
  3. Employee's name & work address.
  4. Supervisor's name, extension, & email.
  5. Employee's name.
  6. Name of doctor who signed the release or ohf.
  7. The date on the release.
  8. The exact wording of the restrictions on the release.
  9. The beginning date of the restrictions.
  10. The end date of the restrictions (you may want to set a reminder in outlook to ask the employee for current medicals).
  11. Figure the number of calendar days. (this will help you keep track of the 90 day maximum.)
  12. Describe the accommodations you are making; avoid restating the restrictions.
  13. Review these with the employee.
  14. You and the employee sign and date the date the agreement is signed.
  15. When an employee provides an extension of his/her restrictions fill in the beginning and end dates on the bottom of release. If the restrictions change, complete a new agreement. If the restrictions increase, give the employee time off to heal.
  16. Sign with the employee and input the date you are signing the agreement (should be a later date than the first signature.)
  17. Fax a copy to Michelle at x43608. Fax copies to your dept. as appropriate. Keep original in a confidential file, separate from the employee's personnel file.