Claims Management Templates & Resources

Brown Envelope Contents

W1: Worker’s Report of Injury

Fitness for Modified Work Form
(Template includes both a letter to the worker and the Doctor)

Modified Work Policy / Procedure

Additional Templates

Letter to the Worker
(communication plan for worker who cannot be accommodated)

Modified Work Plan
(includes schedule of modified work as well as communications requirements)

Completed Samples (for reference)

Letter to the Worker

Modified Work Plan

Fitness for Modified Work Form
(completed by the employer, ready to put into the Brown envelope)

Fitness for Modified Work Form
(completed by the doctor)

Links & Resources

Disability Duration Guidelines (WCB Sask)

WCB Employer Appeals

WCB Premium Rates