Modified duty confirmation memo from supv to employee by YQG6f0


									                                                               Center for Environmental Management
                                                                                   of Military Lands

                                                                             1490 Campus Delivery
                                                                 Fort Collins, Colorado 80523-1490
                                                                         Telephone (970) 491-2748
                                                                               FAX (970) 491-2713



TO:            (Injured employee)

FROM:          (Supervisor)

SUBJECT:       Temporary Modified Duty Letter

This is to confirm that you have been offered temporary modified duty within your restrictions.
 You will continue to report to me working within your restrictions and your regular work shift
unless reduced by your physician. You will be paid your usual hourly wage for the hours that
you work. Your return to work date is (insert date). Please fill out the weekly ‘Time Record
During Workers’ Comp Injury’ form found on the CEMML website under the ‘Forms’ tab at For
questions regarding your Workers’ Comp claim, contact Travelers Insurance at or (800)252-4633. If you have any concerns regarding your
temporary assignment, please let me know.

We look forward to your recovery and return to full duty.

_________________________________            _____________
Employee signature                           Date

_________________________________            _____________
Supervisor signature                         Date

cc: CEMML Human Resources

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