LETTER 1 – REQUEST FOR DOCTOR’S CERTIFICATE
This letter is used to request a Doctor’s Certificate Form (STO2 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 Early Intervention & Return to Work Specialist is available to provide advice.
<Date>
<Employee’s name>
<Employee’s address>
Dear <Employee>:
Re: Doctor’s CertificateForm (STO2 form)<delete references below that are not applicable>
<CEP Master Agreement, Appendix C, 1.04>
<PEA Master Agreement, Appendix A, 1.04>
<UPN/BCNU Master Agreement, Appendix 3, Section 1.04>
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 medical 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). Should your absence continue for longer than 30days, further forms may be required.
<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 a form as previously requestedmay 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 Master 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 & Rehabilitation examination for yourposition.>
<Name>, if you have any questions, please feel free to call me at <phone #>.
Yours truly,
<Supervisor’s name>
<Title>
Enclosure(s)