Return To Work Agreement Template

The worker understands that this is a “last chance” to successfully follow the employer`s drug and non-alcohol employment policy. The employee is aware that failure to comply with this agreement results in immediate termination. This return-to-work agreement model was adapted by an agreement of the U.S. Department of Labor. When workers return from treatment because of drug and alcohol problems that have violated the drug and alcohol policy, you should have them sign an agreement that sets out the expectations that affect both the employer and the worker, as well as all the consequences for the violation of the agreement. The worker has received a copy of the employer`s drug and non-alcohol employment policy and includes all provisions of the directive. The employee agrees to comply with its provisions. If the employee is required to miss work to attend the required appointments, missed work time is treated as family and sick leave, sick leave, leave or personal leave, as available and appropriate. This return to work agreement exists between (company name) (employer) and (worker`s name) (worker`s name). This agreement is necessary because the employee has violated a work rule that could lead to dismissal: (list of rules/rules violated) The employee agrees to waive the use of all alcohol and other drugs, unless prescribed by a physician aware of the history of the employee`s drug abuse.

The worker accepts that all treatment and monitoring costs that are not covered by the employer`s insurance plan are the employee`s responsibility. The employee has voluntarily signed an authorization that allows the employer to obtain information from health care professionals about the employee`s continuing education recommendations and compliance. The employee is committed to respecting all the recommendations of the doctors. The employee documents the obligation to attend appointments and other necessary representations. The employee understands and accepts that the employer monitors compliance with the recommendations of health care professionals. The employee agrees to be subjected to unannounced follow-up tests for a given period (list period).

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