Preferred Worker Job Offer Letter printable pdf download

Preferred Worker Job Offer Letter

See OAR 436-110-0290(2) for more information.

If you have questions or need more help, contact the Workers’ Compensation Division,

503-947-7588; 800-445-3948 (toll-free); fax 503-947-7581.

Preferred Worker Program in Salem,

Date:

Preferred Worker

Name:

Address:

City, State, ZIP:

Dear

Since you are unable to return to your regular job at injury (check all that apply):

We have developed this job within your physical restrictions.

We will use the Preferred Worker Program (PWP) to modify this job within your physical restrictions.

We have provided a temporary job within your physical restrictions pending PWP modification.

Job title:

Start date:

Temporary job title, if applicable:

Start date:

Wages:

Hours:

Worksite location:

Descriptions of job duties, including physical requirements (if known), or attach job descriptions:

Sincerely,

Company name:

Address:

City, State, ZIP:

Phone no.:

I have read and understand this/these job offer(s). I accept this/these job(s) as offered. Yes

Employee signature

Date

4903

440-4903 (1/17/DCBS/WCD/WEB)

Preferred Worker Job Offer Letter