RTW Form.pdf - City of Toronto 2025

1. Click ‘Get Form’ to open the RTW Form.pdf in our editor.
2. Begin with Section A, where you will input your worker information. Fill in your WSIB Claim Number, Employee Number, and personal details such as First Name, Last Name, and Home Telephone Number.
3. Continue by providing your Home Address and the Date of Injury/Onset of Illness. Specify the Area of Injury and your Job at the time of Injury/Illness along with Division and Work Address.
4. Next, enter your Supervisor's Name and their Work Telephone Number. If applicable, provide an Alternate Telephone Number for further contact.
5. Move to Section B to be completed by a health professional. Indicate whether this is an Initial or Follow-Up Form and detail the Nature of Injury/Illness. Check if Complete Recovery is expected and provide Estimated Recovery Time.
6. In this section, indicate your Ability to Work by checking one option that best describes your situation regarding modified duties or inability to work.
7. Complete any necessary precautions related to functional limitations by checking the appropriate boxes under Strength Demands.
8. Finally, Section C requires Worker Consent. Sign and date the form authorizing the health professional to share relevant information regarding your return to work.

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