Home
Forms Library
Work restriction letter sample

Work restriction letter sample 2025

work restriction letter sample Preview on Page 1

Show details

4.5 out of 5

42 votes

The document is a Temporary Work Restriction Letter issued by the County of Los Angeles, outlining medical restrictions for an employee to prevent further injury. It mandates that these restrictions be communicated to the employee and included in their confidential medical file. The letter also instructs the Return to Work Coordinator to schedule a meeting with the employee to assess their ability to return to work, either in their usual position or another role, while adhering to specific guidelines and timelines.

Here's how it works

01. Edit your work restriction letter sample online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send work restriction letter template via email, link, or fax. You can also download it, export it or print it out.

The easiest way to modify Work restriction letter sample in PDF format online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Handling paperwork with our comprehensive and intuitive PDF editor is easy. Adhere to the instructions below to complete Work restriction letter sample online easily and quickly:

Sign in to your account. Log in with your email and password or register a free account to try the product prior to upgrading the subscription.
Import a form. Drag and drop the file from your device or add it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
Edit Work restriction letter sample. Effortlessly add and underline text, insert images, checkmarks, and signs, drop new fillable areas, and rearrange or delete pages from your paperwork.
Get the Work restriction letter sample completed. Download your modified document, export it to the cloud, print it from the editor, or share it with other participants through a Shareable link or as an email attachment.

Make the most of DocHub, the most straightforward editor to rapidly handle your paperwork online!

See more work restriction letter sample versions

We've got more versions of the work restriction letter sample form. Select the right work restriction letter sample version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2009	4.5 Satisfied (42 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a work restriction letter to the employer?

A work restriction letter is filled out by a healthcare professional detailing specific limitations or accommodations and is then submitted to the employer to facilitate necessary adjustments in the employees job responsibilities.

How to write a formal letter requesting for accommodation?

Dear [Insert employers name here]: I am writing this letter to submit a request for accommodations in the workplace. I have pain in my lower back. Sitting or standing for long periods of time in the same position is causing increased pain and is decreasing my mobility.

How to ask for accommodations at work sample letter?

I am writing to request accommodations in the workplace. I have worked at [insert company name] as a [insert your job position] since [approximate date you were hired]. I am experiencing some difficulties in effectively performing my job because of my disability.

How do I write a letter requesting accommodations at work?

Content to consider in body of letter: Identify yourself as a person with a disability. State that you are requesting accommodations under the ADA (or the Rehabilitation Act of 1973 if you are a federal employee) Identify your specific problematic job tasks. Identify your accommodation ideas.

Can I be fired for work restrictions?

California laws protect you when you have a medical condition that impacts your ability to work. The California Fair Employment and Housing Act (FEHA) prohibits employer discrimination based on actual or perceived medical conditions, including firing and other adverse employment actions.

work restriction letter

Work restriction letter sample word format Work restriction letter sample pdf Work restriction letter from doctor Simple work restriction letter sample Work restriction letter sample doc Work restriction letter from doctor template Return to work with restrictions letter template Sample Light duty letter to employer

Related forms

be ready to get more

Complete this form in 5 minutes or less

Get form

How do I tell my boss I need accommodations?

Make your request in writing and write, I am requesting a reasonable accommodation under the ADA. This makes a record of your request and helps your employer know that it should be taken seriously. If you want to have a conversation in person or by phone, that is fine.

What is an example of a work restriction?

A work restriction due to a disability is a job modification because you cannot do specific tasks. For instance, a hand and wrist injury that weakens your grip could mean you cannot lift objects more than 10 or 15 pounds.

Work restriction letter sample 2025

Here's how it works

The easiest way to modify Work restriction letter sample in PDF format online

See more work restriction letter sample versions

Complete this form in 5 minutes or less

Got questions?

What is a work restriction letter to the employer?

How to write a formal letter requesting for accommodation?

How to ask for accommodations at work sample letter?

How do I write a letter requesting accommodations at work?

Can I be fired for work restrictions?

Complete this form in 5 minutes or less

People also ask

How do I tell my boss I need accommodations?

What is an example of a work restriction?

restriction letter

Try more PDF tools