Please Place on Department Letterhead

Please place on department letterhead

Employee Address City RE: Bona Fide Job Offer – Workers’ Compensation

Dear Employee, Dallas County is in receipt of a report dated ______from ______relating to your current medical condition and your ability to work. A copy of that report is enclosed with this letter. Dallas County has used guidelines provided by the physician to identify an appropriate light duty position for you. Dallas County hereby extends to you a bona fide offer of employment pursuant to DWC Rule 129.6. This assignment may last up to a maximum of 45 calendar days (or less, if you are released by your doctor) and will not be extended beyond ______. If applicable, Family Medical Leave (FMLA) may be requested after this date. You were contacted on ______and verbally accepted our offer of light duty. Dallas County hereby extends to you a bona fide offer of employment pursuant to DWC Rule 129.6. You will be expected to return to work on ______at______, Dallas, TX. Your work schedule will be as follows: ______thru ______from ___a.m. to____ p.m. Your wages will remain the same. This position will entail these specific physical and time requirements: According to the attached Work Status Report, dated, ______, you have the following restriction; ______. You are to notify your immediate supervisor if you start to have any issues with your light duty position. Please be assured that Dallas County will only assign you tasks consistent with your physical abilities, knowledge, and skills and will provide you training if necessary. If you accept this offer, please indicate by signing and dating your name below and returning this to the undersigned. If Dallas County does not receive this back from you within seven (7) calendar days of receipt, it will be assume you have rejected this offer. Please contact the undersigned with any questions you might have. Respectfully, Your name, Title

 I accept the light duty position offer to me and agree to fully comply with my doctor’s restrictions.  I refuse the light duty position offered to me (consult with workers comp manager)

______Signature Date

Note to Employee: Please work closely with your supervisor to ensure that any time off related to the workers’ compensation injury is accurately deducted/coded in Kronos.