Doctor’s Note: Work Restrictions Letter from Doctor (Samples)

Employees’ productivity is often affected by occupational and non-occupational medical conditions or injuries. In such cases, an employee may need a doctor’s letter that explicitly states the employees’ medical condition and any restrictions on their ability to fulfil their work. This could be because of several reasons, including being at risk for injury or illness from performing a role, having an existing medical condition, or suffering from mental health issues.Work restrictions letter from doctor can be obtained ahead of time, if needed, when an employee is injured or falls ill.

A work restriction letter is a document written by a doctor that states the activities an employee should or should not be doing for their role. The letter’s purpose is to provide documentation for recommended modifications, medical conditions, and the duration of the restrictions.

Free Sample Letters

By utilizing our pre-built templates, you can streamline the process of obtaining a work restriction letter, saving valuable time and ensuring that all necessary information is included. Furthermore, all of our professionally crafted templates are available for free download, allowing you to easily access high-quality and customizable resources for your specific needs in a formal and efficient manner.

Free doctor's note template for work restrictions 01

Printable sample doctor's note for work restrictions 02

Editable format of doctor's note for work restrictions 03

Doctor's note example for work restrictions 04

    Why and When is it Needed?

    A well-written and thorough work restrictions letter from a doctor can increase productivity and positively impact the company. Moreover, it may often be pivotal in an employee’s recovery journey. This is because exposing the body to too much physical and psychological pressure may have adverse health effects, which may cause severe and permanent health issues and potential lawsuits. In addition, work restrictions help to return employees safely and gradually.

    Most employers require a work restrictions letter from the doctor to inform them about employees’ medical conditions to take appropriate action and make arrangements to accommodate them. Employers might also want doctors to specify if there are grounds for terminating the employee if they cannot perform their duties.

    Work restrictions letter from a doctor are also used to recruit people with disabilities. The doctor can verify the disability through the document and sign off on what duties the employee is limited to.

    Types of Work Restrictions

    Work restrictions are referred to by different names such as transitional work, early-return-to-work programs, light-duty or modified duty as discussed follow. The type of work restriction is dependent on the nature of the medical condition.

    Reduced hours

    The employee can be limited to a particular number of working hours. This can be done by awarding them shorter working days in the initial stages of recovery and gradually increasing these hours with time.

    Shorter workweek

    This involves reducing a whole week’s work to a shorter one. The employer can agree on a weekly schedule, which mandates the employee to take a few days off from the norm. The number of days can be gradually increased as they recover. Shorter workweeks allow the employee to have days for appointments, recovery plans, etc. This can apply to an employee who has been on leave for a long time or is recovering from a severe illness.

    Restricted duties

    This involves changing the duties of the position by eliminating some tasks usually carried out by the employee but are not possible because of their medical conditions. The employee’s tasks can be redistributed to other workers or another position in their department. These modifications can be temporary until the employee recovers or permanent depending on the severity of the injury or illness.

    Modified equipment, tools, and workspaces

    This involves adapting the work environment to fit the employee’s physical needs. Examples of such equipment include a stool or seat, installing accessibility channels, special lighting, and desk accessories or tools. The workspace can also be modified by lowering the heights of objects and fittings or relocating them to ensure they are within comfortable reach.

    Employer’s Responsibilities toward Employee

    The employer’s responsibility is to provide an environment where all employees can perform their duties safely, effectively, and satisfactorily. The employee’s role and the safety and health risks involved in performing these duties should be discussed with the employee’s supervisor as soon as they are aware of a work restriction. The supervisor should evaluate whether any modifications or adaptations are necessary or if a substitute worker is required. If it is decided that changes are required, they must be implemented immediately.

    Employers are thus obligated to accommodate employees with work restrictions letter from a doctor as much as feasibly possible, find alternative and appropriate work for the employee, allow employees to make doctor visitations, and offer vocational rehabilitation and training if the employee is no longer able to fulfil their work. Note that work restrictions are not a viable basis for termination of employment, and employers cannot force the employee to work beyond their allotted restrictions.

    Injured Worker Responsibilities

    After an injury or illness, the first step is to see a doctor examine the extent of the injuries or medical conditions. Next, the employee must ensure the doctor signs off on work restrictions if deemed necessary. Once the employee receives a work restriction letter, they must ensure they discuss their medical conditions with their employers and supervisors to ensure they are aware of any potential risks that may come alongside their duties and give the employer enough time to devise the necessary safety measures in place.

    Employers can offer an injured worker the option of transfer, reallocation of duties, or providing an alternative position. The consequences of not providing the work restrictions letter from the doctor to the employer are the employer anticipates the employee will return to work and carry out their assigned duties as per the employment contract, and failure to do so can warranty termination.

    After resuming official duties with a modified work schedule, the employee should perform their duties as directed by the work restrictions letter from a doctor. If the schedule still impedes the employee’s recovery, they should alert their employer and seek an appointment with the doctor to have the restrictions updated.

    What to Include in a Work Restrictions Letter from a Doctor?

    Work restrictions letter from a doctor should include an accurate description of the employee’s condition and its consequences on performance. The following are the most common items that should be considered when writing a work restrictions letter from a doctor:

    Appropriate salutation

    The letter must be adequately addressed using the name of the person receiving it. This will typically be the employer, and it can be the direct supervisor, HR manager, or any other appropriate representative of the company.

    Date and time

    A work restrictions letter from a doctor should be dated. This will typically be the date when the letter was created and, consequently, the day of the employee’s appointment with the doctor. In some cases, especially if the doctor’s note is unavailable, nurses and doctors will complete their signatures on blank certificates. The employee must fill in the date when they present it to their employers. The letter should also include the time of the appointment.

    Employee name

    All letters should name the employee to show to who their work restrictions belong. In addition, the letter can highlight the employee’s position, date of birth, contact details, and the company where they work.

    Identify the injury of the employee

    The letter should indicate the employee’s medical condition and the extent of damage inflicted on them. This can be done by stating the nature of the injury (broken arm, strained back, or slipped back), how it occurs, the intensity, and whether it is permanent or will affect the employee in the future.

    Specify the restrictions

    The employee’s medical practitioner is bound to mention the physical conditions that require medical supervision for a specified time. These are the limitations that the employee should abide by when performing their duties. In addition, restrictions can be imposed on physical labor or mental input, for example, how much weight they can carry, what tasks are to be avoided, and if protective clothing or equipment is needed. The letter from the doctor should indicate the expected duration of the work restrictions in a specific period, such as weeks, months, or years.


    Before requesting an update or changes to work restrictions, employers must receive recommendations from the doctors to justify their actions. The letter should specify any additional treatment or precautions that the doctor recommends or directs the employer must do to ensure an employee’s safety. This could be anything from adjustments to work duties to alterations in work schedule, supervision, and training.

    Thanks to the recipient

    The letter should include a statement thanking the employer for all their efforts in accommodating the employee’s needs. The letter should also thank them for all the trouble they had to go through in accommodating the employee. The work restrictions letter from a doctor must also stress that they will return to work once they recover, if at all possible.

    Doctor’s name, signature, and date

    The work restrictions letter should include the name and signature of the doctor who issued it. The date it was issued must also be indicated so that there is no confusion about when the employee was examined.

    Work Restrictions Letter from Doctor


    (To) ______________________
    (Address) ______________________
    (City) ______________________ (Zip code) _________

    Sub: Work Restrictions Letter from Doctor

    Dear [Recipient Name]

    I examined (patient’s name) on (Date). Please be advised that my patient, name], has the following medical condition

    a.      Date of injury: ______ [month] ______ [year].
    b.      Nature of injury/problem: ______.
    c.       Location and extent of injury: ______.
    d.      How long will this condition last? (Please specify the exact period in the form of “weeks [or months or years]”).
    e.       Any additional information: ______

     He/she is unable to perform the following tasks for the next (period of time). Please find the details below:

    ·         Standing: _____________________________________
    ·         Walking: ______________________________________
    ·         Sitting: _______________________________________
    ·         Lifting: _______________________________________
    ·         Carrying: ______________________________________
    ·         Use of hands: ___________________________________

    These restrictions should remain in effect for (weeks of restriction)

    Recommendations: ______. (Add any other information as desired)

    Thank you for your continued support.

     Yours faithfully,

    Dr. [Name]

    (Date signed)

    Work Restrictions Letter from Doctor


    To whom it may concern,

    On March 28, 20xx, John Doe was injured while performing their duties in the work environment. When I examined him on March 29, 20xx, it was determined that he had suffered a whiplash injury and would need to follow a strict work restriction for at least six weeks from March 30 to May 10. This ensures that there are no complications or setbacks, and that the injury has healed.

    He is not to perform any activities where he would need to strain or overexert. This means that he will not be able to lift any heavy equipment, debris, backpacks, or tools. He will also not be allowed to sit in a stationary position for more than an hour at a time. Stretching exercises are required twice a day, the first being upon waking up and the second one before bedtime. On April 15, 20xx, follow-up X-rays will be done to ensure that the healing progresses appropriately.

    These restrictions must be adhered to for one month. A follow-up check-up after this period will determine if Mr. John Doe needs to continue with these restrictions or can resume his ordinary work schedule.

    Thank you for understanding while John Doe and I address this matter. We hope he can return to whole duty in two months.


    Allan Walters

    March 28, 20xx



    Legal Matters and Privacy Laws Under HIPAA

    Following are legal considerations worth looking into when utilizing a work restrictions letter from a doctor. For example, HIPAA laws stipulate that if a doctor wants to release the employee’s information to the employee’s employer, the patient must consent or sign a release of information for doctors to share medical records.

    FMLA protection regarding doctor’s letter

    Suppose the employee is covered under Federal labor laws such as the federal workers’ compensation act, federal unemployment benefits act, federal employees’ compensation act, etc. In that case, their employer is obligated to follow all procedures mandated by the law. In addition, these laws guarantee workers are protected from dismissal due to absence from work due to medical conditions.

    Court’s decision

    If an employee has given their employers a qualified letter from a doctor stating the worker is restricted to perform their duties, the employer must do all they can to accommodate and adjust for such an employee. The judge ruled that a work restrictions letter from a doctor is sufficient to prove that an employee cannot return to work as long as it has been indicated in the note. After that, it is up to the employer to comply with FMLA laws.

    ADA (Americans with Disability Act)

    ADA prohibits employers from victimizing individuals with disabilities. This law implies that employers should accommodate qualified disabled employees who present a doctor’s letter with work restrictions. Employers are thus legally obligated to provide reasonable accommodations for employees with disabilities.

    Frequently Asked Questions

    What if an employer cannot accommodate work restrictions?

    There are particular instances when it may be difficult for an employer to adjust or accommodate an employee with work restrictions, such as when there are limited resources and capabilities available in the organization. In such cases, they can find alternative positions to accommodate the employee or offer them options to participate in vocational rehabilitation to train for other roles.

    What happens if the employer is not complying with work restrictions?

    If an employee is not allowed to perform their duties due to work restrictions as indicated by the doctor’s letter, then the employer may be liable for violating the Fair Labor Standards Act and Disability Act. Such employers could be subject to fines and other penalties. Employees should thus consult an attorney to guide them on the way forward.

    What do you do if your employer is violating your light duty restrictions?

    In such a case, the employee may be entitled to file a legal grievance against the employer. It is thus prudent to consult a lawyer.

    What do permanent work restrictions mean?

    A permanent work restriction indicates a limitation in the employee’s ability to perform their duties from the onset. They usually refer to limitations on an employee’s physical capacity, intellectual ability, or mental faculties. Such a condition is considered long-term and will likely affect the employee’s future performance in the organization.

    Can an employer deny work because of medical restrictions?

    An employer cannot legally deny work to an employee due to medical restrictions if the job restrictions are temporary as stated by in the doctor’s letter. However, if the employee is unqualified for a particular job in the organization due to medical restrictions, then such an employer would not be required or expected to hire or even retain such an employee. Therefore, they might have to compensate the employee on a temporary disability basis.

    Can you get sacked from work if you have a doctor’s letter?

    Legally, employers within at-will employment laws can fire employees due to medical issues even if they have submitted a doctor’s letter and followed the appropriate procedure. However, employees can always counter with a lawsuit. Prolonged medical leaves often prompt termination of employment.

    Is it illegal for employers not to accept doctors’ letter?

    In legal terms, the only time employers cannot reject a doctor’s letter is when an employee is taking the medical leave following FMLA laws which allow employees to take an absence from work of up to 12 weeks. However, if there are no state laws governing doctor’s letter, the employer should use company policies that may or may not allow them to reject the doctor’s letter.

    Can an injured worker refuse an offer of re-employment with light-duty?

    An injured worker is expected to report back to work once their employer provides them with a light-duty opportunity. However, if the employee does not wish to return to work in such a condition, they are allowed to. Unfortunately, this may often mean they lose their right to compensation.

    What questions should I ask my doctor about work restrictions from a work injury?

    You should request a report of work-ability or updated work restrictions whenever you visit the doctor during your recovery period. It would be best to ask for specific instructions that do not create more questions than answers.

    What are my options if my doctor has me on work restrictions?

    It would be best to abide by the work restrictions letter from the doctor after notifying your employer. However, if the restrictions are still straining your health, you can opt to seek further modifications through your employer.

    Can an employer request a doctor’s letter for one day?

    Yes. Employers can request a doctor’s letter whenever an employee is absent from work due to medical issues. The policy must, however, apply to all employees. Employers cannot request specific employees to submit doctor’s letter and give others a pass.

    Was this helpful?

    Great! Tell us more about your experience

    Not Up to Par? Help Us Fix It!

    Keep Reading

    Thank You for Your Feedback!

    Your Voice, Our Progress. Your feedback matters a lot to us.