(Date) (Doctor’s Name) (Medical Practice Name) (Address)	(Your Name) Return to Work Coordinator (Employer’s Name) (Email Address) (Phone Number)

Dear Dr. (Doctor’s name),

Re: (Injured Worker’s Full Name) – Work Injury on (Date of Injury)

Thank you for treating (injured worker’s name) in relation to their work-related injury or illness (description of injury) which occurred on (date injury occurred or was estimated to have occurred).

As the Return to Work Coordinator for (employer’s name), my role is to support our employees throughout their recovery and facilitate a safe and sustainable return to work. We are committed to providing suitable duties during the recovery period and are flexible in accommodating medical restrictions, including adjustments to hours, tasks and the work environment.

To assist you in understanding the physical and functional requirements of (Injured Worker’s Name)’s pre-injury role I have attached a copy of their (Job Description/Job Dictionary). Should you wish to arrange a worksite visit or require further details about specific tasks or the work environment, please don’t hesitate to contact me.

Also enclosed is a signed Medical Authority from (injured worker’s name) authorising you to share relevant information regarding their injury or illness, treatment, and work capacity with me.

To help us in identify appropriate and safe duties, we kindly request that you complete a detailed Work Capacity Certificate (WCC).

If you are unfamiliar with the ReturnToWorkSA WCC format, I have included a guide for your reference. The ‘Functional Ability’ section is particularly valuable in helping us tailor duties that support recovery without risk of aggravation.

We appreciate your collaboration in supporting (injured worker’s name)’s recovery and return to work. Please feel free to contact me directly if you have any questions or require further information.

Thank you for your time and support

Yours sincerely

(Coordinator full name)

Return to Work Coordinator

(Employers name)