Sample Graduated Return-to-Work Workplan Agreement


This sample workplan agreement is meant to provide a basis for conversation between an employee and an employer when there is a mutual goal of keeping the employee in the workplace as a productive, contributing member through a respectful and equitable process.


  • Accomodations
  • Start Date, Duration, Plan
  • Additional Accomodations
  • Comittment to Ensure Success
  • Addressing Future Issues
  • Signatures
Link to Tool: 

Sample Workplan

Contact Person/Organization: 

Mental Health Works

Type of Tool:

Publication Date: