Restriction letter for work
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Explanation of the fields to be filled in this letter
- [Your Name]: Enter your full name to identify yourself as the issuer of the restriction letter.
- [Your Position]: Include your job title, such as “HR Manager” or “Supervisor.”
- [Company Name]: Specify the name of the company issuing the restriction letter.
- [Date]: Write the date on which the letter is being issued.
- [Employee’s Name]: Fill in the full name of the employee who will be subject to the restrictions.
- [Employee’s Position]: State the employee’s current position within the company.
- [Company Address]: Include the company’s address where the employee works or is associated with.
- [Reason for Restrictions]: Briefly explain why the restrictions are necessary, such as “medical advice” or “safety regulations.”
- [Source]: Identify who or what has prompted these restrictions, such as “your healthcare provider” or “our safety team.”
- [Restriction 1, 2, 3]: Clearly outline each restriction, providing specific details of what the employee is restricted from doing. Ensure the details are precise and aligned with the recommendations.
- [Start Date of Restrictions]: State when the restrictions will begin.
- [End Date or Condition]: Specify when the restrictions will be lifted or reevaluated, such as “until further evaluation by your healthcare provider.”
- [Your Phone Number] and [Your Email Address]: Provide your contact details so the employee can reach you if they have questions or need further information.
- [Your Signature (if submitting a hard copy)]: Add your signature if the letter is being submitted in print form.
- [Your Printed Name]: Write your full printed name below the signature line.
Example of a correctly completed letter
Restriction letter for work
Maria Johnson
HR Manager
ABC Corporation
October 15, 2024
John Doe
Warehouse Associate
ABC Corporation
456 Elm Street
Anytown, USA 12345
Dear John Doe,
This letter serves to inform you of specific work restrictions that have been put in place due to medical advice from your healthcare provider. These restrictions are intended to ensure your safety and well-being while continuing to perform your role at ABC Corporation.
Based on the information provided by your healthcare provider, the following restrictions will be in effect starting from October 18, 2024:
- Light Duties Only: You are limited to tasks that do not involve lifting more than 10 pounds.
- Limited Standing Time: Please avoid standing for more than 30 minutes at a time.
- No Heavy Machinery: You are restricted from operating heavy machinery during this period.
These restrictions will remain in place until further evaluation by your healthcare provider at your next appointment on November 15, 2024. It is important that these guidelines are strictly followed to prevent any risk to your health and safety as well as to maintain compliance with company policy and legal obligations.
Please communicate any concerns or difficulties you might encounter while working under these restrictions to your supervisor or to the HR department. We are committed to supporting you during this time and will make reasonable accommodations to help you perform your duties within these limitations.
Your safety and well-being are our priority, and we appreciate your cooperation in adhering to these restrictions. If you have any questions or need further clarification regarding this matter, please feel free to reach out to me directly at (555) 987-6543 or mjohnson@abccorp.com.
Thank you for your understanding and cooperation.
Sincerely,
Maria Johnson
HR Manager
ABC Corporation