Job Modification Agreement - Return To Work (RTW) Employer {BWC-2965}

BWC-2965 / RH-15 - JOB MODIFICATION AGREEMENT RETURN-TO-WORK (RTW) EMPLOYER. This form is used to document and approve job modifications for injured workers under the Bureau of Workers' Compensation (BWC) Return-to-Work (RTW) program. It is used by employers who are making adjustments to a worker's job to allow them to safely perform their duties after an injury. The form outlines the specifics of the job modification, including the cost, description, and supplier of the modification. The employer must submit the form to BWC for approval, and once approved, BWC will reimburse 50% of the modification cost initially, with the remaining 50% reimbursed after 90 days, provided the worker continues employment. The form also requires signatures from the employer and the vocational rehabilitation case manager or employment specialist. www.FormsWorkflow.com