This article is based on a lecture presented by Dr. Ahmad Latif at the Employee Health and Wellbeing Conference, held at the InterContinental Hotel in Doha from October 11-13, 2015.

Return-to-Work (RTW) Assessment

Return-to-Work (RTW) assessment is a proactive approach endorsed by many healthcare providers. Its goal is to help restore injured workers to their former lifestyle in the safest and most effective manner possible. The primary aim is to assist the worker in achieving a timely and safe return to suitable employment.

Defining Factors

Several factors outline the level and specifics of the medical assessment:

  • Job type
  • Medical condition
  • Complications
  • Regulations

Objectives of the RTW Program

The company aims to achieve several goals through the RTW program:

  • Reduce the number of days lost to injury or illness.
  • Lessen the financial and emotional impact of the injury or illness on the worker by facilitating an early and safe RTW.
  • Reduce costs related to work and non-work-related injury or illness.
  • Educate workers on disability management.
  • Comply with all legislations.
  • Reduce the number of future injuries and illnesses by promoting a healthy and safe workplace.

Providers of RTW Opinions

  • Occupational Health (OH) practitioners
  • Primary Care Physicians

In the U.S., primary care physicians are requested to provide opinions on the fitness to return to work in up to 10% of all office visits.

Practical Recommendations

There are two extreme approaches to RTW:

  • No return to work assessment at all
  • Excessive medical assessment with unnecessary investigations

Some authors argue against RTW practice, considering RTW forms 'mythical' and unnecessary. However, many support the practice, advocating for a systematic approach to fitness assessments to facilitate evaluation and increase consistency in clinical decisions.

Flexible Approach to RTW

Despite some opposition, RTW assessment is widely implemented. A realistic approach can make it a helpful tool in occupational health. Here are five examples of practical approaches, ranging from simple to complex:

  1. Telephone Consultation

    • Suitable for simple cases such as common cold and hoarseness of voice.
    • Many cases do not require a formal RTW assessment; a phone discussion may suffice.
  2. Face-to-Face Consultation, No Touch Assessment

    • Example: Joint injury where stiffness compromises writing function. Observing the range of motion may be enough to make a decision.
  3. Face-to-Face Consultation with Light Touch

    • Example: Employee with asthma exacerbation. Auscultation of the chest is sufficient to assess fitness.
  4. Face-to-Face Consultation with Laboratory Tests

    • Example: Blood test for employees with diabetes.
  5. Complicated Cases

    • Example: Cardiac cases requiring specialist medical opinion, such as TMT or Bruce protocol.

Return to Work Interview

A RTW interview is a helpful tool to reduce sickness absence and should take place within 24 hours of the employee's return to the workplace. The purposes of the RTW discussion include:

  • Welcoming the employee back to work.
  • Ensuring the employee is fully fit to return and identifying any additional risks.
  • Confirming the reason for the absence and recording the correct dates.
  • Determining if any adjustment is required.

Examples of Temporary Accommodation

  • Light Duties: Less physical effort than the pre-injury job, limited according to healthcare provider recommendations.
  • Lesser Duties: Reduced duties at a slower pace.
  • Alternate Tasks: Performing other duties within the employee's limitations.
  • Reduced Hours: Matching work hours to the worker's tolerance level.
  • Temporary Accommodation as Treatment: Work duties used as part of a conditioning and strengthening process to gradually increase the worker's physical ability.

Phased Return to Work

If the employee has been away from work for more than four weeks or has had a serious illness, a phased return to work may be beneficial.


  • RTW is a helpful occupational health tool if used properly.
  • In many cases, employees do not need any fitness assessment to resume duty.
  • A flexible approach should be considered, choosing assessments based on factors such as job type, medical conditions, and local regulations.


  1. What is Return-to-Work?, Pennsylvania Department of Labor and Industry. From:
  2. Assessing Medical Fitness to Return to Work, Harvard Medical School. From:
  3. Pulse Today, GPs urge employers to stop demanding ‘fitness to return to work’ forms. From:
  4. Russi M, et al., Guidance for Occupational Health Services in Medical Centers, American College of Occupational and Environmental Medicine (ACOEM). From: