TO THE ATTENDING CLINICIAN: Please fill out this form completely. Learn how to write a return-to-work letter with free example templates.The purpose of this Administrative Instruction is to establish and clarify procedures regarding. An employee may use this notice to have their health care provider certify that they may return to work. In this article, we'll share how you can draft a solid return to work letter, along with three excellent tips and a free sample template you could use today. This article will provide a detailed guide on crafting an effective RTW letter, including its importance, essential components, and a sample template. Report injuries within 5 days of knowledge. • Complete Form 5020 and send to your Claim. I am ready to return to work on Monday, ______. Is there any paperwork or are there advance arrangements that I need to make?