Doctor Letter to Manager to Restrict the Working Hours of an Employee

A doctor letter to manager to restrict the working hours of an employee is exactly what it states. The employee may have some illness that is such that it does not favor the employee to work long hours.

This letter is important as a manager needs to know why an employee is asking for a restriction in their working hours. The employee’s claim may also become credible with a letter from the doctor. Illness is something that we cannot control.

We need to continue working if it is possible whether it is with restricted working hours. An employee may not be able to support their family if they do not go to work. Therefore, this letter may aid the employee out when they have an illness or injury.

Tips to write the letter

  1. This letter may be typed in Microsoft Word.
  2. The patient’s name needs to be stated.
  3. The doctor can state when they saw the patient and on what date they diagnosed the patient with an illness or injury.
  4. The illness or injury of the patient may be stated so that the employer could also know the reason behind the request for a restriction in working hours.
  5. It needs to be stated from when the employee should have restrictions on working hours.
  6. The doctor should give an estimate till when these restrictions should remain in place.
  7. The next appointment of the patient can be stated.
  8. The contact details including name, address, phone number and email address of the doctor should be stated in case the manager wishes to contact the doctor.
  9. The doctor’s signature and date are required.

Sample letter:

I examined (patient’s name) on (Date).

Date of injury and or illness: (Date)

The patient named above is medically able to work, but with restrictions on their working hours as of (Date). The patient mentioned earlier is suffering from (state the illness).


These restrictions should remain in place till around (weeks of restriction).

Date of the next appointment (Date).

I suggest these restrictions based on:

The patient gave information/ My examination as well as an assessment of the patient (tick which one).

I have given this form to the above patient.

(Physician’s signature)


Doctor Letter to Manager to Restrict the Working Hours of an Employee

Format: MS Word [.doc]| Download


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