FORM

Form Title: BGIS Letter to Physician Health Care Practitioner

Document #: CORP-HS-11021-EN Revision #: 2

Attention Doctor,

Subject: BGIS Global Integrated Solutions (BGIS) Return To Work Program

BGIS Global Integrated Solutions (BGIS) is committed to the health & safety of all of its team
members regardless of their position or role within our company. While our goal is to eliminate
all workplace injuries, if / when an injury does occur, BGIS is committed to returning the worker
to suitable employment with little or no loss of time away from the workplace.

Please be aware that BGIS has a program to accommodate injured team members with
modified work duties and will create a customized modified work plan that incorporates any
work restrictions prescribed by you.

We ask for your assistance in completing the attached Functional Abilities Form (FAF) which will
allow us to best accommodate the worker so as to prevent re-injury, expedite the healing
process, and ultimately eliminate any lost time and associated lost wages for the worker.

Upon your review, please note that under our modified work program the team member can
take their prescription medication as needed, may sit, stand or rest as required and public
transportation will be paid for by BGIS if there are any driving restrictions.

As a concerned employer we value your input in this program so please advise us at the
number below if there are any further restrictions or modification necessary to accommodate
this injured worker. In circumstances where you feel the program is not acceptable due to the
duties offered please provide us with a list of suitable duties or a clinical explanation so we can
determine an appropriate response and realignment of work tasks.

Thank you for your cooperation and assistance in this matter.

BGIS
1-877-445-0611

Original Doctor - Copy: 1 HSE Dept. 2. WCB/WSIB

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prohibited without the express written permission of BGIS Global Integrated Solutions. © 2017 BGIS Global Integrated Solutions. All rights reserved.