WSIB Sample Return to Work Policy Guideline€¦ · Web view · 2013-03-13The RTW plan shall...

Sample: Return to Work Sample: Return to Work PolicyPolicy

Please note that this document is a sample of policies that have been developed by various companies, and in various jurisdictions. The purpose of this document is to demonstrate what generic elements may be contained within a company’s Return to Work policy, and is intended to represent guidelines only.

This document is intended as a guideline only, and should be used as a sample of what a workplace can consider in developing its own policy. It is based on material developed by the WSIB (Ontario) for distribution to employers as a tool for return to work efforts. Other resources are available at either the WSIB web site - http://www.wsib.on.ca/wsib/wsibsite.nsf/public/home_e or on the Office of the Employer

Adviser’s website at http://www.employeradviser.ca/ Version: September 2010 1

http://www.employeradviser.ca/

http://www.wsib.on.ca/wsib/wsibsite.nsf/public/home_e

LOST TIME PROCEDURES

In companies with a nursing or medical office, below is an example of procedures:

1) Report all work-related injuries and medical complaints ASAP to supervisor. All critical injuries and

fatalities MUST be reported to the Ministry of Labour.

2) Document any medical concerns and any first aid treatment in first aid logManager and Health and Safety Rep to complete accident investigation report

3) If worker requires more than first aid, send worker for medical treatment

4) Ask worker to sign THE FUNCTIONAL ABILITIES FORM

5) Send FUNCTIONAL ABILITIES FORM signed by worker and/or a copy of worker’s FORM 6 (if required) to worker's doctor with Return to Work Letter {attached)

6) Give worker a copy of the Form 7

7) Stay in regular contact with the employee, for example, a telephone call once a week.

8) When the doctor or worker returns the Functional Abilities Form, meet with the worker and anyone else in your company involved in the return to work process

9) Compare the Functional Abilities with the physical requirements (essential duties) of pre-accident job

10) Modify the pre-accident job (essential duties at least) to the functional abilities (if possible/necessary)

11) If you can't modify the pre-accident job to the worker’s functional abilities, then find other suitable work within the worker's functional abilities. The suitable work must be safe and time limited.

12) Jointly develop and agree on RTW plan.Establish:*Goals with timeframes *Hours

*Wages *LocationSpecify: *Accommodations *Roles and responsibilities of worker and management

and any other parties involved in the plan*Give the worker an Offer of Suitable Work Letter (attached)

13) Monitor and evaluate employee's recovery. Meet with the employee at least once/week and document progress of recovery on follow-up component of Return to Work plan

14) Manager should send the completed return to work plan to the claims adjudicator

15) The return to work program is completed when the employee can do the pre-accident job





If the employee cannot return to pre-accident duties at the conclusion of the plan, the manager shall contact the WSIB claims adjudicator for further assistance

16) If there is a critical injury, please notify the Ministry of Labour

When identifying suitable work, consideration will be given to the employee's ability and skills. Every effort should be made to ensure that the work assigned is suited to both the worker's physical and personal abilities, and contributes to the productivity of the business.





POLICY (RETURN TO WORK PROGRAM {RTWP}) – MODEL #1

The management and staff of __________________ are committed to developing and maintaining a safe and healthy work environment.

In keeping with this goal, it is the policy of this company to make every reasonable effort to provide suitable employment to any employee unable to perform his/her duties as a result of a work-related injury.

The purpose of this Return to Work (RTW) policy is:a) to provide for the early and safe return to work of injured employeesb) to provide gainful employment for employees who are permanently disabled due

to an injury in the workplacec) to restore at least the worker’s ability to perform the essential duties of their

pre-injury job

TERMS OF REFERENCE

Temporarily Disabled EmployeesEmployees who are temporarily unable to do their regular job duties due to a compensable injury will be offered suitable employment if:a) A productive work assignment, suitable to the employee's limitations is availableb) The work assignment will have a rehabilitative affect on the employee's conditionc) Complete rehabilitation is expected to occur within four weeks. This placement may be

extended if there is progress in his/her rehabilitation. (Complete rehabilitation means the ability to perform the essential duties of the pre-injury job but it is preferable if the worker is able to perform all his pre-injury job duties)

Permanently Disabled EmployeesEmployees who are permanently disabled due to a compensable injury will be offered suitable work if a work assignment suitable to the employee's limitations, education and training is available. It may be necessary for some employees to obtain additional training before they are qualified to perform the work assignment.

Return to Work Plan (RTW Plan) and PlacementManagement will develop with their injured employee a RTW plan, once a suitable work assignment is identified and the company will agree to send a copy of the plan to the WSIB.

When a suitable match is found, an offer of a suitable work assignment will be made using the RTW plan. The RTW plan shall include the number of weeks of a RTW plan, hours of work to be performed, breaks, any job assistance to be provided and pay structure.

Periodic ReviewThe company management and injured employee should review the employee's progress once a week while on a suitable work assignment. The management and employee should complete the follow-up tracking form.

Employer Responsibilities





Employee Responsibilities





POLICY (RETURN TO WORK PROGRAM {RTWP}) – MODEL #2

The management and staff of _______________ are committed to developing and maintaining a safe and healthy work environment.

In keeping with this goal, it is the policy of this company to make every reasonable effort to provide suitable employment to any employee unable to perform his/her duties as a result of a work-related injury.

The purpose of this Return to Work (RTW) policy is:a) To provide for the early rehabilitation and return to work of injured employeesb) To provide gainful employment for employees who are permanently disabled

due to an injury in the workplace.c) to restore at least the worker’s ability to perform the essential duties of their

pre-injury job

TERMS OF REFERENCE

Temporarily Disabled EmployeesEmployees who are temporarily unable to do their regular duties due to a compensable injury will be offered suitable work if:a) A productive work assignment suitable to the employee's limitations is availableb) The work assignment will have a rehabilitative effect on the employee's condition.c) Complete rehabilitation is expected to occur within four weeks. This placement may be

extended if there is progress in his/her rehabilitation. (Complete rehabilitation means the ability to perform the essential duties of the pre-injury job but it is preferable if the worker is able to perform all his pre-injury job duties)

Permanently Disabled EmployeesEmployees who are permanently disabled due to a compensable injury will be offered suitable work if a work assignment suitable to the employee's limitations, education and training is available. It may be necessary for some employees to obtain additional training before they are qualified to perform the work assignment

Return to Work Plan (RTW)Management will develop with their injured employee a RTWP, once a suitable work assignment is identified and agreed to. The company will send a copy to the WSIB.

Periodic ReviewThe company management and injured employee should review the employee's progress once a week while on a suitable work assignment. The management and employee should complete the follow-up tracking form.

PlacementWhen a suitable match is found, an offer of a suitable work assignment will be made using the RTW plan. The RTW plan shall include the number of weeks of a RTWP, hours of work to be performed, breaks, any job assistance to be provided and pay structure.





NO LOST TIME PROCEDURES (Numbers Refer back to Page 2)

First Aid 1) Same2) Same3) Same

Med Aid 4) SameN.L.T. 5) Same

6) *The employee and employer shall maintain contact on a weekly basis if the employee is not able to return to any suitable work.*The employee should advise the manager of any changes in his/her condition*The employer can request the employee have completed a Functional Abilities Form (FAF) by their health care practitioner any time. The employee shall request the main health care practitioner complete this form and return to manager.

7) When the injured worker returns the FAF, the employer and employee shall meet to discuss the functional precautions and identify tasks the employee could perform. The manager shall draft a return to work plan with the employee.Both parties shall meet once every week (at least) to discuss the worker's progress during the plan. The employee will be provided time to attend any appointments for treatment.The plan is intended to last a between four and twelve weeks. This can be extended in individual cases.

8) If, upon the conclusion of the Return to Work plan, the employee is not able to return to pre-injury employment, the manager shall notify the WSIB claims adjudicator. (Form 7 required after 7 days modified work even if no time lost)

9) The manager will maintain regular contact with the WSIB and will ensure the necessary documentation is sent.

10) The manager will maintain regular contact with the employee and with the WSIB until there is a successful resolution, involving either a return to pre-injury duties or suitable work.

EMPLOYEE RESPONSIBILITIES

Employee*Report promptly any work-related injuries and complaints to immediate supervisor.*Return, as soon as possible the Functional Abilities Form.*Maintain regular contact with the Manager, and keep him/her advised of any changes.*Advise the health care practitioner of the Return to Work Program.*Actively participate in developing his/her Return to Work Program Plan.*Communicate any difficulties or concerns regarding the duties provided, to their manager.*Advise manager if external medical attention is received for a work-related injury (especially first aid).

*Maintain regular contact with the WSIB as required (claims adjudicator)

POLICY





______________________ (company name) understands that it is a good rehabilitation practice to ensure a planned, early and safe return to work following an injury or illness.

_____________________ (company name) shall make every effort to encourage and support an early return to work by employees who have been off work as a result of illness or injury .In the event that suitable work can be identified, the Human Resources Branch will ensure, through the staff member's personal physician and the Workplace Safety & Insurance Board where applicable, that the employee is capable of performing modified or accommodated duties. The Human Resources Branch will inform the employee of the available work and request that he/she report to duty.





TERMS OF REFERENCE

Return to work is part of a good occupational health and safety practice. A Return to Work Program is a company-wide initiative that combines a responsible approach towards returning injured workers to work, while maintaining a commitment of protecting the health and welfare, of all employees.

A Return to Work Program is designed to assist injured and ill employees to make an early and safe return to their regular duties. It is a temporary measure that is intended to bridge the gap between injury and return to full duties.

The modified duties will not normally last longer than twelve weeks. Extensions to this period will be considered on an individual basis.

Modified duties are a means of accommodating an employee's temporary restrictions. A broad approach to accommodation will be adopted that recognizes the unique circumstances in each case.

Accommodations can include:

working fewer hours taking more frequent rest breaks obtaining assistance from a co-worker for more difficult tasks job/responsibility sharing physical changes to the work environment assistive devices assignment to another job special project work

Each manager is encouraged to use whichever measures are most appropriate in the individual case.

LOST TIME INJURIES

In the event that the nature of the injury results in time off work, the employee will contact his or her supervisor to advise them of the length of expected absence, begin to discuss return to work and any anticipated accommodation that may be necessary upon return.

The supervisor will maintain telephone and/or personal contact with the employee on a weekly basis for the first five weeks and at suitable intervals beyond this time. The employee is responsible for keeping the supervisor advised of any changes in his or her physical condition. When possible the employee should talk or meet with the supervisor following his or her medical or health appointments. Both the employee and the supervisor are responsible for maintaining contact with the WSIB as necessary.

When the injured employee is fit to return to work, an individual return to work plan is to be developed by the injured worker, together with his/her supervisor, and union representative as appropriate.

The goal of the company’s RTW program is to assist the employee to make a safe and timely return to pre-injury duties. It is expected that the injured employee will increase the proportion of the pre-injury duties during the course of the program.This document is intended as a guideline only, and should be used as a sample of what a workplace can consider in developing its own policy. It is based on material developed by the WSIB (Ontario) for distribution to employers as a tool for return to work efforts. Other resources are available at either the WSIB web site - http://www.wsib.on.ca/wsib/wsibsite.nsf/public/home_e or on the Office of the Employer




The supervisor is responsible for meeting with the employee at the start of the Return to work plan and when s/he returns to the workplace. Any initial difficulties are to be dealt with at this time. Meetings between these individuals will then occur on a weekly basis or more frequently as necessary. The employee will be provided time to attend any appointments for related treatment.

The Return to Work plan is intended to last a maximum of twelve weeks. Extensions can be provided when medical opinion warrants.

If upon the conclusion of the Modified Work Program, the employee is not capable of returning to pre-injury employment, the WSIB will be contacted.

The supervisor is responsible for ensuring that the necessary documentation is sent to the WSIB.

The supervisor will maintain regular contact with the employee and with the WSIB until there is a successful resolution, involving either a return to the pre-injury duties or some form of permanent accommodation.

RESPONSIBILITIESEMPLOYEE: Report as promptly as possible all work-related injuries and complaints to immediate

supervisor. Obtain necessary paperwork prior to leaving site. Maintain regular contact with his/her Supervisor and keep advised of any changes in

the medical condition. Advise the treating physician of the availability of modified duties. Actively participate in developing a specific Return to Work plan. Communicate any difficulties or concerns regarding the duties provided to the

immediate Supervisor and to the WSIB.

Supervisor Investigate the injury/complaint. Take preventative measures to ensure it does not

happen again. Ensure immediate completion of incident report. Work with the Nurse and employee to design the RTW plan. Meet with the returning employee at the start and end of the first shift to review and

discuss any concerns the employee may have. Maintain progress chart or documentation relating to employee’s injury. Maintain regular contact with the employee during his or her absence from work. Liaise with WSIB personnel. Co-ordinate the development of the employee's return to work plan. Liaise with the department staff to discuss required accommodation/assistance.





Attend regularly scheduled meetings with the employee during the work plan to discuss progress.

Liaise with Human Resources, the Union and other managers in order to develop RTW program opportunities.

Conduct an evaluation of the modified work program on a yearly basis, to determine its effectiveness.

CO-WORKERS: Provide support and encouragement to the employee participating in the RTW

program. Provide direct assistance for specifically designated tasks on a temporary basis.





PHYSICIAN’S MEDICAL REPORT

Dear Doctor:

In conjunction with the staff and union members, OUR COMPANY has developed a Return to Work Program to assist our employees who are injured or ill. This program is intended to permit a safe and timely return to work. The work assignments are designed to suit the employee's current needs and will not expose the employee to any conditions which might aggravate the injury, or cause re-injury. The physical demands of the modified duties are attached. You are requested to complete a Functional Abilities Form (FAF).

Employee Name ________________________________ Date of Accident ______________________________

PHYSICIAN’S STATEMENT(To be completed only if FAF is not available – employer responsible for cost of completion of this form only)

a) Employee may return to work at once without restrictions.

b) Employee may return to work on ____________________ to modified duties with restrictions as follows:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Duration of Restriction: _______________________________________ (days, weeks)

c) If unable to return to work, your professional opinion on a possible return to work date and course of treatment planned.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Physician Name: ________________________________________ Telephone: __________________________

Address: ___________________________________________________________________________________





Signature: _______________________________________________________

Thank you for your co-operation.





EMPLOYEE NOTICE – Suitable Employment

EMPLOYEE NAME: ______________________________________ DATE: _______________________________

We are pleased that you are returning to suitable employment following your accident.

We are providing you with information in order to facilitate your safe return. Working together will ensure that your return to work is safe, timely and supports your full recovery.

As discussed in our meeting on __________________, we recognize your present medical restrictions (as outlined below) and agree to provide suitable employment based on these restrictions.

1. _________________________________________________________________________________________2. _________________________________________________________________________________________3. _________________________________________________________________________________________4. _________________________________________________________________________________________

Your co-operation in the following is expected:

1. If you are experiencing any problems with assigned tasks, please discuss with your supervisor.

2. Your continued safety and recovery is our first concern. If you are asked by a fellow employee to assist in a task which you are not medically capable of doing, explain your restrictions and ask that they request assistance from supervision.

3. If you are on prescribed medication, please inform your manager immediately as to the types, dosage, so that appropriate documentation is maintained and so that we can make fully informed decisions on your Return to Work plan that takes the nature of your medication into account. You are responsible for ensuring that you have adequate supply of your prescribed medication and follow your doctor's instructions regarding its use in order to participate with us in helping you return to work in a safe manner.

4. Every effort must be made by you to attend work. If you are unable to do so, you must notify your Supervisor.

Please report to __________________ at _______ a.m./p.m. on ________________, for the appropriate duties which have been designed around what you reasonably believe you can perform.

Thank you for your co-operation.

Employee Signature ________________________________________________

Supervisor Signature ___________________________________________________





SAMPLE: Return to Work Plan – Progress Chart

NAME: __________________________________________ DEPARTMENT:

______________________________

PROGRAM GOAL:

____________________________________________________________________________

START DATE: _____________________________________ PROGRAM LENGTH: _________________________

Day (1):___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Week (2) – Goal:___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Week (3) – Goal:___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Week (4) – Goal:___________________________________________________________________________________________

___________________________________________________________________________________________





___________________________________________________________________________________________

___________________________________________________________________________________________





Week (5) – Goal:___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Week (6) – Goal:___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Week (7) – Goal:___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Week (8) – Goal:___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Week (9) – Goal:___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

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Week (10) – Goal:___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Week (11) – Goal:___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Week (12) – Goal:___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

Conclusion – Recommendations___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________





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