Return to work zone
 

Find a form or template

Form 14 Rehabilitation and return to work coordinator change of details (PDF 35.9 kb)

Rehabilitation and return to work coordinators should use this form when their details change.

Template 31 Suitable duties program (DOC 187.5 kb)

The suitable duties program template can be used by rehabilitation and return to work coordinators to develop programs for injured workers. You may not need the worker's doctor to sign off on the program if there is enough detail on Part E of the workers' compensation medical certificate.

Workplace policy and procedures template (DOC 320.0 kb)

The template can be used by rehabilitation and return to work coordinators to help obtain workplace rehabilitation accreditation.

Template 30 Injured worker authorisation (DOC 56.5 kb)

The authorisation form can be used by rehabilitation and return to work coordinators to get approval to speak to the injured worker's treating practitioner/s.

Electronic case notes template (DOC 37.0 kb)

Use this template to record return to work activities electronically.

Fax to the treating doctor (DOC 32.0 kb)

Use this template to introduce yourself to the injured worker's treating doctor and to ask for their assistance in developing suitable duties programs.

Hand written case notes template (DOC 56.5 kb)

Hand write return to work activities and keep the hard copy on your injured worker's file.

Initial telephone interview script (DOC 37.0 kb)

Use this script during your initial telephone conversation with the injured worker.

Fax to the treating doctor regarding the suitable duties program (DOC 36.5 kb)

This template may be used when providing a copy of the suitable duties program to the injured worker's treating doctor.

File summary template (DOC 35.5 kb)

Use the file summary template to record details about the injured worker, their treatment providers and your insurer contact.

Improvement action plan (PDF 74.5 kb)

Use this template to develop an improvement action plan after reviewing your overall return to work system.

Performance summary report (PDF 40.1 kb)

Complete a self assessment and record the findings here.