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Phased Return To Work Form
"I need a Phased Return To Work Form for a manufacturing employee returning from a back injury, requiring modified duties and reduced hours starting March 2025, with specific focus on ergonomic accommodations and regular physiotherapy appointments."
1. Employee and Employer Details: Full identification of both the employee and employer, including employee number, department, and relevant contact information
2. Absence Information: Details of the absence period, reason for absence, and relevant medical condition or circumstances
3. Current Work Situation: Description of normal working hours, duties, and responsibilities pre-absence
4. Medical Clearance: Confirmation of fitness to return to work and any medical recommendations or restrictions
5. Phased Return Plan: Detailed weekly schedule showing gradual increase in working hours and duties
6. Support Measures: Outlined support and accommodations to be provided during the return to work period
7. Review Process: Schedule and process for reviewing progress during the phased return
8. Declaration: Signatures of all parties agreeing to the phased return arrangements
1. Workplace Modifications: Details of any required modifications to workplace equipment or environment, used when physical adaptations are necessary
2. Risk Assessment: Assessment of potential risks and mitigation measures, included when returning from serious illness or injury
3. Additional Support Requirements: Specific support measures such as mentoring or training, included when retraining or extra support is needed
4. Emergency Protocols: Special procedures in case of medical emergencies, included for employees with ongoing medical conditions
5. Transport Arrangements: Details of special transport needs or arrangements, included when standard commuting is not possible
1. Schedule A: Detailed Weekly Plan: Week-by-week breakdown of working hours, duties, and progression
2. Schedule B: Medical Information: Relevant medical certificates and recommendations from healthcare providers
3. Schedule C: Risk Assessment Form: Detailed workplace risk assessment related to the employee's condition
4. Schedule D: Progress Review Forms: Templates for weekly/monthly progress review meetings
5. Appendix 1: Contact Information: List of key contacts including supervisors, HR representatives, and emergency contacts
Authors
Manufacturing
Mining
Financial Services
Retail
Healthcare
Education
Construction
Information Technology
Public Sector
Transportation
Agriculture
Professional Services
Hospitality
Telecommunications
Energy and Utilities
Human Resources
Occupational Health
Health and Safety
Employee Relations
Legal and Compliance
Operations
Facilities Management
Risk Management
Wellness and Benefits
Industrial Relations
HR Manager
HR Business Partner
Occupational Health Nurse
Health and Safety Officer
Line Manager
Department Manager
HR Director
Employee Relations Manager
Wellness Coordinator
Risk Manager
Operations Manager
Facilities Manager
Occupational Therapist
HR Administrator
Compliance Officer
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