CBCC WH&S Policy & Procedures - Coolum Beach Christian College
CBCC WH&S Policy & Procedures - Coolum Beach Christian College
CBCC WH&S Policy & Procedures - Coolum Beach Christian College
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SUITABLE DUTIES PROGRAM<br />
(PARTIAL INCAPACITY PAYMENTS)<br />
To:<br />
Work Injury Management Team, Work Cover.<br />
Office: …………………………………………………………………………………….<br />
From: ……………………………………………………………………………………<br />
Rehabilitation Co-ordinator for ………………………………………………………….<br />
Contact Tel …………………………………. Fax ……………………………………...<br />
Date of Request: …../…../…..<br />
Injured Worker’s Full Name: …………………………………………………………...<br />
Claim Number: …………………….………. Period from …../…../….. to ..../…../….. .<br />
Monday<br />
Tuesday<br />
Wednesday<br />
Thursday<br />
Friday<br />
Saturday<br />
Sunday<br />
ONE WEEK<br />
Date<br />
…../…../…..<br />
…../…../…..<br />
…../…../…..<br />
…../…../…..<br />
…../…../…..<br />
…../…../…..<br />
…../…../…..<br />
Hours Worked<br />
…………………………….<br />
…………………………….<br />
…………………………….<br />
…………………………….<br />
…………………………….<br />
…………………………….<br />
…………………………….<br />
Total Weekly Wages paid $ ……………………<br />
Gross wages paid for this period $ …………………… Award Rate $ …………………..<br />
Gross normal weekly earnings $ ………………… Weekly hours specified in Award<br />
…..<br />
These details are essential for Work Cover to calculate correct payment.<br />
NB: A COPY OF THE FOLLOWING MUST BE ATTACHED:<br />
1. Current Medical Certificate<br />
2. Return-to-work plan<br />
- 50 -T:\SAFE <strong>CBCC</strong>\SAFE\S.A.F.E.Risk Management Prog\<strong>CBCC</strong> WH&S <strong>Policy</strong> & <strong>Procedures</strong><br />
Manual.doc
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