Guide To Workers Compensation In Tasmania - WorkCover

Sample return-to-work planThe following return-to-work (RTW) plan has been developed for:1. Surname: Given names:2. Job title: 3. Supervisor:4. Work location:5. Name of rehabilitation coordinator, treating doctor or employee representative:6. Suitable Alternative Duties: Restrictions (including specific medical):7. Specific duties to be avoided:8. Long term goals and/or steps to be taken to facilitate a return to work:9. Hours/days of work:10. Wages, award (if applicable):11. Return date: 12. Length of plan:13. Review dates: 14. Predicted completion date:The following parties have agreed to the plan:Date:WorkerDate:Supervisor/ManagerDate:Treating GPWe have reviewed, understand and agree to the tasks assigned and the above medical restrictions. If any problems occur incompleting tasks, they will be immediately communicated to the worker’s supervisor/manager.A return-to-work plan is to be prepared when a worker is incapacitated for more than 14 days. The plan is to be drawn up within five days ofthe 14-day limit being reached. The legislation provides a penalty for non-compliance. Copies of this document are to be given to the insurer,treating doctor, worker and supervisor/manager.32