Return to Work Plan Builder

Return to Work Plan

Draft template prepared with FairWorkMate.com.au — not legal advice.

Worker and injury details

Worker

To be completed

Role / position

To be completed

Employer

To be completed

Date of injury

To be completed

Scheme / jurisdiction

To be confirmed

Current work capacity

Current certified capacity

4 hours per day, 5 days per week

Pre-injury ordinary hours

8 hours per day

Treating-practitioner restrictions

• To be completed from the worker's certificate of capacity.

Proposed suitable duties

• To be agreed between the worker, employer and treating practitioner.

Graduated return-to-work schedule

Review milestones

• Next review date: To be completed.
• Review the plan with the worker and treating practitioner at each milestone, and whenever capacity, duties or restrictions change.
• Update the certified capacity and schedule after each new certificate of capacity.

Who is responsible

Return-to-work coordinator / supervisor

To be completed

Worker

Attend agreed duties within certified capacity and the agreed hours, and report any difficulty.

Treating practitioner

Certify capacity and review restrictions at each milestone.

Sign-off

Worker signature / date

________________________

Employer signature / date

________________________

Treating practitioner (where required)

________________________

Notes

• Three core employer obligations apply across the schemes: provide suitable or pre-injury duties so far as reasonably practicable once the worker has capacity; participate in an injury-management / return-to-work plan developed with the worker and treating practitioner; and act within the scheme's timeframes. (Source: Safe Work Australia, Comparison of Workers' Compensation Arrangements, Ch 6.)
• Suitable duties are meaningful, productive duties matched to the worker's certified capacity and restrictions — not make-work. They may be modified hours, modified tasks, a different role, or a different location.
• This plan is a template to support a conversation between the worker, employer, treating practitioner and insurer. It is general information, not legal advice, and does not replace your scheme's official forms.