Title Page

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

1.0 Framework & Responsibilities

  • 1.1 Site displays the relevant workers compensation poster/s from the State Regulator with contact details listed

  • 1.2 A RTW/Injury Management Program has been developed, consulted and is available to workers

  • 1.3 Persons undertaking the RTW Coordinator role or similar have undergone the relevant training as required by jurisdictional requirements

  • 1.4 Worker compensation and injury management information regarding a worker is kept confidential

  • 1.5 Managers/Supervisors have received information and instruction on the workers compensation and injury management process, including rights and responsibilities

  • 1.6 Managers can describe their role in immediate response and ongoing duties in relation to injury management

2.0 Initial Requirements

  • 2.1 All injuries/illness are reported to the Supervisor/Manager as soon as practicable after the incident

  • 2.2 All injuries/illnesses are entered into the incident reporting system before the end of the shift in which it occured

  • 2.3 Injured workers have been provided all necessary documentation (claim forms, information leaflets, medical authority forms to sign etc)

  • 2.4 Injured workers have given consent for all stakeholders (i.e. RTW Coordinator, treating doctor, insurer and other treating professionals) to exchange information for the purposes of managing the injury and workers compensation claim

  • 2.5 Reporting requirements to insurer are met within the required timeframes

  • 2.6 Injury management process commences as soon a practicable following a work related injury/illness

3.0 Return to Work (RTW)/Suitable Duties Plan

  • 3.1 A RTW or Suitable Duties Plan has been developed in all cases where an employee is unable to perform their normal duties (i.e. unfit or suitable duties certification)

  • 3.2 The RTW or Suitable Duties Plan has been developed in consultation with relevant parties including the worker, their manager and treating doctor

  • 3.3 The RTW or Suitable Duties Plan is consistent with medical restrictions/advice

  • 3.4 The RTW or Suitable Duties Plan is specific to the employee, goal based and sets out steps to enable a safe return to work, including: duties, restrictions, work hours, relevant dates and treatment

  • 3.5 The RTW or Suitable Duties Plan is compliant and document controlled

4.0 Suitable Duties

  • 4.1 The treating doctor is made aware that suitable duties are and will be provided

  • 4.2 Suitable Duties have been identified and are in accordance with medical capacity in consultation with RTW Coordinator and relevant Manager

  • 4.3 Managers/Supervisors advise relevant staff of the injured workers medical restrictions and ensure that appropriate assistance is provided

5.0 Return to Work Management

  • 5.1 Regular progress meetings are occurring between injured worker, their manager, RTW Coordinator and treating doctor (where relevant)

  • 5.2 RTW Coordinator has made regular case file notes in relation to all discussions

  • 5.3 Manager and RTW Coordinator can describe appropriate actions to be taken when injured workers are not cooperating

  • 5.4 The injured worker's manager consults with the RTW Coordinator upon receipt of a request for annual leave for a worker with an active workers compensation claim

  • 5.5 Workers are given the opportunity to provide feedback regarding the injury management process

  • 5.6 The service has established a preferred medical provider for injured workers

  • 5.7 Soft copy documents are held on a back up drive with restricted access

Auditor Comments

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.