Injury Management Coaching Record

• Site name:

• Site Manager

• Date of initial visit

  Date

• Date of verification visit:

  Date

• Duration of visit

• Record compiled by

• Met with:

• Met with - verification visit

Good practices:

• The site displayed the following good practices:

Contractors, Suppliers, Demonstrators & Visitors Folder

• Folder is located at refund counter/customer service and is not stored on the counter

  Yes

  No

  N/A

• The correct form is used

  Yes

  No

  N/A

• Sign-in check completed by team member/supervisor, including initialling the form as required.

  Yes

  No

  N/A

• Site induction and evacuation procedure outlined upon sign in.

  Yes

  No

  N/A

Training

• Training:

Injury and Claims Management

• Number of current open claims

• Claim files are stored in a locked filing cabinet/area

  Yes

  No

  N/A

• Claim files are set up according to standard format

  Yes

  No

  N/A

• Review of Open Claim

Review of open claim

• Claim:

• Managers Injury and Claims Checklist completed and on file

  Yes

  No

  N/A

• Progress notes on filed and updated regularly

  Yes

  No

  N/A

• All Medical Certificates are on file

  Yes

  No

  N/A

• Periods of partial capacity have a corresponding RTW Plan completed.

  Yes

  No

  N/A

• Plans have been signed by team member and site representative

  Yes

  No

  N/A

• Consultation is demonstrated through ticking boxes in Distribution section of plan and use of Treating Practitioner Fax Coversheet

  Yes

  No

  N/A

• Wages information included on files as appropriate and necessary

  Yes

  No

  N/A

• Consent to Disclose Medical Information and InjuryCARE Referral and Consent Form (if applicable) signed and on file

  Yes

  No

  N/A

• Incident report and investigation report on file

  Yes

  No

  N/A

• Further actions:

Grab Packs

• Grab packs in situ

  Yes

  No

  N/A

• Further actions:

Site Inspection

• Outcome of site inspection