Queensland Rehabilitation File Assessment

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1.INITIAL CONTACT

• Has the injury been reported to the business within 48 hours?

  Yes

  No

  N/A

• Has the Rehabilitation and Return to Work Coordinator (RRTWC) contacted the injured worker within 48 hours of the incident/injury.

  Yes

  No

  N/A

• Has the worker been offered first aid and/or immediate treatment?

  Yes

  No

  N/A

• Has early contact (in the first 72 hours) been made with the Manager, Treating Doctor, Allied Health Provider(s) (if applicable) and Qantas Workers. Compensation Department (Insurer)?

  Yes

  No

  N/A

• Has the Insurer has been notified with 48hours of incident report to employer?

  Yes

  No

  N/A

• Has the Insurer been provided with the claim paper work within legislative time frames?

  Yes

  No

  N/A

2. CLAIM FORMS & INVESTIGATIONS

• Has the Incident report form (and where required workers statement) been competed?

  Yes

  No

  N/A

• Investigations are completed and action items closed out?

  Yes

  No

  N/A

• Has the Claim Form been completed in its entirety?

  Yes

  No

  N/A

• If the injured worker declines to lodge a Workers Compensation Claim, has the appropriate form been completed?

  Yes

  No

  N/A

• Has a copy of all above mentioned forms been loaded to SIMS?

  Yes

  No

  N/A

3. ROLES & RESPONSIBILITIES

• Has the role of the RRTWC been explained to the injured worker and contacts provided?

  Yes

  No

  N/A

• Has the Injury Management Guide for Queensland Employees been explained and provided to the employee?<br>

  Yes

  No

  N/A

• Has the Injury Management Guide Acknowledgement form been signed?

  Yes

  No

  N/A

• Has a copy of the above mentioned form been loaded to SIMS?

  Yes

  No

  N/A

4. CONSENT & CONFIDENTIALITY

• Has the Authority to Release Medical Information form been explained to the injured worker?

  Yes

  No

  N/A

• Has the Authority to Release Medical Information form been signed by the injured worker?

  Yes

  No

  N/A

• Is all employee information stored in a secure location?

  Yes

  No

  N/A

• There is evidence on file that return to work review meetings are held in a confidential area and the injured worker has been offered the opportunity to bring a support person?

  Yes

  No

  N/A

• Consent is gained for external parties/ additional stakeholders ( ie unions) involved in the process?

  Yes

  No

  N/A

• A copy of the above mentioned documents have been loaded to SIMS?

  Yes

  No

  N/A

5. MEDICAL CERTIFICATES

• Does the medical certificate have the correct and complete details for the injured worker?<br>

  Yes

  No

  N/A

• Does the medical certificate have a correct/ valid diagnosis?<br>

  Yes

  No

  N/A

• Does the medical certificate have the level of capacity noted?<br>

  Yes

  No

  N/A

• Is there a review date for non-clearance certificates?<br>

  Yes

  No

  N/A

• Is the medical certificate signed and dated by the treating medical practitioner? <br>

  Yes

  No

  N/A

• Are restrictions noted appropriately on the certificate?<br>

  Yes

  No

  N/A

• Are all medical certificates loaded in SIMS?<br>

  Yes

  No

  N/A

6. SIMS

• Is there a short file or claim file for the injured worker?<br> S 105

  Yes

  No

  N/A

• Is the name of the RRTWC/RTWC who is responsible for the injured worker correctly allocated in SIMS?

  Yes

  No

  N/A

• Does the RRTWC/RTWC responsible for the file reside in the state of the injured worker? <br>S226 Act

  Yes

  No

  N/A

• Are all notes and documents entered in a timely manner? <br>-within 5 business days WC CSS

  Yes

  No

  N/A

7. REHABILITATION & RETURN TO WORK PLAN

• Has the treating Doctor been provided with a list of suitable duties?

  Yes

  No

  N/A

• Has the injured worker been consulted about in the identification of suitable duties process?

  Yes

  No

  N/A

• Has the Manager/ Supervisor been consulted in the identification of suitable duties?

  Yes

  No

  N/A

• Has a suitable duties plan been created for each period of capacity in line with medical certificates?

  Yes

  No

  N/A

• Do suitable duties plans detail tasks performed as well as medical restrictions?

  Yes

  No

  N/A

• Has the suitable duties plan been signed by all relevant parties?

  Yes

  No

  N/A

• Have all Return to Work Plans/ Suitable Duties programs have been loaded in SIMS?

  Yes

  No

  N/A

8. COMMUNICATION & COORDINATION

• Is there evidence of communication/ discussion with the injured worker regarding their rehabilitation and progress with their suitable duties program?

  Yes

  No

  N/A

• Is there evidence of communication on the worker's progress with the workers Manager/ Supervisor?

  Yes

  No

  N/A

• Has contact been made with the treating doctor to confirm the RTW goal, time frames for recovery, treatment recommendations and with advice on workplace rehabilitation?<br>QLD - S106 (5)(c)

  Yes

  No

  N/A

• Have anticipated time frames for recovery have been discussed with the injured worker?

  Yes

  No

  N/A

• Is there evidence of communication with the treating doctor regarding the injured worker's progress with their return to work program?

  Yes

  No

  N/A

• Is there evidence on file of discussions with allied health personnel?

  Yes

  No

  N/A

• Is there evidence on file of timely communication with the Claims Analyst / Claims Manager?

  Yes

  No

  N/A

• Where rehabilitation providers are involved, is communication noted at least fortnightly?

  Yes

  No

  N/A

• Are return to work reviews/ meetings held between all relevant stakeholders?

  Yes

  No

  N/A

• For closed files, workers have been sent a claim closure letter?

  Yes

  No

  N/A

• For closed files, a file assessment has been completed?

  Yes

  No

  N/A

9. FILE NOTES

• Notes are entered by the appropriate RRTWC/ RTWC listed on claim?

  Yes

  No

  N/A

• Are file notes written in an accurate and objective manner?<br>QLD - S107 (2a)<br>

  Yes

  No

  N/A

• Are file notes kept in a confidential manner ie relate only to worker, relevant to injury and rehabilitation of worker?

  Yes

  No

  N/A

• Do file notes contain actions and decisions?<br>QLD- S107(2b)

  Yes

  No

  N/A

• Do file notes contain reasons for actions and decisions?<br>QLD- S107(2b)

  Yes

  No

  N/A

10. AUDIT FINDINGS & ACTIONS

• Compliance / Non Compliance applies to Acts or Regulations .
  Conformance / Non Conformance applies to Qantas group policies and procedures