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  • Work Plan Template 01 22 03

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    Sakthi
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    This return to work plan outlines an employee's gradual return over 4 weeks, including their starting and target work days and hours per week. The employee's name, job title, location, and support person are listed. Each week outlines the planned work days and hours as well as breaks and duties, with room for comments. The plan is signed by the employee, manager, treatment provider, and case owner.

    Original Description:

    Work plan and site assesment report

    Original Title

    Work-Plan-Template-01-22-03

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    This return to work plan outlines an employee's gradual return over 4 weeks, including their starting and target work days and hours per week. The employee's name, job title, location, and support person are listed. Each week outlines the planned work days and hours as well as breaks and duties, with room for comments. The plan is signed by the employee, manager, treatment provider, and case owner.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    13 views3 pages

    Work Plan Template 01 22 03

    Uploaded by

    Sakthi
    This return to work plan outlines an employee's gradual return over 4 weeks, including their starting and target work days and hours per week. The employee's name, job title, location, and support person are listed. Each week outlines the planned work days and hours as well as breaks and duties, with room for comments. The plan is signed by the employee, manager, treatment provider, and case owner.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 3

    RETURN TO WORK PLAN TEMPLATE – BASIC

    Employee details

    Name Job Title

    Hrs worked per day Hrs worked per week

    Location of work __________ Date to Commence:


    ___________

    Workplace support person __________________

    Goals of Return-to-Work Plan


    ______________________________________________________________
    ______________________________________________________________
    ______________________________________________________________
    ______________________________________________________________

    Starting work days: Target work days:

    Starting work hrs: Target work hrs:


    Return to Work Outline
    Week 1
    Days Work (circle) M T W T F S S
    Hours per Days
    Breaks to be taken (no. & frequency)
    Duties

    Week 2
    Days Work (circle) M T W T F S S
    Hours per Days
    Breaks to be taken (no. & frequency)
    Duties

    Week 3
    Days Work (circle) M T W T F S S
    Hours per Days
    Breaks to be taken (no. & frequency)
    Duties

    Week 4
    Days Work (circle) M T W T F S S
    Hours per Days
    Breaks to be taken (no. & frequency)
    Duties

    Comments and actions during plan period:


    Review Dates

    Signed By

    Employee: ____________________
    Manager/Supervisor: _______________

    Treatment Provider: _________________


    Case Owner: ________________

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