While you always try to provide the safest working environment for your staff, even the most proactive injury prevention program cannot entirely eliminate illness and injury. The establishment of a return to work (RTW) program is critical to successfully managing your Workers’ Compensation claim and injury management costs. Likewise, it is extremely important that your YMCA have a successful RTW program to help maintain the quality of services you provide for your community.
The primary benefit of a return to work program is to facilitate the earliest possible return of injured workers to the workplace to perform meaningful, productive work within their physical capabilities. An effective RTW program requires the involvement and cooperation of a number of parties, including your employees, health care providers, and YMCA leadership.
The information presented in this Guide outlines our goal at The Redwoods Group to assist you with maintaining a healthy and safe environment for your employees.
To All Employees:
The health and welfare of all employees is a top priority of this organization. When one of our employees is injured on the job, we are committed to returning that employee to productive work and full wages as soon as possible.
Our Return to Work program incorporates temporary, transitional duty jobs, which consist of some type of modification to your original job, a different job or several part-time tasks combined into one job. The transitional job will be provided until the treating physician releases you to your full, regular work or until you reach maximum medical improvement. This program has proven effective in returning injured employees back to production work quickly and also aid in the healing process.
The success of this program is the responsibility of everyone, from senior management to each individual employee. Only by working together can we provide a safe and secure workplace.
We all should be alert for potential accidents and strive to prevent them. If they occur, let us work together to minimize the effects. These efforts will be a benefit to us all.
A successful return to work program utilizes a team approach. This team includes your Return to Work (RTW) Coordinator, your management personnel, Redwoods’ Case Management Specialist, the claims team, and medical providers.
The first step is to designate a RTW Coordinator – someone who is enthusiastic – to oversee the program and to assist supervisors and the injured employee in returning to work. (The coordinator position does not have to be full time, but oversight of this program does need to be a person within your organization). The Coordinator must be methodical in applying the program and must maintain thorough documentation of all actions. Information such as the result of an injury may be confidential and should be handled accordingly. The Return to Work Coordinator will work closely with The Redwoods Group Case Management Specialist, the employees, and the supervisors.
Return to Work Coordinator duties include:
Maintain a safe work environment!
Report unsafe conditions!
Understand the Y’s modified duty/RTW commitment!
Participate in injury review process!
Redwoods Case Management Specialist:
Physician: Please fill out this form and fax it to 800-478-6068, attention: Angela McGarity
Employee: Completed form must be returned to your employer following each examination.
YMCA: When received, route this form to The Redwoods Group immediately.
Date of injury/illness:
Brief diagnosis of injury (indicate clinical manifestation of condition to what body part or surface):
Patient has been advised of the following regarding return to work:
|Number of consecutive hours the patient can perform the specified activity during an 8-hour work period||6-8||4-5||1-3||0|
|Weight-handling frequencies per hour||15 or more||10-14||1-9||0|
|Lifting/carrying less than 10 pounds||_||_||_||_|
|Lifting/carrying 10-20 pounds||_||_||_||_|
|Lifting/carrying 20-50 pounds||_||_||_||_|
|Lifting/carrying 50-100 pounds||_||_||_||_|
Patient discharged? Yes / No
Next scheduled examination/treatment date:
Attending physician’s signature:
(For YMCA and Redwoods’ Case Management Specialist Use)
Employee job title:
Supervisor interviewed? Yes / No
If yes, list supervisor name:
Was the employee hired with any restrictions? Yes / No
If yes, explain the restrictions:
Typical work hours per week:
Overtime? Yes / No
Breaks? Yes / No
If yes, list frequency:
|Body movements at work||Rarely||Occasionally (1/3 or less)||Frequently (1/3 to 2/3)||Continuously (2/3 or more)|
|Vertical reaching at or above shoulder height||_||_||_||_|
Describe the driving involved:
|Body movements at work||Weights handled (lbs.)||Item||Alone or assisted?||Push/pull/lift?||Times per day||Distance moved|
|More than 50||_||_||_||_||_||_|
|Hand coordination||Movement required||Tool/machine||Left||Right||Both|
Inside Work - Percentage performed inside:
Outside Work - Percentage performed outside:
Work around moving machinery? Yes / No
If yes, describe:
Check each of the following that the employee comes in contact with:
For YMCA and Redwoods’ Case Management Specialist Use
|Date||Hours Worked||Tasks performed||Comments regarding injured worker’s tolerance of modified-duty tasks||Initials|
|Sunday||_||_||_||Injured Worker: / Supervisor:|
|Monday||_||_||_||Injured Worker: / Supervisor:|
|Tuesday||_||_||_||Injured Worker: / Supervisor:|
|Wednesday||_||_||_||Injured Worker: / Supervisor:|
|Thursday||_||_||_||Injured Worker: / Supervisor:|
|Friday||_||_||_||Injured Worker: / Supervisor:|
|Saturday||_||_||_||Injured Worker: / Supervisor:|
I clearly understand, take responsibility for, and acknowledge the limitations my physician has placed on me while participating in this temporary transitional work program.