Return to Work Plan: Full Version
Name: Mr Archie Brown / Fit for Work ScotlandUnique Identifier: 020 160 1534
Our assessment identified that you are currently absent from work due to the following condition(s):
Right hip pain.
On exploring the impact on your current ability to work, you disclosed difficulty with:
Reduced ability to perform your work tasks due to pain and discomfort in your right hip.
You identified your most common work tasks as:
Task 1 / Sitting at a desk (communal use) dealing with customer enquires and orders via the telephone.
Task 2 / Using the telephone.
Task 3 / Carrying and lifting meal baskets and stock items.
Task 4 / Bending and lifting meals from the freezers.
Task 5 / Not applicable.
You perceived your current difficulties with performing these tasks as:
Task 1 / The chair does not provide sufficent support when sitting for prolonged periods and as a result your symptoms are aggravated.
Task 2 / As you use a handset, which you hold between your ear and shoulder, your posture is strained and therefore causes you pain and discomfort.
Task 3 / Due to a prolonged absence from your work, your strength, confidence and tolerence for this task is reduced.
Task 4 / This causes pain and discomfort in your hip.
Task 5 / Not applicable.
Taking into account the information you provided, my assessment is that you are currently:
May be fit for work with the following adjustments:
Phased return to work
· Following a prolonged absence, a phased return to work is recommended. This will allow you to build up your strength and tolerance for the workplace. For example, during your first week you attend 09:00-13:00 hours only. This can be increased accordingly each week following a discussion between you and your employer regarding your progress.
Amended Duties
· Due to the pain and discomfort you experience when replenishing stock, it is recommended that you refrain from carrying out this task presently and that a risk assessment is undertaken.
· It is also suggested that your employer aims to provide you with a balanced work load throughout the day e.g. equal tasks between telesales and picking. This will ensure you have a mixture of sitting and standing tasks which will be more beneficial for your condition.
Workplace adaptations
· It is suggested your employer considers use of a suitable office chair, one which will provide low back support and therefore promote an optimal seated posture.
· It is also recommended you use a telephone headset to prevent you from adopting an awkward posture when using the telephone.
· To prevent you from carrying heavy loads in a basket e.g. frozen meals, it is suggested your employer consider use of a trolley with wheels. This would ensure your safety when completing this task as well as reduce the likelihood of further pain and discomfort.
It is recommended that the above adjustments are kept in place for a minimum of four weeks. Ideally, the workplace adaptations will be kept in place permanently to ensure your continued health and safety in the workplace.
These recommendations are valid between:
23 April 2015 / and / 05 May 2015
(Anticipated return to work date)
We agreed these recommendations could support you in improving your current circumstance and returning to work:
1. Until you receive your appointment with an NHS physiotherapist, visit www.nhsinform.co.uk/msk for information and advice on exercises that can help to alleviate your symptoms and promote self-management.
2. By visiting www.paintoolkit.org and www.painconcern.org.uk for practical information and advice on how to self-manage your symptoms, including specific information on how to pace yourself.
3. By ensuring you take regular breaks throughout your working day, particularly when seated at the desk e.g. micro breaks every 20-30 minutes, for a duration of 1-3 minutes each time. This will allow you to adjust your posture and prevent aggravation of your symptoms.
We discussed that your employer may be able to support your return to work by considering these suggestions:
1. Meeting prior to your return to work to agree and sign off any reasonable adjustments and other support mechanisms.
2. Organise an opportunity for you to visit your workplace prior to your agreed return to work date in order for you to meet your colleagues informally.
3. By visiting www.healthyworkinglives.com/advice for practical information and advice to help improve the health and safety and the wellbeing of everyone at work, including how to carry out a risk assessment.
Your referrer asked this specific question:
Not applicable.
The Fit for Work Scotland response is:
Not applicable.
I have applied the guidelines from the disability provisions of the equality act 2010 and can confirm that your current circumstances indicate:
The Equality Act 2010 may apply. The reasoning applied is that you appear to have a physical impairment which has a long term, substantial adverse effect on your ability to carry out normal day-to-day activities. This does not imply that you cannot work but does suggest greater accommodations from your employer in their future planning and work support.
After verbal agreement of your return to work plan, you provided consent for the Fit for Work Scotland to share the plan with:
You
Your General Practitioner
Your Employer
We agreed that we will contact you again in relation to the following:
To conclude your engagement with Fit for Work Scotland.
Date of next contact:
19 May 2015 at 13:00 hours.
If you have any questions relating to the detail contained within your Return to Work Plan, please contact your Fit for Work Scotland Health Care Practitioner on the details below:
Katrina Taylor
Case Manager / 01355 575 507
can be utilised on its own to provide evidence
of your current fitness for work
If you have any questions regarding information contained within your Return to Work Plan, Please contact your Fit for Work Scotland health care practitioner on the details contained at the bottom of your plan.
The Fit for Work Scotland website contains lots of helpful return to work advice. The website is available at www.FitForWork.scot
If you would rather engage over the telephone, you can contact the Fit for Work Scotland Advice Line on 0800 019 2211 where a qualified Occupational Health advisor will be happy to assist you.
Return to Work Plan: Summary
Guidance Notes
If you are not fit for work, or your employer cannot support your return to work, your employer should consider paying statutory sick pay (SSP) based on the information provided. If SSP cannot be paid, or SSP is ending, your employer will give you form SSP1 to claim social security benefits.
The Fit for Work Scotland Recommendations are as follows:
Your Return to WorkCertificate Content / Your Individual Response
Employee’s Name: / Mr Archie Brown
Address: / 1 Main Street
Hamilton
ML3 0TA
Date of Birth: / 01/01/1970
I assessed your case on: / 23 April 2015
And because of the following condition(s): / Right hip pain.
I advise you that: / May be fit for work with the following adjustments:
· Phased return to work
· Amended Duties
· Workplace adaptations / Notes
Not fit for work = Refrain from working for period stated below
May be fit for work = If employer is able to meet recommendations given below, employee could return
If available, and with your employer’s agreement, you may benefit from: / Phased return to work
· Following a prolonged absence, a phased return to work is recommended. This will allow you to build up your strength and tolerance for the workplace. For example, during your first week you attend 09:00-13:00 hours only. This can be increased accordingly each week following a discussion between you and your employer regarding your progress.
Amended Duties
· Due to the pain and discomfort you experience when replenishing stock, it is recommended that your colleagues carry out this task until your strength and tolerance improves.
Continued over the page…
Amended duties (continued…)
· It is also suggested that your employer aims to provide you with a balanced work load throughout the day e.g. equal tasks between telesales and picking. This will ensure you have a mixture of sitting and standing tasks which will be more beneficial for your condition.
Workplace adaptations
· It is suggested your employer considers use of a suitable office chair, one which will provide low back support and therefore promote an optimal seated posture.
· It is also recommended you use a telephone headset to prevent you from adopting an awkward posture when using the telephone.
· To prevent you from carrying heavy loads in a basket e.g. frozen meals, it is suggested your employer consider use of a trolley with wheels. This would ensure your safety when completing this task as well as reduce the likelihood of further pain and discomfort.
It is recommended that the above adjustments are kept in place for a minimum of four weeks. Ideally, the workplace adaptations will be kept in place permanently to ensure your continued health and safety in the workplace.
This will be the case: / From: 23 April 2015 / To: 05 May 2015
Fit for Work Scotland Practitioner Signature: / Katrina Taylor
Case Manager
Date of Statement: / 23 April 2015
For Social Security Benefit Claimants Only – Please Turn Over Page for Declaration
Return to Work Plan: Making a claim to social security benefits
You can use the Return to Work Plan summary to make a claim to social security benefits. Please read the notes below and fill in your details if you are claiming social security benefit, and sign and date the declaration. If you cannot fill in your details yourself, ask someone else to do it for you.
What the advice means when claiming benefits
Not fit for work:
Your health professional will advise this when they believe that your health condition means you should refrain from work for the stated period of time.
Maybe fit for work taking account of the following advice:
Your health professional will recommend this when they believe that you may be able to return to work with some support from your employer. Sometimes it may not be possible for your employer to act on the health professional’s advice and you will not be able to return to work until you have further recovered. You do not need to get a further statement from your doctor to confirm this.
If you are employed
If you are not fit for work, or your employer cannot support your return to work, your employer should consider paying statutory sick pay (SSP) based on the information provided. If SSP cannot be paid, or your SSP is ending, your employer will give you form SSP1 to claim social security benefits.
Social Security benefit claiming
If you are claiming social security benefits because of your health condition, send this form to your Jobcentre Plus office. If you are claiming social security benefits for any other reason, you must inform Jobcentre Plus of your change of circumstances.
If you wish to make a new claim to social security benefits you can:
· Download a claim form at www.direct.gov.uk/benefits or
· Phone 0800 055 6688 (8am to 6pm Monday to Friday). Text phone users call 0800 023 4888.
Patient Name:Date of Birth:
National Insurance Number:
Declaration – for social security benefit claimants only
I agree that my doctor may give the Department for Work and Pensions or a health professional acting on its behalf information which is needed to process my claim to benefit and any request for it to be looked at again
Your Signature:
Date:
Further Information
More information can be found online at:
www.FitForWork.scot
Or by ringing 0800 019 2211