1. Early Safe Return to Work (ESRTW)

2. Employer Responsibility
Work injuries requiring medical attention must be reported to WSIB within 3 days
Form 7 is completed and forwarded to WSIB
Must ensure that first aid treatment is available to employee and recorded in first aid log book
Investigate the accident/injury and manage the claim
Liaise with WSIB personnel

3. Supervisor
Investigate the injury/complaint. Take preventative measures to ensure it doesn’t happen again
Ensure immediate completion of incident report
Meet with the returning employee at the start and end of the first shift to review and discuss any concerns the employee may have

4. Continued
Maintain progress chart or documentation relating to employee’s injury.
Maintain regular contact with the employee during his/her absence from work
Co-ordinate the development of the employee’s return to work plan.
Schedule regular meetings with employee to discuss progress

5. Responsibilities - Employee
Immediately report all work-related injuries and complaints to supervisor
Obtain necessary paperwork prior to leaving site
Complete section A and sign the New FAF release of functional abilities section
Maintain regular contact with supervisor and keep advised of any changes in medical condition

6. Employee responsibility Continued
Advise the treating physician of the availability of modified duties
Actively participate in developing a specific return to work plan
Communicate any difficulties or concerns regarding the Return to Work Program to supervisor and WSIB

7. Joint Responsibility Maintain regular contact following injury
Ensure Functional Ability Forms are completed and returned as soon as possible
Review all possible modified work within precautions
Design a modified work plan
All workplace parties must be kept informed of progress and adjust plan accordingly

8. Completing the University of Windsor Accident/Incident Report
It is important to understand that all of the questions on the Accident/Incident form will assist in completing the Workplace Safety & Insurance Board (WSIB) Form 7.
The Acc/Inc Form is to be completed by the Supervisor and the Worker, where practicable.

9. University of Windsor Accident Incident Report Section A: Employee Information

10. DESCRIPTION OF THE EVENT Section B
This section will explain the what , when, where and why of the incident and who may have witnessed it. When completing this section, it is important that you include as much information as possible regarding the Acc/Inc. The reason for this is that the Office of Occupational Health & Safety will have to communicate with the WSIB on medical or lost-time claims and provide detailed information regarding the claim

11. Section B: DESCRIPTION OF THE EVENT

12. Completing Section C
When completing this section the supervisor and the worker should discuss possible solutions to preventing a recurrence of the incident.
The Supervisor will then communicate with the person responsible for the corrective measures i.e loose floor tile caused the worker to trip. Maintenance would be contacted to come and repair the floor.

13. University of Windsor Accident Incident Report Section C: PREVENTIVE AND CORRECTIVE ACTION RESULTING FROM ACCIDENT INVESTIGATION

14. Section D: Medical Care
This section must be completed If the worker is going to seek medical attention for a work related injury or condition.
i.e. Worker is able to complete the Acc/Inc. Form but will need medical attention. The University of Windsor has the worker transported to seek medical attention and would enter the Health Care Practitioner’s information.

15. University of Windsor Accident Incident Report Section D

16. University of Windsor Accident Incident Report Section E & F

17. Functional Ability Form
Utilize the Functional Abilities Form to assist in early and safe return to work
The Supervisor will send it with the employee when he/she first seeks medical attention and ongoing depending on severity of injury and progress
It will assist all parties in determining the employee’s abilities
Can assist work place parties to identify necessary accommodations or alternate duties for RTW

18. New Functional Abilities Form

19. FAF Continued

20. Worker’s Signature Why is it needed? The new legislation requires it
Acts as a worker’s application for benefits
Acts as worker’s permission for the treating practitioner to release functional abilities (FA) information to the employer
(FA information used to plan an early and safe return to work)

21. New FAF Worker Signature

22. Functional Abilities Section

23. FAF continued

24. FAF continued

25. University of Windsor’s Procedures
If the employee requires only first aid the supervisor fills out accident/incident only.
If the employee requires medical attention they must take the WSIB Functional Abilities Form with them when going for medical aid and return it as soon as practicable.
The Employee must sign the release of functional abilities section of the FAF (B:Workers signature)

26. Procedures Continued
Supervisors must also fill out the accident/incident form for medical aid claims.
All documents must be forwarded to the Office of Occupational Health & Safety within 24 hours of the accident/incident.
The forms may be faxed to , but the originals must be sent through inter-university mail.

27. Conclusion
Working together we can make all the pieces fit and improve all the aspects of Early Safe Return to Work.

28. ESRTW Quiz
Take the Quiz

29. Applicable WSIB Policies for ESRTW
ESRTW Overview:
The Goal of ESRTW & Roles of the Parties:
Workplace Party Co-operation:
FAF for Timely Return to Work:
Mediation Services: