Early Safe Return to Work(ESRTW)

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

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

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

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

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

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

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.

University of Windsor Accident Incident ReportSection A: Employee Information

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

Section B: DESCRIPTION OF THE EVENT

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.

University of Windsor Accident Incident ReportSection C:

PREVENTIVE AND CORRECTIVE ACTION RESULTING FROM

ACCIDENT INVESTIGATION

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.

University of Windsor Accident Incident ReportSection D

University of Windsor Accident Incident ReportSection E & F

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

New Functional Abilities Form

FAF Continued

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)

New FAF Worker Signature

Functional Abilities Section

FAF continued

FAF continued

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)

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 971-3671, but the originals must be sent through inter-university mail.

Conclusion

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

Applicable WSIB Policies for ESRTW

• ESRTW Overview: 19-02-01

• The Goal of ESRTW & Roles of the Parties: 19-02-02

• Workplace Party Co-operation: 19-02-03

• FAF for Timely Return to Work: 19-02-04

• Mediation Services: 19-02-06