[MCOH-EH] Return to Work Form

[Kris Arnold]

Enass,

I do not have a form to share with you, although I use one.  It is
extremely simple with a check box for full duty and one for modified duty
with a box for listing accommodations/restrictions and a place for the
physician/nurse practitioner to sign and one for the employee, of
particular value when they are returning with modifications.  There is,
then a place for the employee to sign acknowledging review of any
accommodations.

In general, the concept of a return to work note from the occupational
health/employee health service is to state to management that the employee
is either fit to safely and effectively perform the essential job functions
of their position, not necessarily the specific job assignment unless it
has additional job function capacity requirements, or that they have a
disability for which accommodations are being recommended.

For example, your institution might have a class of employees as
housekeepers with certain lifting, pushing, pulling, bending, etc,
activities which the employee must be deemed capable of safely performing.
 Some of your housekeeping staff might be assigned to certain areas such as
laboratory areas where they may need to wear personal protective equipment,
possibly including respirators, to safely enter the area.  These
housekeepers would then need to be assessed for the additional job function
of wearing a respirator prior to clearance. You may want to have such items
on your form for the necessary times.

Additionally, you would want an area on the form for listing
accommodations/modifications to either the physical activities of the
employee or to the work environment.  For example, a person who has a
cervical strain but needs to manage phone calls and enter data on a
computer at the same time, might benefit from being provided with a
telephone headset if they do not already have one for their worksite.

Key to all of this is a strong understanding of the essential job tasks of
different classes of employees, including issues around safety of the
employee to others, which, in a health care setting, includes risks of
disease transmission to patients or other employees.  Thus, if a
practitioner other than the occupational physician/nurse practitioner is
being relied on for a preliminary decision, that practitioner should be
supplied with a job function description that they should be required to
sign and return to employee health.  Ideally, your office would then review
both the clinical care issues, as much as you are allowed to in
non-work-related conditions, and any documentation of capability to perform
expected functions prior to final release to work at whatever level is
appropriate.  Additionally, if there is a question, use of a
job/injury-focused functional capacity evaluation can become a part of the
clearance and the clearance form information.

You and other list members probably know all this, but it is sometimes
helpful to put out all the issues to help construct your own most relevant
process and associated forms.

Best.

Kris Arnold, MD, MPH
Chief Medical Officer
ArLac Global Health Services
Lexington, MA
USA


On Sun, Aug 24, 2014 at 9:14 AM, Enass Awad <umhaneen at gmail.com> wrote:

> Dear Colleagues:
>   Will be very obliged if you can share drafts or templates of return to
> work forms that you use. We are developing a new form for the university
> employees and I will like to look at multiple formats before finalizing our
> own. This is a major science research university however employees'
> backgrounds range from teaching academic staff to adminsitrative staff to
> postdoc and postgraduate students.
>
> Thanks in advance,
>
> Enass.
>
> --
> Enass Awad A/Rahman,MD,MPH,FACOEM
> Occupational Medicine Consultant
> King Abdullah University of Science and Technology
> Thuwal-Jeddah
> Kingdom of Saudi Arabia
> Tel: 0966128084102
> Mobile :0966548543844
> Email: enass.arahman at kaust.edu.sa
>
>
>
> "We can enrich the world if we choose to embrace our similarities; we can
> destroy the world if we choose to emphasize our differences."
>
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