WORKER ONBOARDING FORM

    RTW Rehab – Worker Onboarding Form

    RTW Rehab

    "Helping people return to activity: Healthy People, Healthy Communities"

    WORKER DETAILS (Required)

    INCIDENT DETAILS (Required)

    YOUR CURRENT WORK STATUS

    Is fit for pre-incident work

    Has capacity for some type of work

    Has no current capacity for any work

    PRE-INCIDENT EMPLOYER DETAILS

    NOMINATED TREATING DOCTOR DETAILS (If known)

    INSURER DETAILS (If known)

    YOUR RIGHTS AND RESPONSIBILITIES

    Your Rights:
    1. Fair treatment with dignity and respect
    2. Confidentiality and privacy
    3. Clear information and involvement in decision-making
    4. Culturally sensitive support

    Your Responsibilities:
    1. Keep connected with your RTW Rehab Team
    a. Clearly state your goals, needs and barriers
    b. Keep us updated on your progress
    2. Attending appointments and having a say in the creation of your Graded return to Activity Plan
    3. Providing medical certificates as required
    4. Open and honest communication


    RTW Roles

    MOST DIRECT PATH BACK TO WORK

    SIRA guides and encourages the stakeholders to explore appropriate avenues where possible, to problem solve and support the Worker along the most direct path back to work.
    We help Workers achieve their goals of getting back to work as soon as possible, while also focusing on work safety, suitability, and sustainability with the same employer or, where necessary, with a new employer.

    AUTHORITY TO OBTAIN AND RELEASE INFORMATION – CONSENT (Required)

    I,, give permission for RTW Rehab (Workplace Rehabilitation Provider, SIRA Number 335) to obtain and release medical and rehabilitation information from my Doctor(s), relevant Treating Health Professionals, Employer, Union (if applicable), and Insurer / Funder.


    I understand that this information will only relate to the injury for which I have been referred and will be regarded as totally confidential.
    Any photos we take of you and your activities and use in our reports will be de-identified, by blurring or concealing your face or any other identifiable or distinguishable markings.


    You are able to withdraw your Consent at any stage - please inform us should you ever choose to cease your Consent.

    NB: Some organisations are legally entitled to receive information about an Injured Worker who is claiming Compensation,
    i.e. Insurers and their Legal Representatives, the State Insurance Regulatory Authority (SIRA), a NSW Court of Law, and the NSW Workers Compensation Commission.

    OTHER STAKEHOLDERS TO WORK WITH

    Pre Incident Employer

    Nominated Treating Doctor (GP)

    Nominated Treating Therapist (Physical Therapist, Psychologist, etc)

    Solicitor

    Union Representative

    Insurer

    PREFERRED WORKPLACE REHABILITATION PROVIDER CONFIRMATION(Required)

    RTW Rehab (SIRA provider number 335) provides a collaborative approach with all parties to bring about positive and effective outcomes. We facilitate and Support your occupational rehabilitation needs and graduated return to activity by working with you, the Employer(s), the Insurer, your Treating Health Professional(s) and any other parties that may be involved.

    I,, am requesting RTW Rehab to be my preferred Workplace Rehabilitation Provider.