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 Report
Section 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 Report
Section 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 Report
Section D
University of Windsor Accident Incident Report
Section 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 interuniversity 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