McGill
BC Cancer Agency
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Temporary RTW Plan Tool


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Six Key Elements Planning Tool:

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1 Anticipated start and end dates

Why is this important?

By setting an anticipated start and end date to the plan, you are delineating and ensuring that all parties are clear about expectations within this time period. If the plan needs to change within the delineated time period, you can create a new plan with the employee.

MM/DD/YYYY

MM/DD/YYYY
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2 Work schedule

Why is this important?

By noting work days and work hours you provide clear expectations regarding work days and times for the employee. By gradually increasing work hours you allow an employee to gradually increase his/her work tolerance. This also allows you as the employer to plan and provide any supports to the employee who is returning to work.
A description of work days and work hours per day that the employee will be expected to complete.
  • Enter the number of hours the employee will be expected to complete on each day of the week they're scheduled to work.
  • Leave the box blank or enter 0 if they don't work on that day.
  • You can press the TAB key on your keyboard (if available) to go to the next day.
Sun Mon Tue Wed Thu Fri Sat

Total hours: 0

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3 Essential tasks & duties

Why is this important?

By identifying the essential tasks and duties that the employee will be expected to resume within this return to work plan, you can clearly identify expectations. By ordering and prioritizing the tasks, it helps to identify which tasks need to be done first in a graduated return to work.
For help identifying essential tasks and duties, read the definition and/or see the Task Analysis Worksheet.

Move You can prioritize the tasks by rearranging them. Click and drag the boxes to rearrange.

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4 Medical limitations

Why is this important?

By writing down any medical restrictions or limitations that have been identified by the employee’s health care team you ensure the health and safety of the employee.
Factory workers
A description of medical restrictions or limitations (if any) that must be adhered to and how long these restrictions or limitations should remain in place.
You have identified the following essential tasks:

1) Are there any medical restrictions or limitations that the employee and/or the employer must adhere to?

   

2) List the employee's medical restrictions or limitations as listed by the healthcare provider that could impact completion of essential tasks:

3) If these restrictions will be temporary, how long will they need to stay in place?

Approximately days
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5 Workplace accommodations

Why is this important?

By identifying and implementing workplace accommodations you can enhance an employee's potential to successfully return to work and enhance retention of valuable employees.
Workplace accommodations are modifications to a job or the workplace environment that allow qualified job applicants/employees with an illness, injury or disability to participate in the job application process or to perform the essential tasks of the job.

Workplace accommodations can include changes to the physical environment, changes to an individual’s work tasks and duties, flexible scheduling, adaptive technologies, strategies to ensure job success, and supports such as a co-worker or job coach.
You have identified the following essential tasks:

1) First, list all restrictions, limitations and accommodations that are recommended or that you have identified as beneficial to facilitating the employee's successful return to work. For ideas, see our article Job accommodations for cancer specific symptoms.

2) Based on the essential duties you listed in step 3, identify whether accommodations are needed by clicking yes or no below. If you click yes for a task, provide job accommodations ideas in the text box. For ideas, see our article Job accommodations for cancer specific symptoms.

  • Task:   Needs accommodation?      
    Describe the accommodation(s) required, and the reason(s) for needing them:
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6 Monitoring the Return to Work Plan

Why is this important?

By establishing a formalized plan and identifying who will be monitoring the plan you ensure that issues are identified when they arise, that recommended restrictions and accommodations are implanted and that changes get made to the plan as required.
Follow up meeting
A description of how (and by whom) an employee’s progress will be monitored, recorded and shared and how modifications to the return to work and accommodation plans are made, if and as required.