WorkSafeBC Certificate of Recognition Program

Injury Management/RTW

Large Employer Audit ToolAugust 2008

For use by Enform

Revisions approved May 2009

Company Name:

Company Location:

Date of Audit:

Auditor:

Date Submitted:

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 2

AUDIT ELEMENT INFORMATION

Type of Audit / Auditor Site Location # Site Personnel # Interviewed (based onEnform audit sample sizeStandard)

Internal Auditor 1

Maintenance 2

Recertification 3

External Auditor 4

Qualifying 5

Maintenance 6

Recertification 7

Total:

Company InformationLegal Name

Common (Trade) Name:

Address

Primary Contact

WorkSafeBC InformationAccount Number Nature of business

Classification Unit(s)

Auditor InformationName: Auditor Certification Number :Company: Phone Number:

Fax Number:City: Email:Prov:

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 3

INJURY MANAGEMENT/RTW AUDIT ELEMENT

Introduction

Injury management/return-to-work programs are a proactive way for employers to help injured workers stay at work or return toproductive and safe employment as soon as physically possible. They are based on the fact that many injured workers can safelyperform productive work during the process of recovery. Returning to work is part of the worker's therapy and recovery.

Effective injury management/return-to-work programs are initiated when the worker first contacts the employer. At this time, an earlyintervention procedure can be initiated to determine if the worker is capable of staying at work performing their normal duties ormodified duties while the injury heals. These at work programs are an effective tool utilized to ensure healing occurs while the injuredworker is still performing meaningful and productive work. In many cases, this prevents any time loss from work. If workers do needtime away from work, the injury management/return-to-work program can reintegrate the injured worker into the workforce muchearlier.

Reasons for an Injury Management/RTW Program

• Manage work-related injuries/illnesses from time of occurrence• Facilitate the recovery of injured/ill workers• Prevent disability• Ensure fair and consistent treatment of injured/ill workers• Prevent the loss of valuable workers• Maintain communication between all parties involved in the Injury Management/RTW process• Minimize impact of work-related injuries/illnesses on productivity• Manage costs of work-related injuries/illnesses• Impact WorkSafeBC premiums

o Positive influence on Experience Ratingo Increase likelihood of reduction in classification unit base rate

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 4

Purpose

This audit element is intended for companies with workforces of 20 or more workers.

This audit element provides the employer with a tool:

• To examine and review the capability of the company's Injury Management/RTW Program• To receive an external assessment of the company's Injury Management/RTW Program• To identify areas where the company's Injury Management/RTW Program could be improved• To initiate a process of continual improvement of the Injury Management/RTW Program, therefore to reduce the

impact (financial and human) of work-related injuries/illnesses

Completion of this audit element, by an external auditor certified by the certifying partner, with a passing mark of at least80 percent, allows the certifying partner to award the RTW COR and can entitle the employer to receive a rebate fromWorkSafeBC.

Process

Although the RTW audit element is scored independently of the OHS audit with which it may be concurrently performed,the auditor should conduct documentation reviews, observations and particularly interviews in such manner as to ensureefficient completion of the work, rather than conducting two separate audits. RTW element interview questions should beblended with OHS questions, rather than conducting two separate sets of interviews.

Note

When this audit element is completed for RTW COR certification, it must be applied to the employer's completeoperation in each of the CUs for which the employer is seeking COR certification, or to a representative selectionof business sites in each CU, as determined by the auditor without influence of the employer. Information providedon page 2 must accurately reflect the sites to which this audit element data applies.

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 5

Definitions

Alternate Duties: plan under which the worker is able to return to pre-injury/illness job site but not own job. Workermay act as a helper for another job or can perform work that is specifically reserved for injuredworkers. The objective is to keep the worker at the job site, possibly while receiving treatment at thesame time. Work included in the plan is meaningful and productive.

Contact Personnel: personnel designated by the employer with responsibility for establishing / maintaining contact withthe injured worker; e.g. first aid attendant, supervisor, or other personnel

Education: a process by which knowledge (theory) is conveyed

Employee: any person employed by the company

Employer: all aspects of an organization, business, firm, entity, etc. registered under one WorkSafeBC accountnumber

Graduated Return to Work:return to work plan under which the worker is gradually progressed to the full regular pre-injury workover a specified period of time. Work may be graduated with respect to modified working hoursand/or alternate duties. It is important to ensure that all return to work plans have a specified enddate. Work included in the plan is meaningful and productive.

Injury Management/RTW Coordinator:an employee, or 3rd party provider, assigned the responsibility of overseeing the InjuryManagement/RTW Program(Actual job titles will vary depending on the company)

Injury Management/RTW Program:a detailed planned process to manage the impact of work-related injury/illness.

Modified Duties: plan under which the worker is able to return to own job with changes to specific duties or method ofhow those duties are to be performed. e.g. Only lift to a specific height or up to a specific weight, oradditional equipment is provided, such as footstool or ladder, or only perform specified parts of theregular duties. Work included in the plan is meaningful and productive.

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 6

Policy: an official declaration (statement) of the general principles by which a company is guided in itsmanagement.a plan or course of action intended to influence and determine decisions, actions and other matters

Practice: guideline that governs employee conduct in a given situation

Procedure: series of steps that instruct an employee in the completion of a specific task

RTW Plan: an individualized, planned process to manage the impact of a worker's injury/illness. It is important toensure that all return to work plans have a specified end date. Work included in the plan is meaningfuland productive.

Stay at Work: an early intervention process that provides modified or alternate duties to an injured worker beforetime loss occurs.

Supervisor/Manager: a person who instructs, directs and controls workers in the performance of their duties

Training: a process by which a skill is developed

Worker: a worker in this document specifically means an individual engaged as an employee by the companyto conduct work on its behalf.

Completion of the Audit Element

Achievement of an item is verified by one or more of three possible methodologies:• Documentation: written proof or evidence• Observation: the auditor directly experiences/notes/observes the standard in practice• Interview: auditor initiated and controlled face to face talk with a company employee

Points can be provided in two ways. All or nothing which will be identified by a comma e.g. (0,5) or partial pointsidentified by a hyphen e.g. (0-10).

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 7

The RTW Plan Chart indicates the number of RTW plans that must be reviewed. The auditor should review RTW Plansthat represent variance in restrictions accommodated, duration of RTW Plan, and worker's pre injury/illness job/department. The auditor should review both completed and ongoing RTW plans (If there are no ongoing RTW plansin place at the time of the audit, the auditor should include the most recent RTW Plan in the review.) If there have beenno injuries the question should be marked as N/A and the points for the element adjusted accordingly.

Note: Personal Information - A knowledgeable person, such as the Injury Management/RTW Coordinator, mustensure that no personal information is reviewed by the auditor. In the event that personal information isinadvertently revealed to the auditor in the normal course of their duties, the auditor must treat that informationwith utmost confidentiality as in all other audit activities.

RTW PLAN CHART# of RTWPlans

1 - 8 9 - 11 12 - 13 14 - 15 16 - 17 18 - 19 20 - 23 24 - 27

Min #reviewed

all

# of RTWPlans

28 - 34 35 - 44 45 - 54 55 - 67 68 - 80 81 - 100 >100

Min. #reviewed

15

8 9 10 11 12 13 14

16 17 18 19 20 20%

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 8

1. Injury Management/RTW Policy, Management and Leadership

1.1) Is there a corporate policy,statement or letter of intent outliningthe company's commitment to theInjury Management/RTW Programthat details the programs objectives?

D (0,20) Review documentationsupporting an Injury Management/RTW Program.If there is a policy or letter of intentaward 20 points. This document shalloutline both the objectives of theprogram and include an indication ofcommitment to the Injury Management/RTW Program in orderfor points to be awarded. Note: Someemployers may includetheir Injury Management/RTW policyas part of their overall SafetyManagement Policy.

O (0,10) If the document is posted inat least 70% of fixed workplaces (e.g.offices, shops, mobile offices?) award10 points.

D

/20

O

/10

Total

/30Notes:

IQuestions Guidelines Score

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 9

1.2) Is there a written InjuryManagement/RTW Program?

D (0,20) Confirm proof of a writtenInjury Management/RTW Program.Award 20 points if there is a writtenInjury Management/RTW Programthat contains at a minimum:

• Policy• Responsibilities• Employee Training• Processes for managing injuries/RTW.

D O Total

/20Notes:

1.3) Are outcomes of the InjuryManagement/RTW Programtracked?

D (0,10) Review documentation todetermine if outcomes are tracked.

Award 10 points if outcomes aretracked in at least 70% of thedocuments reviewed.

D O Total

/10Notes:

/20

/10

I

I

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 10

1.4) Are outcomes of the InjuryManagement/RTW Programanalyzed?

D (0,10) Review documentation todetermine if outcomes are analyzed.

Award 10 points if outcomes areanalyzed in at least 70% of thedocuments reviewed.

D O I Total

Notes:

1.5) Is the analysis of programoutcomes utilized to improve theprogram?

I (0,30) Interview management todetermine if actions are implementedto address the opportunitiesidentified. If information is reviewedand actions are implemented asevidenced by a minimum of 70%positive responses, award 30 points.

D O I Total

/30Notes:

/10/10

/30

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 11

2. Resources, Education and Training

2.1) Have the duties of an InjuryManagement/RTW Coordinator beenassigned and does this outline theauthority to establish and implementRTW plans?

D (0,10) Review roles andresponsibilities document to determineif program coordination duties havebeen assigned. If duties have beenassigned award 10 points. I (0,10)Interview workers, supervisorsand managers to determine if authorityto establish RTW plans is known. Ifauthority is known as evidenced by aminimum of 70% positive responses,award 10 points.

D

/10

I

/10

Total

/20Notes:

OQuestions Guideline Score

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 12

2.2) Has education been provided toensure the coordinator has anunderstanding of InjuryManagement/RTW programs?

D (0,15) Review training records orcredentials of the coordinator todetermine if training on InjuryManagement/RTW programs hastaken place. If training has takenplace, award 15 points.

D O Total

/15Notes:

/15

I

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 13

2.3) Does the individual assigned theduties of the Injury Management/RTWcoordinator have an awareness oflegislation relevant to InjuryManagement/RTW? (i.e. HumanRights, Workers Compensation)

I (0,15) Interview Injury Management/RTW Program coordinator to determineawareness of Human Rights andWorkers Compensation legislation.The Injury Management/RTWcoordinator should, at minimum, knowwhere to access the information. Ifawareness is apparent, award 15points.

D I Total

/15Notes:

2.4) Are policies and/or procedures inplace regarding retention of records?(eg. Return to Work and Stay at Work)

D (0,10) Review policies/procedures todetermine if records are retained forthe required number of years.If policy/procedures are established forretention of records, award 10 points.

D O I Total

/10Notes:

/10

O

/15

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 14

2.5) Have relevant groups, such asHuman Resources, InjuryManagement/RTW and/or OHS, beeneducated in privacy issues related toInjury Management/RTW?

D (0,10) Review records to determineif education on privacy issues hasbeen provided. If records indicateeducation has been provided to at least70% of employees within the relevantgroups, award 10 points.

D O I Total

/10Notes:

/10

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 15

3. Stay at Work and Return to WorkMany injuries do not require time away from work. Productive, meaningful duties can be performed by workers withoutcausing further injury while allowing for healing to occur. Once an injury requires time away from work the injured workerwill require reintegration into the workplace.

Questions Score3.1) Does the company havea written process (series ofsteps) for dealing with allInjury Management/RTWcases and is this posted?

D (0,5) Review documentation to determine if a writtenprocess is outlined. If a process exists, award 5points.

Note: The process should provide the employer'ssummarized step-by-step instruction for injurymanagement. For example:1- 1st response to injury2- workers reporting requirements3- contact with worker4- supervisors/managers requirements for reporting toemployer5- employer's requirements for reporting6- employer's requirements for reintegrating workerback into workforce. O (0,10) If the process is postedin at least 70% of conspicuous places available to allemployees, award 10 points Note: Where there is noopportunity to post information for workers,documentation detailing the process must be readilyaccessible by workers through an alternate meanswhich meets the intent of posting information.

D

/5

O

/10

Total

/15Notes:

IGuideline

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 16

3.2) Does the company have a"Stay at Work" initiative as part oftheir Injury Management/RTWprogram?

D (0,15) Review procedures to determine ifa "Stay at Work" process is outlined. Ifprocedures are established for a "Stay atWork" process award 15 points.

D O I Total

/15Notes:

3.3) Does the company havealternate duties identified in writing?(meaningful/productive duties) Aresupervisors aware that they can offermodified duties when required?

D (0,10) Review program documentation todetermine if possible alternate duties areidentified. If alternate duties have beenidentified in writing, award 10 points.I (0,10) Interview supervisors to determineif they have knowledge of the possibility ofproviding modified or alternate work toinjured workers. If supervisors are awarethat they have the ability to offer alternateduties as evidenced by a minimum of 70%positive responses, award 10 points.

D

/10

I

/10

Total

/20Notes:

/15

O

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 17

3.4) Is education on "Stay at Work"procedures provided to contactpersonnel and are these proceduresbeing followed?

D (0,10) Review documentation todetermine if education for contactpersonnel has taken place? Ifdocumentation supports this for at least80% of contact personnel, award 10 points.

I (0-10) Interview contact personnel todetermine if procedures are being followed.

Award points based on % of positiveresponses.

D

/10

I

/10

Total

/20Notes:

3.5) Is there a guideline in placeoutlining when contact is first madewith the injured worker, or in somecircumstances their emergencycontact, who is absent from work?And, is this guideline beingfollowed?

D (0,10) Review documentation outliningthe Injury Management /RTW process todetermine if timelines are established. Iftimelines are established, award 10 points.I (0-10) Interview Injury Management /RTWcoordinator and injured workers todetermine if guideline is being followed.Award points based on % of positiveresponses.

D

/10

I

/10

Total

/20Notes:

O

O

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 18

3.6) Is there a process to monitorreturn to work plans and is theprocess being followed?

D (0,15) Review documentation todetermine if there is a written process tomonitor Injury Management /RTW plans.If monitoring of plans is documented, award15 points.

D (0,15) If monitoring of plans isdocumented and this process is beingfollowed, as evidenced by a minimum of70% of the RTW plans award 15 points.

D/15

O Total

/30D

/15Notes:

3.7) Are end dates established forall Injury Management/RTW plans?

D (0,10) Review documentation todetermine if all Injury Management/RTWplans have an established end date. Ifend dates are established for 70% of theplans, award 10 points. Note: Excludeconsideration of plans for which an end dateis medically undeterminable or for whichthe medical information does not indicatean end date.

D O Total

/10Notes:

I

I

/10

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 19

3.8) Are Injury Management/RTWplans modified to reflect progressionof healing?

D (0,10) Review documentation todetermine if Injury Management/RTWplans are being modified, or if there is aprocess in place to considermodification, based on theprogression or non progression ofthe worker's abilities.

If it is standard practice to modifyInjury Management/RTW plansbased on the worker's abilities,award 10 points.

D O Total

/10Notes:

3.9) Are workers and supervisorsknowledgeable of the reportingprocess and requirements underworkers compensation legislation?(worker and employer responsibilitiesfor reporting injuries)

I (0-10) Interview workers andsupervisors to determine theirknowledge of the reporting process.

Award points based on the % ofpositive responses.

D Total

/10Notes:

I

/10

O I

/10

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 20

3.10) Do company policies and/orprocedures support a coordinatedapproach to Injury Management/RTW?

D (0,10) Review documentation todetermine if policies and/orprocedures reflect coordinationbetween the injured worker,supervisor, RTW coordinator, union(if present) and HR department (ifpresent) If documentation supportscoordination, award 10 points.

D O Totals

/10Notes:

3.11) Do the various departmentswork together and support the sameobjectives? (ie: Human Resources,OH&S, Injury Management/RTWdepartments (if separate))

I (0,10) Interview members of theindividual departments to determineif they work together to support theobjectives of an Injury Management/RTW Program.

If groups work together to supportthe Injury Management/RTW processas evidenced by a minimumof 70% positive responses award 10points.

D Totals

/10Notes:

I

/10

O I

/10

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 21

4. Communication

Score4.1) Have Injury Management/RTW policies and proceduresbeen effectively communicatedto all workers, supervisors, andmanagers?

D (0,20) Review documentation (trainingrecords, shop safety meeting minutes, safetycommittee minutes) to determine if policies andprocedures have been communicated to allemployees.If Injury Management/RTW policies andprocedures have been communicated to atleast 90% of employees as evidenced by asystematic process to provide InjuryManagement/RTW information to theworkforce, award 20 points.

I (0-25) Interview employees to determineawareness of the Injury Management/RTWProgram.

Award points based on % of positive responses.

D

/20

O

/25

Total

/45Notes:

GuidelinesQuestionsI

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 22

4.2) Does the employeractively promote the benefitsof the Injury Management /RTW Program?

I (0-10) Interview workers and supervisors todetermine if the program is actively promoted.Award point based on % of positive responses.

O (0,10) If promotional information is postedaward 10 points in at least 70% of workplaces.Note: Where there is no opportunity to postinformation for workers, it may be determinedto be acceptable if the employer has distributedprinted information to workers.

D

/10

I

/10

Total

/20Notes:

4.3) Are new employeesprovided with information onthe Injury Management/RTWProgram at a new employeeorientation?

Either O or D, not bothO (0,20) Attend a new employee orientation todetermine if new workers are provided with anoutline of the Injury Management/RTW Program.If workers are provided with information, award 20points.(If an orientation is not scheduled, document reviewcan be used to obtain this information.)Or:D (0,20) Review training documentation todetermine if Injury Management/RTW Programinformation is provided in a new employeeorientation.If documentation includes information on theInjury Management/RTW Program award 20points.

D O Total

/20Either / OrNotes:

O

I

/20 /20

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 23

4.4) Are medical practitionersadvised of the company's InjuryManagement/RTWinitiatives? (The employer hasa process to communicate withmedical practitioners outliningthe ability to accommodateinjured workers. An examplecommonly used is a writtenpackage sent with the injuredworker to the physician)

D (0,20) Review documentation to determine ifa process is in place to make medicalpractitioners aware of the InjuryManagement/RTW program (the ability of theemployer to provide alternate or modifiedduties.) If communication process has beenestablished, award 20 points.

D O Total

/20Notes:

I

/20

WorkSafeBC - Injury Management/RTW Large Employer Audit Tool Revised May, 2009 24

Injury Management/RTW Audit Element Scoring Summary

Large Employer (20 or more employees)Element % Maximum Points Points

Awarded%

1. Injury Mgmt/RTW Policy, Management and Leadership 22 100

2. Resources, Education and Training 16 70

3. Stay at Work and Return to Work. 38 170

4. Communication 24 105

Total 100 445