Template

Return to Work Site Visit and Rehabilitation Checklist

by Paul Butcher, from the Community

30+

This return to work site visit checklist supports rehabilitation planning for injured employees. Use it to capture injury details, medical certificates, restrictions, current treatment, and upcoming reviews. Document suitable duties, hours, graduated return to work plans, and assistance from external providers. Identify barriers, set RTW goals, outline activities and timelines, and confirm manager support. Record home activity limitations, required workplace adjustments, and action items. This structured visit record helps coordinate employers, supervisors, and rehabilitation providers so workers can safely and progressively resume pre injury duties.

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Return to Work Plan Template
This structured Return to Work Plan template helps employers, consultants, and workers coordinate a safe, timely return after injury or illness. Capture pre-injury role and schedule, injury type, affected body parts, and likely cause. Record medical restrictions and current capacity from the treating practitioner, then define suitable duties, adjusted hours, and workplace modifications. Document client support, alternative duties, upcoming treatments, and recovery timelines. Include notes from consultations with the worker and practitioner, address concerns, and outline actions. The plan concludes with acknowledgments from the worker, consultant, and client supervisor to confirm responsibilities and commitment.
by Jamie Mallinder, from the Community
Downloads: 0
Get
Template
Return to Work Checklist
Streamline employee reintegration after illness or injury with a structured return to work checklist for transport and rail teams. Capture location, manager and employee details, dates of sickness and return, reasons for absence, and total days off. Verify reporting procedures, self-certification, and fit notes, and record medical advice, prescribed medication, and notification forms. Assess business impact, reference attendance procedures, and document accidents or annual leave overlaps. Plan rehabilitation steps, welfare or counseling services, and actions to prevent recurrence, with signatures from both employee and manager.
by Ray Upton, from the Community
Downloads: 0
Get
Template
NGP Rehabilitation Crew Audit Checklist
This NGP Rehabilitation Crew Audit helps teams verify compliance with environmental requirements during site rehabilitation. Use it to check for spill kit availability, correct hazardous materials storage per SDS, current weed hygiene certifications, installation of erosion and sediment controls, removal of construction waste, and proper re-spreading of topsoil to support site restoration. Suitable for pipeline and utilities projects as well as mining and construction sites, the checklist supports consistent, documented environmental performance across crews and locations.
by Matt McDermott, from the Community
Downloads: 10+
Get
Template
Work Injury Report Template
Use this Work Injury Report template to document workplace incidents thoroughly and consistently. Record employer and employee details, date and time, location, type of injury, body part affected, activities at the time, equipment involved, and a narrative of how the event occurred. Log treatment provided, healthcare providers, hospitalization, witness details, and return to work dates. Support internal reporting, workers compensation, and safety compliance across industries.
by Dan Elwell, from the Community
Downloads: 0
Get

Return to Work Site Visit and Rehabilitation Checklist

About author

You might also like

Return to Work Plan Template

Return to Work Checklist

NGP Rehabilitation Crew Audit Checklist

Work Injury Report Template

You might also like

Return to Work Plan Template

Return to Work Checklist

NGP Rehabilitation Crew Audit Checklist

Work Injury Report Template