Return to work plan, Sione Fifita, Kirribank Distribution
Return to work letter template with adjusted duties set out week by week
A return after a workplace injury goes wrong when the plan lives in someone's head and the worker finds out the limits by hitting them. This letter puts six weeks of graded hours, duties and lifting limits in one table, lists the certified restrictions, fixes four review dates and names the person to call when a task hurts.
The document, page by page
Every page as it renders and as it prints, with nothing summarised. Read the wording before you reuse it.
Section by section
What each section is for, so you can keep the ones you need and drop the rest.
- Letterhead and addressee
- Kirribank Distribution masthead with ABN, 30 October 2026.
- Subject
- Your return to work from Monday 9 November 2026.
- What this plan is based on
- The 18 August injury, a certificate dated 27 October, a meeting on 29 October.
- Return date, hours, full duties
- Three values: 9 November, four hours a day, full duties from 21 December.
- Your duties, week by week
- Period, hours, duties and lifting limit across three steps.
- Restrictions on the certificate
- Overhead reaching, ladders, the order picker, hourly breaks, no overtime.
- Reviews, and who holds this plan
- Four review dates and who attends each.
- If a duty hurts
- A callout: the coordinator's number, and the plan changed rather than enforced.
- The law and the claim
- Two New South Wales Acts, the regulator and the claim number.
- Signature block
- One party, the worker, signing without giving up any right.
How to adapt this document
For a return after a non work injury, keep the graded duties table and the restrictions list but remove every reference to the claim, the insurer and the workers compensation Acts, because the framework is then the medical certificate and the employer's own policy. For a return after extended parental or personal leave, replace the lifting limits with the practical arrangements the person needs, such as hours, system access and what changed while they were away. For a plan covering a worker at more than one site, add a column naming the site for each period and repeat the restrictions in the site induction.
Which law the terms follow
The artifact is written for a New South Wales workplace. The obligations to offer suitable duties, to plan the return with the worker and the treating doctor and to keep a return to work program come from the Workers Compensation Act 1987 (NSW) and the Workplace Injury Management and Workers Compensation Act 1998 (NSW), both named in the letter. The State Insurance Regulatory Authority publishes the guidelines the program follows, and the certificate of capacity sets the limits the duties table has to stay inside. Weekly payments run through the accepted claim, which is why the claim number is on the page.
What makes this document work
The graded return is a table, not a promise to review
Four hours a day for weeks one and two on pick face counts and label printing with a 5 kg limit, six hours for weeks three and four, 7.6 hours with machine pallet wrapping for weeks five and six, then pre injury duties from 21 December if the review agrees. A supervisor can roster straight from a row.
Restrictions are quoted from the certificate, not paraphrased
No reaching above shoulder height with the right arm, no ladder work and no order picker, a ten minute break away from the pick face every hour, no overtime and no weekend shifts while the plan runs. Four lines that a stand in supervisor can check a task against.
Stopping is made easy and blameless
The callout says to tell the coordinator on 02 9756 1184 or any supervisor the same day, that the plan is changed rather than enforced, that nothing here is a test you can fail, and that no duty is to be done through pain. That is what makes a worker speak up in week two instead of week five.
Questions people ask
Who writes the return to work plan?
The employer, working from the treating doctor's certificate of capacity and in consultation with the worker and the insurer. Larger employers have a return to work coordinator, named in this letter, and the worker should always get a copy. A plan the worker has not seen is not a plan.
What are suitable duties?
Work the injured person can safely do within the limits on their certificate, whether that is their usual job with restrictions or different tasks. They have to be real work with value rather than invented tasks, which is why every duty in this table is part of the normal warehouse day.
Does the worker have to accept the duties offered?
An injured worker on a claim generally has obligations to participate in planning and take part in suitable work when it is offered within their capacity. The offer itself has to be reasonable and inside the certified limits, which is the point of setting the limits out in writing before the first shift.
What happens to pay on reduced hours?
Where the claim is accepted, weekly payments under the workers compensation scheme generally make up the difference, on a formula that steps down over time. This letter says the pay is made up under the accepted claim and gives the claim number, so the worker can raise a shortfall with the right people.
How often should a plan be reviewed?
At each step up in hours or duties, and whenever the certificate changes. This one fixes four dates, 6 November for signing, 20 November, 4 December with a new certificate, and 18 December before full duties. Reviews at fixed dates stop a plan running for months past its usefulness.
Build your own in about a minute
The button below opens the generator with this use case already described. Change the wording to match your own, generate, then edit anything you like.
Make one like thisOther document examples
Show cause letter template with three dated allegations and a deadline
A show cause letter asks someone to answer before anything is decided, so it has to state what is alleged precisely enough to answer and say clearly that no finding has been made. This one numbers three allegations with their dates, lists the four documents relied on, and gives five business days to respond.
Final written warning template that lists every warning already given
A final warning is only final if the record shows what came before it, and most fail because the earlier steps were verbal and undated. This one lists three prior warnings with dates and who gave them, four dated late starts since the last one, the response given at the meeting, and the consequence in a single sentence.
Retirement congratulations letter to a groundskeeper after 22 years
A retirement congratulations letter from an employer has two jobs: to thank someone specifically for what they did, and to confirm the practical arrangements for their last weeks. This one names a groundskeeper's three biggest contributions in numbers, then sets out his final day, final pay and farewell in a short table and a callout.
Want the steps in the builder? Read Create a document with AI, then Send a document for signature. For everything this generator can do, see the document maker.
Written and checked by the OneCraft team. Last checked .