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Free return to work plan
Free return to work plan (PDF-ready). Set suitable duties, restrictions, review dates and stakeholders for an injured worker's recovery.
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15 checks · 3 sections · Sign-off
15 checks
The fields in the printable form, in a view that fits your screen.
- Worker name
- Position / department
- Supervisor
- Claim no. / insurer
- Treating doctor
- Certificate dates
- Return to work coordinator
- Plan start date
MEDICAL CAPACITY AND RESTRICTIONS
SUITABLE DUTIES
SUPPORT, HOURS AND REVIEW
Declaration & Sign-Off
I confirm that all items have been inspected/completed as indicated above. Any defects or concerns have been noted and reported.
Completed By
Printed name · Signature · Date
Reviewed / Approved By
Printed name · Signature · Date
The MapTrack return to work plan contains 15 checks across 3 sections.
Co-Founder & Commercial Director
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Key takeaways
- The MapTrack return to work plan contains 15 checks across 3 sections. Sections covered: MEDICAL CAPACITY AND RESTRICTIONS, SUITABLE DUTIES, SUPPORT, HOURS AND REVIEW.
- Worker details: name, position, department, and supervisor
- Injury or illness summary and the date it occurred or was reported
- Claim number and insurer or scheme agent, where a claim exists
What is a return to work plan?
A return to work plan is the agreed document that sets out how an injured or ill worker will safely return to work, including the suitable duties they will do, the medical restrictions they must stay within, the hours and any graduated increase, the review dates, and who is responsible for what. It records the worker's details, the injury and the treating doctor's certificate of capacity, the specific duties the worker can and cannot do, the support and adjustments needed, and the signatures of the worker, employer and, where relevant, the return to work coordinator. It is the practical bridge between a medical certificate and the actual work the person does each day.
Getting an injured worker back to safe, meaningful work early is both good practice and a legal duty. Each Australian state and territory runs its own workers compensation and injury management scheme, and employers generally must provide suitable duties and participate in planning a worker's recovery at work. A clear plan keeps everyone aligned: the worker knows what they can do, the supervisor knows what to allocate, and the treating doctor's restrictions are actually followed on the floor. It also creates the record that the scheme, insurer and regulator expect, showing the employer met its obligation to support the worker's recovery rather than leaving them off work longer than the injury requires.
Learn more about compliance and inspections in MapTrack.
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Benefits of using this return to work plan
- Safe duties: written suitable duties and restrictions keep the worker within their medical capacity on every shift, not just on paper.
- Shared understanding: worker, supervisor and coordinator all sign the same plan, so everyone knows the duties and limits.
- Graduated recovery: staged hours and duties let the worker build back up safely instead of an all-or-nothing return.
- Restriction compliance: mapping the doctor's restrictions to real tasks stops a worker being given duties that breach their certificate.
- Review discipline: scheduled review dates keep the plan current as the worker recovers rather than freezing at the first version.
- Scheme evidence: a documented plan is the record the insurer and regulator expect to show the employer supported the recovery.
- Faster durable return: early, structured return to suitable work is linked to better recovery and lower time lost overall.
What to include in a return to work plan
- Worker details: name, position, department, and supervisor
- Injury or illness summary and the date it occurred or was reported
- Claim number and insurer or scheme agent, where a claim exists
- Treating doctor and current certificate of capacity dates
- Medical restrictions and capacity: what the worker can and cannot do, and for how long
- Suitable duties: the specific tasks the worker will perform within their capacity
- Hours and graduated upgrade plan: days, hours per day, and planned increases
- Support and adjustments: equipment, workspace changes, breaks, or supervision needed
- Review dates and next medical review
- Responsibilities and signatures: worker, supervisor, return to work coordinator, and date
How to use this return to work plan
Confirm capacity from the certificate
Start from the treating doctor's certificate of capacity and record exactly what the worker can and cannot do, for how many hours, and for how long. The plan must be built on the medical restrictions, so do not guess or assume capacity, and do not exceed what the certificate allows even if the worker feels able.
Identify genuine suitable duties
Work with the supervisor to find real, useful duties that fit within the worker's restrictions, not made-up tasks that waste the person's time. Match each duty to the medical capacity, check it does not breach any restriction, and make sure the work is meaningful enough that the worker and the team see the value in it.
Set hours and a graduated upgrade
Agree the starting days and hours and a planned, staged increase toward the worker's pre-injury role where recovery allows. A graduated return lets the worker build capacity safely, so set clear upgrade points tied to review dates rather than expecting a full return on day one or leaving the ramp open-ended.
Agree responsibilities and sign the plan
Record who is responsible for each part of the plan, including the supervisor allocating duties, the coordinator monitoring progress and the worker reporting any problems. Have the worker, supervisor and return to work coordinator sign it, because a plan the worker has agreed to and holds a copy of is far more likely to be followed.
Review, adjust and progress the plan
Set review dates and check progress against them, adjusting duties and hours as the worker recovers or if the medical position changes. Update the plan at each medical review and record the changes, so it always reflects current capacity rather than a version that no longer matches what the worker can safely do.
How often should you complete this form?
Put a return to work plan in place as soon as an injured worker has a certificate of capacity that allows any form of work, including reduced hours or suitable duties. The sooner a safe plan is agreed, the better the recovery outcome tends to be.
Review the plan at regular intervals, commonly every one to two weeks early on and at each medical review, and update it whenever the worker's capacity changes or a new certificate is issued. A plan that is set once and never revisited quickly stops matching the worker's actual recovery, so build the review dates into the plan itself and keep the worker, supervisor and coordinator aligned as it progresses.
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Frequently asked questions
Practical answers about the form, record keeping and using MapTrack.
Workers compensation and injury management are run by each state and territory, so there is no single national scheme and the exact wording differs, but employers generally have a duty to support an injured worker's recovery at work, provide suitable duties where the worker has capacity, and participate in return to work planning. Many schemes require a documented plan once a worker has partial capacity. Check the authority for your jurisdiction, for example WorkCover Queensland, SIRA and icare in NSW, WorkSafe Victoria, ReturnToWorkSA, WorkCover WA, WorkSafe Tasmania, WorkSafe ACT, NT WorkSafe, or Comcare for Commonwealth employers, for the specific obligations and timeframes that apply to you.
Link to this answerReview it regularly, commonly every one to two weeks in the early stages and at each medical review, and update it whenever the worker's capacity changes or a new certificate of capacity is issued. Recovery is not static, so a plan that is agreed once and left unchanged quickly stops matching what the worker can safely do. Building review dates into the plan keeps the duties and hours aligned with current medical advice.
Link to this answerSuitable duties are real, useful tasks an injured worker can do safely within the restrictions on their certificate of capacity. They might be modified versions of the usual role, reduced hours, or different tasks that fit the worker's current capacity. They should be meaningful rather than token make-work, and must stay within the medical restrictions. Good suitable duties keep the worker connected to the workplace and supported while they recover, which tends to improve the outcome.
Link to this answerTypically the injured worker, their supervisor or manager, the employer's return to work coordinator, and the treating doctor whose certificate sets the capacity. Where there is a claim, the insurer or scheme agent is also involved, and a rehabilitation provider may help with more complex cases. The worker should always be part of developing the plan and hold a copy, because a plan agreed with the worker is far more likely to be followed than one imposed on them.
Link to this answerYes, it is completely free. It downloads as a PDF you can keep or print for the worker's file. You do not need a MapTrack account. MapTrack is an asset and equipment tracking platform rather than a case management tool, so use this plan for the injury management itself. If you also need to manage the equipment and adjustments a worker uses, MapTrack tracks assets and their history. Start a free trial or book a demo to see how.
Link to this answerApplicable regulatory standards
This form is a starting point. Check the current requirements that apply to your equipment, work and location. The form alone does not establish compliance.
- State and territory workers compensation and injury management schemes (no national scheme): for example WorkCover Queensland; SIRA and icare (NSW); WorkSafe Victoria; ReturnToWorkSA; WorkCover WA; WorkSafe Tasmania; WorkSafe ACT; NT WorkSafe
- Safety, Rehabilitation and Compensation Act 1988 (Comcare scheme, for Commonwealth employers and licensed self-insurers)
- Model Work Health and Safety (WHS) Act, as enacted in each state and territory (duty to ensure worker health and safety so far as is reasonably practicable); in Victoria, the Occupational Health and Safety Act 2004 (Vic)
- ISO 45001:2018 Occupational health and safety management systems
MapTrack publishes this template. The linked authorities publish their own guidance; they haven't endorsed this form.
The numbers behind this return to work plan
Every figure below is sourced and dated, so you can quote it in a toolbox talk, a budget case or a board paper without having to chase the original report.
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The MapTrack return to work plan contains 15 checks across 3 sections.
- Short attribution
- MapTrack Return to Work Plan, https://www.maptrack.com/templates/return-to-work-plan-template
- Reference list
- MapTrack. (2026). Return to Work Plan [Checklist template]. Retrieved from https://www.maptrack.com/templates/return-to-work-plan-template
Free to reuse with credit under a Creative Commons Attribution 4.0 licence. If you’d rather link straight to it, the page is https://www.maptrack.com/templates/return-to-work-plan-template.
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<div style="max-width:480px;font-family:system-ui,-apple-system,'Segoe UI',Roboto,sans-serif;border:1px solid #E5E7EB;border-radius:12px;padding:20px;background:#ffffff;">
<p style="font-size:12px;font-weight:700;letter-spacing:0.05em;text-transform:uppercase;color:#071D49;margin:0;">Free template</p>
<p style="font-size:18px;font-weight:700;color:#071D49;margin:6px 0 0;">Return to Work Plan</p>
<ul style="margin:12px 0 0;padding-left:18px;color:#374151;font-size:14px;line-height:1.6;">
<li style="margin:4px 0;">Worker details: name, position, department, and supervisor</li>
<li style="margin:4px 0;">Injury or illness summary and the date it occurred or was reported</li>
<li style="margin:4px 0;">Claim number and insurer or scheme agent, where a claim exists</li>
<li style="margin:4px 0;">Treating doctor and current certificate of capacity dates</li>
<li style="margin:4px 0;">Medical restrictions and capacity: what the worker can and cannot do, and for how long</li>
<li style="margin:4px 0;">Suitable duties: the specific tasks the worker will perform within their capacity</li>
</ul>
<p style="font-size:13px;color:#6B7280;margin:14px 0 0;padding-top:12px;border-top:1px solid #E5E7EB;">Free <a href="https://www.maptrack.com/templates/return-to-work-plan-template" style="color:#071D49;font-weight:600;text-decoration:none;">Return to Work Plan</a> by MapTrack</p>
</div>Free to reuse, including commercially. This template is published under a Creative Commons Attribution 4.0 licence. Copy it, adapt it, put it on your own site or in your own docs. All we ask is that you credit MapTrack with a link back to this page. The snippet above already includes that credit, so if you use it as-is you’re covered.
About the author
Co-Founder & Commercial Director
Jarrod has spent over a decade in technology consulting and asset management, including roles at Accenture (mining and heavy industry) and CGI as an Asset Management Consultant. He co-founded MapTrack and built and scaled its original platform, then rebuilt it with Lachlan and Alex from thousands of customer conversations and 300+ user research sessions with field teams. His consulting background gives him deep insight into the operational and compliance challenges facing asset-intensive Australian businesses.
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