Belte r r a Cor p or at ion S afety M an ual D oc I D C H S M BE L 2 0 1 7 Pa g e 4 73 of 53 8 I N JU R Y M A N A GE M EN T R ET U R N T O W OR K B R A N C H M A N A GER I M R T W C OOR D I N A T O R C H EC K L I ST Doc u m e n t Identif icat ion F R M 020C P age Nu m b e r 1 of 1 Doc u m e n t C r e ation Dat e J une 30 2014 Im p le m e n tat ion Dat e S e ptembe r 1 2 014 I NJ URY MAN AG EM E NT R ETU R N T O W ORK B ra n c h Ma na ge r or De sig n a te C he c kli st T he f ol l ow i ng i s a che c k l i st o f du t i es t he B r an ch M an ag e r o r de si g na t e is r esp on si bl e f or w i t hi n t he I nj u r y M an ag ement R e t urn t o W o r k pro gram 91 O n g oi ng O v ersee s con t r ol o f t he di r ectio n o f I M R T W pro gram S up po r t I M R T W an d en sure i t i s be i n g ad m i ni st e r ed an d en f o r ced i n al l ar ea s R esp on si bl e f or t he da y t o day ad m i ni st r a t i on o f I M R T W pro gra m E nsu r e al l pe r t i ne nt W C B cl ai m s r ep or t s a r e sub m i t t ed t o t he co r po r a t e o f f i ce as r e q ui r ed E nsu r e supe r v i sors are gi v en t he r eso u r ces a nd t i m e t o p r ep are t he P hy si cal D emand An al y si s o f po si t i on s r el ated t o t he i n j ury S up po r t an d pa r t i ci pa t e i n I M R T W se m i na r s or t r ai ni ng s 92 A t T i m e o f I n ci de nt R esp on si bl e f or t he da y t o day ad m i ni st r a t i on o f I M R T W pro gra m Le ad t he i nv estig atio n an d coor pe r ate w i t h Co r po r ate H S de pa r t m en t i n c on du ct i ng a t ho r ou g h i nv estig atio n Fo l l o w s up w ee k l y w i t h an i nj ured w ork e r w hi l e on l ea v e and r eco r d on I nj ury C omm un i ca t i on Lo g E nsu r e al l pe r t i ne nt W C B cl ai m s r ep or t s a r e sub m i t t ed t o t he co r po r a t e o f f i ce as r e q ui r ed 93 R etur n T o W o r k Fo r i nj u r i es w i t h m od i f i ed du t i es U si n g t he P hy si cian P hy s i ca l A ss es sm en t R ep or t an d t he S up erv i sors pr ep ared R eturn t o Work P l an c r e ate t he O f f er Le t t er of S uit ab l e Emp l oy men t an d o f f e r i t t o t he i nj u r ed w or k e r I f t he w ork e r acc ep t s t he o f f er D esi g n Re t urn t o W o r k P l an w i t h t he i nj u r ed w or kers i np ut W o r ke r r etu r ns t o w or k o n li g ht m od i f i ed du t i es I n f o r m an d f orw ard do cu m en t s t o I M R T W C oo r di na t or Fo l l o w s up w ee k l y w i t h an i nj ured w ork e r on ce t h ey r etur n t o w ork on a m od i f i ed w or k p r o g r a m an d r eco r ds on an I nj u r y C omm un i ca t i on Lo g