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Real Estate Agent : Return to Work Checklist and Plan
Please complete with your patient
Worker name:
_____________________ Claim number:______________ Injury: _____________________
Worker will be able to participate in the duties as below from: / / to / /
Full time Part time ______hours per day _____days/week
N.B. Based on your information, a suitable duties plan will be established at the worker's place of
employment. In the absence of task availability at their usual workplace the worker will continue to be paid
weekly compensation and WorkCover will source suitable alternative workplace rehabilitation with a host
employer.
Please consider the “health benefits of good work” and focus on what your patient can do.
Tick if
suitable
Job Tasks Limitations/Comments
Accepting and listing properties and businesses for sale and lease,
conducting inspections, and advising buyers on the merits of
properties and businesses and the terms of sale or lease
Advising vendors of sales and marketing options such as sale by
auction and open house inspections
Cataloguing and detailing land, buildings and businesses for sale
or lease and arranging advertising
Assessing buyers' needs and locating properties and businesses
for their consideration
Offering valuations and advice for buying and selling properties
and businesses, and structuring the terms of settlement
Collecting and holding rent monies from tenants, and remitting to
owner on agreed basis
Monitoring and addressing non-compliance with terms and
conditions of tenancy and pursuing rental arrears
Developing and implementing business plans, budgets, policies
and procedures for the agency
May arrange finance, land brokerage, conveyancing and
maintenance of premises
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Worker name:
_____________________ Claim number:______________ Injury: _____________________
If none of the above tasks or alternate duties are appropriate at this time, please advise a review date or
timeframe to some form of return to work ___________________________________ / _____ / _____
Please tick here if you have been unable to identify any tasks and you would prefer an allied health
provider to help implement a return to work plan.
Other comments:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
SIGNATURES
Treating Medical Practitioner: __________________________________________ / _____ / _____
Worker: __________________________________________ / _____ / _____
Employer: __________________________________________ / _____ / _____
Submission and payment for this form (WorkCover Queensland claims only)
If this form is requested as part of a workers' compensation claim, please forward this completed form via our
online services, or alternatively by faxing to 1300 651 387. You can charge for a "completed form" under the
relevant table of costs, found on our website worksafe.qld.gov.au
. This form will become part of a claim file
and may therefore be read by claims staff, WorkCover Queensland’s network of advisory doctors, specialists
at the Medical Assessment Tribunal or during legal proceedings.
In addition, the form that you provide may be released to another person (usually the worker or employer)
under the Right to Information Act (2009), the workers’ compensation legislation or as authorised or required
by law.
