ACC7431 Back to Work - initial and progress report

ACC 7431 Back to Work – Initial and Progress Report A Back to Work (BTW) provider completes this form to update ACC on a client's progress towards their return-to-work rehabilitation. Submit this form to the ACC contact person or claims@acc.co.nz 1. Report stage [x] Initial — Complete sections 1 to 7 and sign section 9 [ ] Progress (number): — Additionally complete section 8 and sign section 9. Only the current progress report is required. Date of this report: 22/05/2026 2. Client details Client name: Owen Murray Claim number: 10082147 Date of injury: 22/09/2025 3. Supplier Contact details Supplier company name: Southern Vocational Rehabilitation Services Service Delivery Company name: Southern Vocational Rehabilitation Services Lead Provider name: Aroha Tane Lead Provider phone: 03 477 8821 Lead Provider email address: a.tane@svrs.co.nz 4. Overall objectives What is the overall objective specified in the referral? You may tick more than one [x] Regain fitness for Pre-injury Work Role Please also complete section 6a [x] Work readiness for Vocational independence (VI) Please also complete section 6b [ ] Obtain employment [ ] Other Comment: Owen would like to return to his pre-injury role as a chainsaw operator and forestry contractor. The clinical team supports a parallel pathway: exploring vocational independence options should the demands of forestry prove unsustainable following his ACL reconstruction and lateral meniscectomy. The final pathway will be determined at the 12 week functional re-evaluation. 5. Relevant contacts involved in the client's rehabilitation Name of personRoleEmailPhoneDate of contactMr Henry WilsonOrthopaedic Surgeonh.wilson@otagosurg.co.nz03 477 556330/09/2025Dr Pita NgataGeneral Practitionerp.ngata@silverpinemed.co.nz03 466 291214/05/2026Karen MurraySpouse and Support Person-027 521 449812/05/2026Aroha TaneLead Provider, Vocational Rehabilitation Consultanta.tane@svrs.co.nz03 477 882112/05/2026 6. Initial assessment Date of initial assessment: 12/05/2026 Outcome target date on referral: 30/09/2026 Outcome target date following assessment: 30/09/2026 If applicable, the reason for the new target date: <u>Assessment summary of the Client</u> Brief injury history Owen sustained a right knee injury on 22/09/2025 while operating a chainsaw in steep terrain in the Catlins forestry block. He slipped on a wet log and fell; full PPE was intact and there was no chainsaw laceration. MRI on 26/09/2025 confirmed an ACL rupture, lateral meniscal tear, and a Grade II MCL sprain. He underwent arthroscopic ACL reconstruction (hamstring autograft) and lateral partial meniscectomy on 30/09/2025 under Mr Henry Wilson at Otago Orthopaedic Surgery. Post-operative recovery has been slower than anticipated, with persistent effusion and quadriceps inhibition requiring an additional two months of structured physiotherapy before weight-bearing strengthening commenced. Functional presentation / limitations Now 8 months post-surgery. Owen walks on level ground for 30 to 40 minutes without significant symptoms. Stair tolerance is limited; he descends one step at a time. Pain on prolonged standing beyond 2 hours. Reduced confidence with uneven terrain and steep slopes. Right quadriceps strength is approximately 70% of the left on manual muscle testing. Single leg hop test at 60% of the unaffected side. Unable to kneel for sustained periods or squat below 90 degrees of knee flexion without discomfort. KOOS (Knee injury and Osteoarthritis Outcome Score) sport and recreation subscale: 38/100. Medical certificate status Currently on a fully unfit medical certificate from his GP, Dr Pita Ngata, last reviewed 14/05/2026 and due for re-review 14/07/2026. Biopsychosocial, cultural, and other factors (including barriers) Owen is the family's primary income earner and his wife Karen works part-time, creating financial pressure from the extended time off work. He has a strong cultural connection to the land and the forestry community in Southland; his identity is closely tied to outdoor manual work. With 28 years of forestry experience and limited formal qualifications outside trade certifications, transitioning to a different industry would be a significant adjustment. At 52, Owen is openly considering whether forestry remains realistic given his current knee restrictions. He reports some low mood, attributed to inactivity and a sense of lost identity, and is not currently engaged with psychological support but is open to it. He has a supportive whānau and forestry community network. 6a. Pre-Injury Work Role Please complete this section if the objective includes regaining fitness for the pre-injury role Has an assessment of the Client's pre-injury work role been completed previously? [ ] Yes — SAW or WSA Report Date: [x] No Please complete the pre-injury role assessment below Pre-injury role title Forestry contractor and chainsaw operator (self-employed under contract to Southern Forestry Operations). Pre-injury role normal working hours/days 50 to 55 hours per week, 5 to 6 days, typically 6:30am to 4:30pm, with seasonal variation. Pre-injury role work tasks Felling mature plantation trees with chainsaw; limbing and bucking logs; setting chokers for logging; operating ground-based felling equipment; minor machinery maintenance; on-site safety supervision; assisting hauler operations on steep terrain; truck loading; daily PPE checks and tool sharpening. Pre-injury role physical and cognitive demands Sustained standing, walking, and climbing on uneven and steep terrain; carrying a chainsaw (8 to 10 kg) for extended periods; frequent kneeling, squatting, and crouching; repetitive lifting of logs and tools up to 30 kg; sustained shoulder and trunk endurance; high-vigilance terrain hazard assessment; rapid decision-making in a high-risk environment; precise hand-eye coordination for chainsaw operation; weather tolerance; team communication on noisy sites. What rehabilitation does the Client require to regain fitness for this role? Owen requires a structured, work-specific functional rehabilitation programme focused on rebuilding lower limb strength (particularly quadriceps), single-leg control, balance and proprioception on uneven surfaces, and progressive load tolerance for kneeling, squatting, and load carriage. A graded re-introduction to terrain-based functional tasks is essential to confirm whether the right knee can sustain the demands of full forestry work. Concurrent attention to mood and identity-related concerns is recommended. Estimated programme duration is 16 weeks, with a 12 week functional re-evaluation to determine continuation of the pre-injury pathway or transition to vocational independence. 6b. Work readiness for Vocational independence (VI) Please complete this section if the objective includes achieving work readiness for VI Has an IOA/IMA been completed? [ ] Yes [x] No If no, is an IOA/IMA recommended? i.e. the outcome is unlikely to be regaining fitness for the pre-injury role [x] Yes [ ] No Other non-specific rehabilitation required, or barriers to be addressed, to achieve work readiness: Cardiovascular reconditioning following 8 months of significantly reduced activity Psychological support for adjustment, identity, and mood concerns Career counselling and skills mapping in the event the VI pathway becomes necessary Computer and basic administrative skill development if a transition to office-based or supervisory roles within the forestry sector is being considered Exploration of transferable skills (site safety, training, mentoring of newer operators) that could open lower-physical-demand roles within forestry 7. Activities to help achieve the overall objective List of proposed activities to meet the rehabilitation requirements as listed in 6a and/or 6bProposed completion date of the activityLower limb strengthening and proprioception programme (physiotherapy 2/week)14/08/2026Functional terrain progression programme (graded exposure to slopes, uneven ground, kneeling tasks)28/08/2026Work specific functional rehabilitation including chainsaw simulation and load carriage28/08/2026Cardiovascular reconditioning (cycling, swimming, walking programme)30/06/2026Psychological support referral and initial engagement21/06/2026Career counselling and skills mapping session (contingency for VI pathway)30/06/2026IOA/IMA initiation as a parallel contingency30/06/202612 week functional re-evaluation and pathway decision04/08/2026 Is a Work Specific Functional Rehabilitation required as part of this service? [x] Yes [ ] No If yes, provide the reason for why programme is required: Owen's pre-injury role as a forestry contractor involves high-risk, terrain-specific physical demands (sustained kneeling, squatting, load carriage on slopes, and chainsaw operation) that cannot be adequately replicated or assessed within standard gym-based rehabilitation. A Work Specific Functional Rehabilitation programme is required to safely progress and objectively assess his readiness to return to forestry work, and to confirm the appropriate pathway at the 12 week functional re-evaluation. 9. Provider declaration and signature I declare the information provided by me on this form is, to the best of my knowledge, accurate and complete. Provider name: Aroha Tane Provider discipline: Vocational Rehabilitation Consultant (Occupational Therapist) Signature: Date: 22/05/2026 When we collect, use and store information, we comply with the Privacy Act 2020 and the Health Information Privacy Code 2020. For further details see ACC's privacy policy, available at www.acc.co.nz. We use the information collected on this form to fulfil the requirements of the Accident Compensation Act 2001. Items for Clinician Review Section 6, KOOS sport and recreation subscale: stated verbally as "thirty-eight out of one hundred"; verify 38/100 matches Owen's documented KOOS questionnaire result rather than a clinical estimate. Section 6a, Pre-injury normal working hours: stated as "around 50 to 55 hours per week"; confirm the exact contracted hours with Owen's forestry contracting agreement before submission.