ACC7980 Back to Work completion report

ACC 7980 Back to Work – Completion Report A Back to Work (BTW) provider completes and submits this form to ACC on the date the client is discharged from the BTW programme. Submit this form to the ACC contact person or claims@acc.co.nz 1. Client details Client name: David Park Claim number: 10067890 Date of injury: 15/09/2025 2. Supplier Contact details Supplier company name: Pathways Rehabilitation Services Service Delivery Company name: Pathways Rehabilitation Services Lead Provider name: Liam Brennan Lead Provider phone: 03 379 4521 Lead Provider email address: l.brennan@pathwaysrehab.co.nz 3. Completion Outcome OutcomeOutcome AchievedRehabilitation complete for the pre-injury role and this role is now considered sustainable[ ]The client is considered work ready for vocational independence[x]Obtained employment[ ]No outcome achieved[ ] Pre-Injury role: Hours per week: Job Type/Role: Other details: 4. Rehabilitation Confirm the rehabilitation completed to achieve and confirm the outcome above Include the vocational training and rehabilitation provided to the client and the date it was completed. Also include any previously recommended vocational training and rehab not provided and the reason why David completed a comprehensive Back to Work programme over eight months following an ACL reconstruction and partial medial meniscectomy on 22/09/2025. Rehabilitation included structured physiotherapy with progressive strengthening and proprioception work (06/10/2025 to 14/03/2026), pool-based therapy (12/12/2025 to 28/02/2026), gradual return to functional weight-bearing activities, a work conditioning programme (15/03/2026 to 30/04/2026), and vocational counselling with occupational therapy (commenced 04/04/2026, completed 12/05/2026). The Initial Occupational Assessment (IOA) was completed on 18/04/2026 and the Initial Medical Assessment (IMA) was completed on 25/04/2026. David has made substantial recovery but is unable to return to his pre-injury role as a construction labourer due to permanent restrictions on heavy lifting above 15 kg, prolonged kneeling, ladder and scaffold work, and sustained working at heights. CV development, vocational counselling, and transferable skills mapping have been provided. No previously recommended vocational training or rehabilitation was withheld. List the work types from the IOA/IMA that the client is now considered work ready for Construction site supervisor Traffic management controller (Level 2) Building project administrator Quantity surveying assistant Construction health and safety officer List any additional work types (not from the IOA/IMA) that you have identified and consider the client is work ready for Tool and equipment hire counter supervisor Site security supervisor (light duties) Building materials sales representative List any work types assessed as medically sustainable (or likely to be) in the IMA that the Client is not considered work ready for Site foreman with hands-on physical involvement: medically sustainable per the IMA, but David lacks the current technical qualifications and trade certification required for the foreman scope; would require further training before being considered work ready. If no outcome was achieved, please give details as to why (including any partially achieved outcomes): Does this client require any more assistance from ACC? [x] Yes [ ] No If yes, what assistance is required? David would benefit from referral to ACC's Job Search and Vocational Placement support to transition from work-ready status into sustained employment. Recommended supports include CV refinement, interview preparation, employer engagement within the construction sector, and ongoing case management until employment is secured. Consideration of a short upskilling course in site supervision (e.g. Site Safe Supervisor Gold Card) would significantly broaden David's employability. Any additional comments: David has demonstrated excellent motivation and engagement throughout the BTW programme. His 22 years of construction experience and strong health and safety awareness position him well for supervisory and administrative roles within the sector. Recommend follow-up at 3 months post-employment to confirm role sustainability and address any emerging issues. 5. 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: Liam Brennan 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 1, Date of injury: stated verbally as "September last year" rather than an explicit date; verify 15/09/2025 against the claim record before submission. Section 4, IMA completion date: IMA reportedly completed "late April" in the audio; confirm 25/04/2026 matches the actual date on the IMA report.