ACC7983 Stay at Work completion report

ACC7983 Stay at Work – Completion Report A Stay at Work (SAW) provider completes and submits this form to ACC on the date the client is discharged from the SAW programme. Submit this form to the ACC contact person or claims@acc.co.nz 1. Client details Client name: Aisha Patel Claim number: 10054321 Date of injury: 12/03/2026 2. Supplier Contact details Supplier company name: WorkAble NZ Vocational Rehabilitation Service Delivery Company name: WorkAble NZ Vocational Rehabilitation Lead Provider name: Emma Walsh Lead Provider email address: e.walsh@workablenz.co.nz Lead Provider discipline: Physiotherapist Lead Provider phone: 09 442 3187 3. Completion report ResultExpected result achievedHrs per weekCompletion date - please note if achieved or expectedSame job, same employer[x] Yes [ ] No3222/05/2026 [x] Achieved [ ] ExpectedModified job, same employer[ ] Yes [ ] No--New job, same employer[ ] Yes [ ] No-- Has the client received medical clearance to return to work? Please attach a copy of the medical clearance certification [x] Yes [ ] No If the client has not returned to their pre-injury work tasks, what are the reasons? Does this client need any more assistance from ACC? [ ] Yes [x] No If yes, what help is required? Please list all activities completed to support vocational rehabilitationDate completedInitial vocational assessment and workplace observation17/03/2026Workplace modifications agreed with employer (no overhead lifting and no repetitive reaching for the first 4 weeks)24/03/2026Graduated return to work plan implemented (4 hrs/day, 3 days/week)30/03/2026Worksite ergonomic assessment06/04/2026Mid-programme review with employer and client21/04/2026Progression to 6 hrs/day, 5 days/week05/05/2026Return to full pre-injury duties (32 hrs/week)19/05/2026Final review and discharge from SAW programme22/05/2026 4. 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: Emma Walsh Provider discipline: Physiotherapist 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 as "around mid-March" in the audio rather than an explicit date; verify 12/03/2026 against the claim record before submission. Section 3, Pre-injury hours: confirm 32 hrs/week reflects Aisha's contracted pre-injury schedule and not a recently varied roster.