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:** John Smith **Claim number:** ACC000-TESTCLAIM-07 **Date of injury:** 05/05/2026 **2. Supplier Contact details** **Supplier company name:** Daily Bugle Occupational Health Services **Service Delivery Company name:** Daily Bugle Occupational Health Services **Lead Provider name:** Peter Parker **Lead Provider email address:** peter.parker@dailybugleoh.co.nz **Lead Provider discipline:** Occupational Health Nurse **Lead Provider phone:** 03 555 0620 **3. Completion report** | Result | Expected result achieved | Hrs per week | Completion date - please note if achieved or expected | | --- | --- | --- | --- | | Same job, same employer | [x] Yes [ ] No | 40 | 20/10/2026 [x] Achieved [ ] Expected | | Modified job, same employer | [x] Yes [ ] No | 20 | 15/08/2026 [x] Achieved [ ] Expected | | New job, same employer | - | - | - | **Has the client received medical clearance to return to work?** _"Please attach a copy of the medical clearance certification"_ [x] Yes [ ] No **Does this client need any more assistance from ACC?** [ ] Yes [x] No | Please list all activities completed to support vocational rehabilitation | Date completed | | --- | --- | | Graduated increase in working hours, from 20 to 40 hours per week | 20/10/2026 | | Ergonomic wrist splint fitting and workstation assessment | 20/05/2026 | | On-the-job wrist strengthening exercises | 20/10/2026 | **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: Peter Parker Provider discipline: Occupational Health Nurse Signature: Date: 20/10/2026 "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](https://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 3 – Completion report: "Modified job, same employer" was marked as achieved on 15/08/2026 as an interim step before "Same job, same employer" was achieved on 20/10/2026; confirm this two-stage progression is accurately captured rather than a single outcome. [ ] Section 3 – Activities table: the ergonomic wrist splint fitting and workstation assessment date (20/05/2026) was placed early in the timeline as a reasonable inference from the injury date (05/05/2026); confirm the exact date if available.