ACC7430 SAW Initial/Progress Report

**ACC7430** **Stay at Work – Initial and Progress Report** "A Stay at Work (SAW) provider completes this form to update ACC on a client's progress towards returning to their pre-injury work." "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): **Date of this report:** 20/05/2026 **2. Client details** **Client name:** John Smith **Claim number:** ACC000-TESTCLAIM-07 **Date of injury:** 05/05/2026 **Client email:** john.smith@example.co.nz **3. 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 **4. Overall objectives** [ ] Same job, same employer [x] Modified job, same employer [ ] New job, same employer [ ] Other **Comment:** The client will return on a modified basis with wrist restrictions and reduced hours before progressing towards his full pre-injury duties. **5. Relevant contacts involved in the client's rehabilitation** | Name of person | Role | Email | Phone | Date of contact | | --- | --- | --- | --- | --- | | Dr John Watson | GP | - | - | 18/05/2026 | | Mary Jane Watson | Employer / HR Manager | mj.watson@example.co.nz | 03 555 0733 | 18/05/2026 | **6. Initial assessment** **Date of initial assessment:** 18/05/2026 **Return to work target date on referral:** 01/06/2026 **Return to work target date following assessment:** 15/06/2026 **Clinical reason for the new target date:** The target date was extended by two weeks to allow for a wrist splint fitting and an ergonomic workstation assessment before the client begins modified duties. **Return to Work Plan:** | Dates | Days to work | Hours per day | Work tasks | Details of restrictions and rehabilitation | | --- | --- | --- | --- | --- | | 20/05/2026 to 15/06/2026 | Monday to Friday | 4 | Light administrative duties, no repetitive typing or filing | No lifting over 2kg; no repetitive wrist movements | **Assessment summary of the client and the workplace** **Brief injury history and functional presentation** The client sustained a wrist sprain following a fall at work on 05/05/2026, presenting with reduced grip strength and reduced range of motion in the affected wrist. **Physical Function:** Limited wrist dorsiflexion and reduced grip strength on the affected side, with pain on repetitive gripping tasks. **Orebro score:** 38. This score is below the threshold of 50, indicating a lower estimated risk of future work disability at this stage. **Medication:** Ibuprofen, taken as needed for pain. **Pain:** Intermittent aching pain in the wrist, worse with gripping and repetitive tasks. **Sleep:** Mildly disrupted due to occasional discomfort, but not significantly impacting overall sleep quality. **Transport:** The client drives independently and reported no transport-related barriers. **Activities of Daily Living (ADLs):** The client is largely independent with daily activities, with some difficulty performing heavier lifting tasks at home. **Psychosocial factors:** The client is motivated to return to work and has a supportive employer willing to accommodate modified duties. **Medical certificate status** The client currently holds a partial capacity certificate. **Pre-injury role title** Administrative Assistant **Normal working hours/days** Monday to Friday, 8:00am to 4:30pm (40 hours per week) **Work tasks of the role** Data entry, filing, answering phones, and general computer-based administrative tasks. **Physical and cognitive demands of the role** Repetitive typing and mouse use, with occasional filing tasks requiring grip strength. **Barriers and opportunities identified at assessment** Barriers in engaging in the return to work programme or achieving a return to work: Repetitive computer-based tasks, particularly typing, are likely to aggravate the client's wrist symptoms if resumed at full duty too quickly. Opportunities to address these barriers and achieve a successful outcome: An ergonomic keyboard and mouse setup, combined with a gradual increase in typing duration, is expected to support a safe return to full administrative duties. **7. Activities to help achieve the overall objective and address any identified barriers** | List of initial activities | Proposed completion date of the activity | Detail the outcome of activity and how this will achieve the overall objective | | --- | --- | --- | | Wrist splint fitting | 20/05/2026 | Provides support during early return to modified duties | | Ergonomic workstation assessment | 25/05/2026 | Reduces repetitive strain on the wrist during typing tasks | | Graduated increase in working hours | 15/06/2026 | Builds tolerance towards full pre-injury hours | **Is a Work Specific Functional Rehabilitation required as part of this service?** [x] Yes [ ] No **If yes, provide the reason the programme is required:** The client's role requires repetitive typing and data entry, so a work-specific functional rehabilitation programme is needed to rebuild his tolerance for these tasks before returning to full duties. _"If yes, complete the table below"_ | Work Task | Client's current ability to undertake the task | Specific functional activities to be undertaken | | --- | --- | --- | | Typing / data entry | Limited; currently tolerates approximately 15 minutes before discomfort | Graded typing tolerance-building exercises, wrist stretches, and trial of ergonomic equipment | **8. Progress report** **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:** Peter Parker **Provider discipline:** Occupational Health Nurse **Signature:** **Date:** 20/05/2026 "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](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 6 – Orebro score: the score of 38 and its "below 50" interpretation were reconstructed for this fictional example rather than taken from an administered questionnaire; verify against the client's actual completed Orebro form. [ ] Section 6 – Clinical reason for new target date: the two-week extension rationale (splint fitting and ergonomic assessment) is a reasonable inference from the activities listed in section 7 rather than an explicit quoted clinical statement; confirm wording against the assessment note. [ ] Section 8 – Progress report: correctly left blank, as this is an Initial report per section 1; confirm no progress content was intended for this submission.