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Rehabilitation program (SRC40)


This form is used to document the agreed rehabilitation program for an injured or ill employee. This includes, overall goal(s) (for example—to achieve an early, safe and durable return to work), consultation with key stakeholders, responsibilities for key stakeholders, actions and expected outcomes and, critical dates and costs.

Available formats

Below is a completed sample of this form.

Last updated: June 2018

If you would like to request this publication in a different format to what is available for download (above), or the publication is not currently available for download, please refer to:

Page last updated: 17 Feb 2020