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    Services Requested (Enter total hours approved in relevant boxes below)

    *(Travel funding not included)

    Initial Needs Assessment

    6 hours

    Medical case conference

    1 hour

    Workplace Assessment

    4.5 hours – standard report

    6 hours - If report is to include background information (symptoms, function, treatment, treater contact)

    Development of graded Return to Work Plan

    1 hour per new plan (not a revision)

    Vocational Assessment

    6 hours for base report

    8 hours - If report is to include an in depth labour market

    Vocational counselling

    5 hours

    Ergonomic Assessment

    3 hours

    Functional Capacity Evaluation

    5 hours

    Employability Assessment (TPD)

    10 hours for desk-based assessment

    12 hours for telehealth or in- person interview

    Transferable Skills Assessment (TPD)

    6 hours

    12 hours – including labour market research including labour market contacts

    Comparative Task Analysis

    6 hours

    7 hours – including Set up and interview (with customer or another business)

    ADL Assessment (TPD)

    7 hours for PADLs

    8 hours for Home duties

    Exercise Physiology Initial Assessment

    3.5 hours

    Travel Hours Approved


    Additional Funding (Hours) Approved


    TOTAL SERVICE HOURS

    TOTAL APPROVED FEES

    *(Hourly rate calculated at $224.70 INC GST)

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