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Developing an Action Plan

Action plan


My activity goals (for example, I want to be able to do the dishes, go to the movies, take part in a social event etc)


I have difficulty with the following activities


While I am getting better, I can make these activities easier by


As I build myself back up to my usual activity level, I will make myself more comfortable by doing the following things (for example, listening to music to relax, sleeping with a pillow under my legs, walking 20 minutes a day etc)


I will measure my progress by


Fill this section in two weeks later:

I have made the following improvements and progress in building up to my usual activities



My return to work plan


Parts of my job I can still do


Parts of my job I may have difficulty with


Ways I can get around these difficulties


Things I need to talk to my line manager or colleagues about


Other problems at work that I need to deal with, how I can solve them and who I need to talk to about them


Things I enjoy about my work

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