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