HomeMy WebLinkAboutPR 572 HR - Disability Support Program
1 PR.572.HR
PROCEDURE PR.572.HR
TITLE: DISABILITY SUPPORT PROGRAM – INDIVIDUAL ACCOMMODATION
PLANS
Date issued: 01 April 2014
Last revised: 14 November 2017
Authorization: Senior Staff: 01 April 2014
1.0 OBJECTIVE
To outline the Ottawa-Carleton District School Board’s proactive and supportive Disability
Support Program which ensures that employees with disabilities are provided with safe,
medically supported and appropriate work-related accommodations.
2.0 DEFINITIONS
In this procedure,
1. Accommodation refers to using all reasonable efforts to prevent and remove barriers
that impede individuals with disabilities from participating fully as employees of the
District. Accommodation involves three principles:
(a) respect for dignity;
(b) individual accommodation; and
(c) inclusion and full participation.
2. Barrier refers to anything that prevents a person with a disability from fully participating in
all aspects of the workplace because of his/her disability. This includes, but is not limited
to, a physical barrier, an architectural barrier, information or communications barrier, an
attitudinal barrier, a technological barrier, a policy, procedure or a practice.
3. Cognitive Abilities refers to a description of an employee’s mental processes and may
include a listing of any restrictions. This is normally provided by a health professional.
4. Disability means:
(a) any degree of physical disability, infirmity, malformation or disfigurement that is
caused by bodily injury, birth defect or illness and, without limiting the generality of
the foregoing, includes diabetes mellitus, epilepsy, a brain injury, any degree of
paralysis, amputation, lack of physical co-ordination, blindness or visual
impairment, deafness or hearing impediment, muteness or speech impediment or
physical reliance on a guide dog or other animal or on a wheelchair or other
remedial appliance or device;
(b) a condition of mental impairment or a developmental disability;
2 PR.572.HR
(c) a learning disability, or dysfunction in one or more of the processes involved in
understanding or using symbols or spoken language;
(d) a mental disorder; or
(e) an injury or disability for which benefits were claimed or received under the
insurance plan established under the Workplace Safety and Insurance Act, 1997.
The definition includes disabilities of different severity, visible as well as non-visible
disabilities, and disabilities the effects of which may come and go.
5. District means the Ottawa-Carleton District School Board (OCDSB).
6. Essential Duties means the duties necessary to produce the actual job outcome. The
job outcome is the production or provision of the final product or service required. The
overall objective of the position constitutes job outcome. In determining essential duties
of a position, consideration should be given to:
(a) how often each duty is undertaken;
(b) the proportion of time spent at each specific duty; and
(c) the contents of any current and relevant job posting.
7. Functional Abilities means a description of what an employee can physically do and
may include a listing of any physical restrictions. This is normally provided by a health
professional.
8. Health Professional means health care providers regulated under the Regulated Health
Professionals Act including, but not limited to, physician (including specialist or
surgeons), chiropractor, physiotherapist, occupational therapist, psychologist, audiologist,
dentist, and other health professionals, as applicable.
9. Individual Accommodation Plan (IAP) means a written plan developed cooperatively
by the employer and the employee who is seeking accommodations that specifies any
physical or cognitive restrictions associated with the disability, and the nature of any
accommodations or modifications that will be put in place at the employee’s work site, or
in the work itself.
10. Maximum Medical Recovery (MMR) means the point at which an employee has
reached a plateau in his or her recovery at which time it is unlikely that there will be any
further significant improvement in his or her medical impairment as determined by a
Health Professional.
11. Physical/Cognitive Demands Analysis (PDA/CDA) means the process by which job
tasks are analyzed to understand the physical, cognitive, and environmental demands of
the job.
12. Service Dog means a working dog trained to the needs of specific, recognized medical
conditions. Such conditions include, but are not limited to autism, epilepsy, post-traumatic
stress disorder (PTSD), and unstable blood sugar levels. However, for the purpose of this
procedure the term “Service Dog” will be assumed to also include guide dogs and
hearing dogs. This does not include companion or therapy animals.
3 PR.572.HR
13. Supervisor means any employee who is responsible for the work of another employee,
including, but not limited to, supervisory officers, principals, and managers.
14. Therapy or Companion animals mean animals selected for traits, such as calmness
and friendliness, that are used to provide love and companionship, or for their calming
effect on their handlers. These animals are NOT approved to accompany students and/or
staff at the OCDSB.
15. Undue Hardship means the legal threshold or limit of the District’s capacity to
accommodate based on an objective assessment of costs, outside sources of funding (if
any), and health and safety considerations.
3.0 RESPONSIBILITY
1. The Human Resources, Recruitment and Staffing Division will be responsible for:
(a) ensuring that job applicants are advised of the process to request
accommodations that may be required during the selection process;
(b) ensuring that all newly hired employees are aware of the District’s Disability
Support Program; and
(c) referring newly hired employees with a disability who may be candidates for the
Disability Support Program to Employee Wellness and Disability Management.
2. The Human Resources, Employee Wellness and Disability Management Division will be
responsible for:
(a) identifying likely candidates for the Disability Support Program;
(b) coordinating the IAP process including the development, implementation and
monitoring of the IAP;
(c) providing support to the employee and the supervisor; and
(d) liaising with the treating health care professionals and, where appropriate,
representatives of the Workplace Safety and Insurance Board (WSIB) and long-
term disability (LTD) insurers.
3. Supervisors will be responsible for:
(a) ensuring that employees are aware of the District’s Disability Support Program;
(b) referring any employee who may be a candidate for the Disability Support
Program to Employee Wellness and Disability Management;
(c) participating and cooperating with Employee Wellness and Disability Management
in the development and implementation of IAPs for employees with disabilities
assigned to work in their school or department;
(d) supporting and implementing accommodation measures in accordance with the
Ontario Human Rights Code and the IAP;
4 PR.572.HR
(e) considering the requirements of an IAP when assessing work performance; and
(f) advising the incoming supervisor of the existence of an IAP for a staff member
when leaving the current work location or department.
4. Employees, who require accommodation either to attend work, remain at work or return
to work, will be responsible for:
(a) informing Employee Wellness and Disability Management of their need for
accommodation;
(b) providing information upon request to assist in the assessment, consideration and
implementation of an IAP;
(c) obtaining medical aid immediately and engaging in medical rehabilitation and/or
treatment that can be expected to assist in a timely return to work or support for
remaining at work;
(d) participating and cooperating in the development of an IAP;
(e) complying with all requirements as outlined in Appendix A: Protocol for the Use of
a Service Dog for an Employee at the OCDSB (if applicable); and
(f) sharing the IAP with a new supervisor in the current work location or department,
or when transferring to a new work location or department.
4.0 PROCEDURES
General Requirements
1. The District will make every reasonable effort, to the point of undue hardship, to
accommodate employees with disabilities by modifying the work and/or workplace to
meet an employee’s medically-supported needs related to a disability. Employee co-
operation, support, and participation are required and essential to the success of the
Disability Support Program.
Requesting Accommodation
2. The District will include information on job postings for prospective job applicants on the
process for requesting accommodations that may be required as part of the selection
process.
3. A copy of this procedure will be provided upon offer of employment to inform new
employees of the Disability Support Program.
4. Upon receipt of an offer of employment, new employees will notify Human Resources
Recruitment and Staffing of a requirement for accommodations related to a disability.
5. Current employees will report promptly to their supervisor all injuries, illnesses and/or
accommodation requirements that may interfere with the employee’s ability to attend
work, return to work, or perform the full range of their duties.
5 PR.572.HR
Development of an Individual Accommodation Plan
6. Candidates for the Disability Support Program will be identified based on information
received from the employee, the employee’s supervisor, Human Resources Recruitment
and Staffing, treating health care professionals and, where appropriate, representatives
of the Workplace Safety and Insurance Board (WSIB) and long-term disability (LTD)
insurers.
7. Employees who are requesting accommodation will provide suitable medical
documentation from the appropriate treating health professional, as determined by
Employee Wellness and Disability Management.
8. At the discretion of Employee Wellness and Disability Management, employees may be
required to participate in a Functional Abilities Evaluation (FAE) and/or an Independent
Medical Evaluation (IME), conducted by a third party health professional, to identif y
limitations and/or restrictions and to assist in the development of an IAP. A PDA/CDA or
job description, if available, may be provided to the health professional for review. Where
functional abilities information is not available, the WSIB Standard Precautions may be
used as a guide for developing an appropriate return to work plan.
9. The IAP will be developed by Employee Wellness and Disability Management in
consultation with the employee and the employee’s supervisor .
10. The IAP will be based on the employee’s functional/cognitive abilities and medically
supported limitations, if required. An IAP may include, but is not restricted to, some or all
of the following accommodations:
(a) reduced or modified work hours;
(b) modification of duties;
(c) workplace modification;
(d) removal of physical barriers; and
(e) reassignment to another available position if the em ployee has the necessary
skills and abilities to perform the essential duties of the new position.
11. The IAP may include the following information:
(a) the names of the parties involved in the development of the plan;
(b) the applicable timeframe, where applicable;
(c) essential duties and tasks of the job;
(d) specific physical requirements or limitations and/or functional/cognitive abilities
and limitations or restrictions of the employee, as outlined in medical
documentation, including the date of relevant medical information ;
(e) work schedule and location(s);
(f) follow-up review date(s) by Employee Wellness and Disability Management, if
applicable;
6 PR.572.HR
(g) schedule for a gradual increase in hours worked and/or gradual return to work
assigned under the Disability Support Program, if applicable;
(h) expected date for completion of the plan, if applicable;
(i) conditions for withdrawal of the employee from the Disability Support Program;
and
(j) signatures of the employee, Employee Wellness and Disability Management
representative, supervisor, and appropriate treating health professional, as
required.
12. In the case of a minor work-related injury that has resulted in temporary disability, and in
consultation with Employee Wellness and Disability Management, the supervisor will
discuss the Disability Support Program with the employee and develop and implement a
temporary IAP.
13. A copy of the written IAP will be distributed to all relevant parties, including the employee
and the employee’s immediate supervisor, and, where applicable, the WSIB and the
employee’s appropriate treating health professional.
Implementation of the Individual Accommodation Plan
14. An outline of the IAP will be provided to the appropriate treating health professional, if
required, with an indication that accommodations and/or modified work are available.
The outline may include information regarding the employee’s job description and a PDA
or CDA.
15. The employee’s work and/or workplace will be modified as set in the IAP prior to the
employee’s commencement of his or her IAP. Modifications may include, but are not
limited to, the following:
(a) assigning appropriate work or duties in accordance with the IAP; and
(b) modifying the physical environment to remove barriers, as set out in the IAP.
16. The employee’s co-workers may be required by the supervisor to assist in an
accommodation, where appropriate.
17. The employee and the employee’s supervisor will comply with the restrictions and
conditions set out in the IAP and ensure that no tasks are being performed other than
those in accordance with the employee’s written IAP.
18. The employee will share the IAP with his or her new supervisor upon transfer to a new
work location or department.
19. The employee will maintain reasonable and regular contact with Employee Wellness and
Disability Management to provide updates on status, changes in condition and to review
progress based on the timetable established in their IAP.
20. Whenever possible, and in accordance with the District’s expectations for all employees,
the employee will schedule medical appointments so that they do not interfere with
established work hours.
7 PR.572.HR
Monitoring the Individual Accommodation Plan
21. The employee’s supervisor and if appropriate, the treating Health Professional, will
monitor the progress of the employee and immediately report any problems or concerns
to Employee Wellness and Disability Management.
22. As required, the employee’s IAP will be reviewed and any necessary adjustments based
upon changes to functional/cognitive abilities or restrictions/limitations will be made to
support the employee’s success. The frequency of these reviews will be established as
part of the development of the IAP, and may be adjusted as necessary.
23. For employees deemed permanently disabled and unable to perform the essential duties
of his or her job, a medical review will be conducted to determine the employee’s ability
to meet the essential duties of an alternative occupation. Employee Wellness and
Disability Management will work with the appropriate workplace parties to find an
available position to the point of undue hardship.
24. The IAP will be closed when the employee has reached maximum medical recovery and
is able to return to full duties without restrictions or limitations.
Communication
25. The District will ensure that all employees are aware of the District’s Disability Support
Program.
5.0 APPENDICIES
Appendix A: Protocol for the Use of a Service Dog for an Employee at the OCDSB
Appendix B: OCDSB 035 Standardized Medical Certificate for ETFO, PVP, Union Exempt
Appendix C: OSSTF Abilities Form
6.0 REFERENCE DOCUMENTS
Accessibility for Ontarians with Disabilities Act, 2005 (AODA)
Regulation 191/11 Integrated Accessibility Standards (AODA regarding service dogs)
Blind Persons Rights Act 2007
Charter of Rights and Freedoms
Human Rights Code
Municipal Freedom of Information and Protection of Privacy Act, 1990
Ontarians with Disabilities Act, 2001
Ontario Human Rights Code, 1990
Personal Health Information Protection Act, 2004, SO, c. 3
Workplace Safety and Insurance Act, 1997
OCDSB Policy P.027.GOV: Corporate Records Management
OCDSB Policy P.121.GOV: Accessibility
OCDSB Policy P.128.GOV: Privacy Policy - Municipal Freedom of Information and Protection of
Privacy Act, 1990
OCDSB Procedure PR.516.GOV: Corporate Records Management
OCDSB Procedure PR.637.HR: Employee Medical Records Management
OCDSB Procedure PR.669.GOV: Privacy Breach
OCDSB Employee Sick Leave Program
Meghan Search and Rescue Standard in Support of Accessibility: Persons with a Disability
Teamed with Service Dogs
Appendix A
Page 1 of 5
PROTOCOL FOR THE USE OF A SERVICE DOG FOR AN
EMPLOYEE AT THE OCDSB
Employees requiring an accommodation at work must first follow the requirements of
OCDSB PR.572.HR: Disability Support Program – Individual Accommodation Plans.
General Principles
These guidelines apply in situations where an employee with a disability requires the
support of a service dog in order to access employment.
The success of the implementation of a service dog into a work setting depends on
clear communication, a well-informed school/work community and careful planning. The
information you provide will assist Employee Wellness and the supervisor to make the
best possible decisions for you, students, staff, volunteers and visitors in the work place.
The information will be filed in your Employee Wellness file.
The use of a service dog is considered to be an accommodation in accordance with
your Individual Accommodation Plan, to prevent and remove barriers that are impeding
your ability to participate fully as an employee of the Board. Requests for companion or
therapy animals will be denied.
The well-being of the dog is very important. Its care, handling and training needs will
be addressed, and your input as a trained handler, is valuable. The supervisor also
needs to know what other resources are available to facilitate the transition to work and
the implementation of the plan. Strategies for becoming familiar with the building and
school grounds, introduction to work routines, assemblies/concerts/meetings, recess,
and informing the staff about interacting with the dog will need to be included in the
planning to be as successful as possible. It is important that you provide the information
that addresses the safety of the students and staff, such as any history of aggressive
behaviour by the dog.
Responsibilities
Employees requesting use of a service dog at work will:
a) fulfill all the requirements for medical documentation under OCDSB
PR.572.HR;
b) provide Employee Wellness with a completed “Request for Service Dog for an
Employee” form (attachment 1);
c) provide Employee Wellness with a letter from a registered service dog
training center stating that a Certified Service Dog has been assigned to work
with you;
i. All service dogs accompanying an employee must be certified
and licensed in Canada.
Page 2 of 5
ii. Training schools for any type of service dog to be used in
OCDSB facilities must either be accredited by the IGDF or ADI
or use the MSAR training standard.
d) provide Employee Wellness with a copy of the service dog’s registration,
training certificate, up-to-date vaccination certificate, and applicable dog
license;
e) provide Employee Wellness and the supervisor with any training records for
the dog that may be requested. The employee will ensure that the service dog
is re-certified on an annual basis, if required, and that the licenses,
vaccinations, and registrations are up to date;
f) provide Employee Wellness with documentation of insurance, as it relates to
the Service Dog, and assumption of all liability related to the dog’s behavior;
g) work with the supervisor to develop a mutually agreed upon plan (Attachment
2: Management Plan for the Care of the Service Dog) that addresses the care
and physical needs of the dog. Service dogs admitted to the workplace
should be day-trained and not need to be fed during work hours;
h) work with the supervisor and Employee Wellness to address any issues and
or changes with the service dog and/or address any potential changes in the
work/workplace routine;
i) assume all duties of the handler ;
j) assume financial responsibility for the dog, including, but not limited to,
training, veterinary care, required equipment, dog care items, and other
related costs; and
k) Provide timely updates, information, and documentation to the supervisor and
Employee Wellness of any changes in the need for accommodation and/or
regarding the service dog.
Communications
1. Supervisors will:
a) work cooperatively with Employee Wellness and the employee in the
development of the communication plan to facilitate and support the
introduction of the service dog into the workplace;
b) notify staff, in writing, that a request for a service dog has been made and
copy all union presidents (Attachment 3);
Page 3 of 5
c) schedule a staff meeting to provide further information and answer staff
questions;
d) in cases where the dog will accompany an employee to a school,
(i) ensure that the school community, including school council,
parents of the students and the students in whose classroom
the service dog will be are informed (Attachment 4); and
(ii) schedule an information session for members of the school
community and school council – as required – and respond
to students or staff who may have expressed allergies,
phobias or cultural sensitivities to dogs, in accordance with
P.108.SCO and PR.548.SCO: Care of Students with Severe,
Life-Threatening Medical Conditions; and
e) in that the employee may be requested to attend on a field trip which will
require the service dog to accompany the employee on a school bus, the
supervisor/principal will share information related to the service dog with
OSTA in advance to ensure appropriate accommodation.
Implementation
1. The supervisor will, in co-operation with the employee, work with the service dog
training center and all applicable staff to set up a workplace visit, by the trainer,
during which the role of the service dog will be explained to the students/staff.
2. Prior to the permanent introduction of the service dog, the dog will have a minimum
of three days of training in the workplace, which do not need to be consecutive.
Emergency procedures associated with the introduction of the service dog to the
school environment will be established. During the training period, the service dog
must be exposed to fire and lock-down alarms and other workplace routines in order
to gauge the dog’s reaction. Should the dog react negatively, the trainer will provide
further training to familiarize the dog with the school routines and the alarms.
3. The trainer will work with the supervisor and the employee, and other applicable staff
in establishing a safe area in which the service dog can be left during periods when
the employee must be separated from the dog, if applicable. Examples include the
employee’s time in a kitchen, a shop, or a pool.
4. Once the service dog is introduced to the workplace, appropriate signage will be
placed at all entrances alerting visitors to the presence of the dog.
5. The supervisor will address, in consultation with the employee, any issues/concerns
arising after the service dog is in the school/workplace.
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6. The trainer will re-attend the workplace in the event of changes to the employee’s
workplace and routines, as required.
Definitions
1. Accommodation refers to using all reasonable efforts to prevent and remove barriers
that impede individuals with disabilities from participating fully as employees of the
District. Accommodation involves three principles:
a) respect for dignity;
b) individual accommodation; and
c) inclusion and full participation.
2. Assistance Dogs International (ADI) means a coalition of not-for-profit organizations
that train and place service dogs.
3. Board means the Board of Trustees of the Ottawa-Carleton District School Board
(OCDSB).
4. Handler means the person for whom the dog has been prescribed (the employee)
or, if the employee is unable to act in that capacity, another adult trained to work with
the dog would be the handler.
a) Secondary Handler means an adult trained in the use of basic commands
with service dog, who can act as the handler should the primary handler be
temporarily unable to act in that fashion.
b) Tandem Handling means a trained adult acts as the handler.
5. The International Guide Dog Federation (IGDF) means an organization whose
members train and provide guide dogs to visually impaired and blind people around
the world.
6. MSAR: The “Meghan Search and Rescue Standard in Support of Accessibility [by]
Persons with a Disability Teamed with Service Dogs” means a training standard for
service dogs that is, in lieu of a national standard, the level of training preferred by
the Board.
7. National Standard of Canada for Service Dog Teams means a standard developed
to provide a benchmark for the performance of service dog teams. These
performance requirements assure the legitimacy and efficacy of both the person with
the disability, the service dog and the secondary handlers (as required) to form a
service dog team that can work safely in public places. [Note: to be published in
2018]
Page 5 of 5
8. Ottawa Student Transportation Authority (OSTA) means the recognized agent for
transportation services for the Ottawa-Carleton District School Board.
9. Service Dogs means working dogs trained to the needs of specific, recognized
medical conditions. Such conditions include, but are not limited to autism, epilepsy,
and post-traumatic stress disorder (PTSD), and unstable blood sugar levels.
However, for the purpose of this procedure the term “Service Dog” will be assumed
to also include guide dogs and hearing dogs.
Attachments
Attachment 1: OCDSB 915 Request for a Service Dog to Accompany an Employee
Attachment 2: OCDSB914 Management Plan for the Care of a Service Dog for an
Employee
Attachment 3: Letter for School Staff
Attachment 4: Letter for Parents
Attachment 1 to Appendix A
OCDSB 915 Human Resources (November 2017)
OCDSB 915: REQUEST FOR A SERVICE DOG TO ACCOMPANY AN EMPLOYEE
(References: PR.572.HR)
THIS FORM IS TO BE COMPLETED BY THE EMPLOYEE AND SUBMITTED TO EMPLOYEE
WELLNESS.
Name of Employee: ____________________________EIN. ____________________
School:____________________________Departmentlocation:____________________
a) I request that I be authorized to have a service dog accompany me to work.
b) The service dog will provide me with the following assistance: (attach documentation
as necessary)
____________________________________________________________________
____________________________________________________________________
c) Length of time the employee and the service dog have worked together: __________
d) Duration of the requested intervention _________________________
e) Documentation submitted with this request:
i)Medical documentation as required by Employee Wellness;
ii)a copy of dog’s registration and training certification with a recognized training
centre;
iii)a copy of current, official vaccination certificate for the dog;
iv) proof of municipal dog licence;
v)a copy of training certification of the Handler (individual responsible for the
dog), if applicable; and
vi)A copy of liability insurance coverage.
I acknowledge that I am responsible for costs for the dog, including, but not limited to,
training, veterinary care, and other related costs.
Signature(s) of employee: -------------------------------------------------------------------
Date: ------------------------------------------------ Print name: --------------------------------------------
Personal information on this form is collected under the authority of sections 58.5(1) and 265 (d) of the
Education Act, R.S.O. 1990, c.E2, as amended, and in accordance with section 29 (2) of the Municipal
Freedom of Information and Protection of Privacy Act. It will be used for the purpose of managing
student learning and well-being. Access to information will be limited to those who have an
administrative need, to the student to whom the information relates and the parent(s)/guardian (s) of a
student who is under 18 years of age. Questions about this collection should be directed to the school
principal.
Attachment 2 to Appendix A
OCDSB 914 Human Resources (November 2017)
OCDSB914: MANAGEMENT PLAN FOR THE CARE OF A SERVICE DOG FOR AN
EMPLOYEE
(Reference: PR.572.HR)
THIS FORM IS TO BE COMPLETED BY THE EMPLOYEE IN COLLABORATION
WITH THE EMPLOYEE WELLNESS AND THE SUPERVISOR.
Name of employee: ___________________________
School: ___________________________________
Name of dog:______________________________
Water Needs: (provision of water bowl, procedure for use, cleaning, etc.). Note: it is the
expectation that the dog will not be fed during school/work hours.
___________________________________________________________________
Other needs of the service dog. Note: it is the expectation that service dogs will be day
trained.
_______________________________________________
Are rest periods from work with employee required? (frequency / location)
_____________________________________________________________________
Hot / Cold Weather considerations:
_____________________________________________________________________
Supervision duty (if the service dog is not able to work with the employee) (location)
_____________________________________________________________________
Outline plan for the service dog where it is not permitted to accompany the employee:
Kitchen:
______________________________________________________________________
Shop class:
______________________________________________________________________
Pool:
______________________________________________________________________
OCDSB 914 School Operations (October 2017)
Other:
I understand that the care of the service dog is NOT the responsibility of the Ottawa -
Carleton District School Board and that the responsibility rests solely with the employee.
Signature of employee:
-------------------------------------------------------------------
Print name: --------------------------------------------
Date: ----------------------------------------------------
Personal information on this form is collected under the authority of sections 58.5(1) and 265 (d) of the
Education Act, R.S.O. 1990, c.E2, as amended, and in accordance with section 29(2) of the Municipal
Freedom of Information and Protection of Privacy Act. It will be used for the purpose of mana ging
student learning and well-being. Access to information will be limited to those who have an
administrative need, to the student to whom the information relates and the parent(s)/guardian (s) of a
student who is under 18 years of age. Questions about this collection should be directed to the school
principal.
Attachment 3 to Appendix A
[Letter for Staff]
(school logo)
Date
SERVICE DOG FOR AN EMPLOYEE
(Reference: PR.572.HR)
Dear Staff:
This letter is to inform you that we are in the process of finalizing the approval of a
request for a certified service dog in our school assisting one of our employees. We
have had some experience with service dogs at the OCDSB and we are confident that
we will be prepared for the dog’s arrival.
Service dogs are specially trained to meet individual needs (e.g. seeing eye dogs,
seizure alert dogs, autism service dogs, diabetes alert dogs) to prevent and remove
barriers that impede individuals with disabilities from participating fully as employees of
the District. The right to have a service dog is protected by Human Rights legislation
and the Accessibility for Ontarians with Disabilities Act.
As always, we are committed to providing a safe and an inclusive, respectful working
environment for all employees here at [school/department]. I am sure that there will be
many questions about the role of the service dog, including any restrictions and
limitations, and protocols regarding interaction with the dog. Further information will be
shared in advance of the arrival of the service dog. In the meantime, if you have any
questions or concerns, please speak to me as soon as possible.
Sincerely,
Supervisor
c.c HR Officer, Employee Wellness
Principal, Learning Support Services
Labour Relations Officer
President, Ottawa-Carleton - ETFO or President, OSSTF-TBU
President, OSSTF-SSP
President, OSSTF-PSSU
President, OSSTF-ESP
President, OSSTF-PSSP
President, OSSTF-PECCS
President, OCEOTA or President, OSSTF-OT
Attachment 4 to Appendix A
[Letter for Parents/Guardians of Students at School]
school logo
SERVICE DOG FOR AN EMPLOYEE
(Reference: PR.572.HR)
Date
Dear Parents:
This letter is to inform you that we are in the process of finalizing approval of a request
for a certified service dog in our school assisting one of our employees. We have had
some experience with service dogs at the OCDSB and we are confident that we will be
prepared for the dog’s arrival.
Service dogs are specially trained to meet individual needs (e.g. seeing eye dogs,
seizure alert dogs, autism service dogs, diabetes alert dogs) to prevent and remove
barriers that impede individuals with disabilities from participating fully as employees of
the District. The right to have a service dog is protected by Human Rights legislation
and the Accessibility for Ontarians with Disabilities Act.
As always, we are committed to providing an inclusive, safe and respectful environment
at school for all students and staff. I understand there may be questions about the role
of the service dog, including any restrictions and limitations, and protocols regarding
interaction with the dog. If your child has allergies, phobias or cultural sensitivities
related to dogs or if you have any other questions pertaining to the above, please do not
hesitate to contact me.
Sincerely,
Principal
c.c HR Officer, Employee Wellness
School Council
Superintendent of Instruction
Principal, Learning Support Services
Trustee
February 2012 revision (ETFO, PVP, Union Exempt)
Standardized Medical Certificate
Phone: 613-596-8250 Fax: 613-596-8798
Page 1 of 2
Part A - To Be Completed by Employee
Last Name: __________________________________First Name: _______________________
Work location: __________________________________EIN: _________________________
I will be / have been absent from work since (date) ____________. I hereby consent to the completion and submission of the
appropriate sections of this form by my regulated health care professional for submission in confidence to the Employee Wellness &
Disability Management Division at Ottawa-Carleton District School Board.
______________________________________________ _______________________________________
Employee’s Signature Date
Part B - To Be Completed by Employee’s Regulated Treating Healthcare Practitioner
1. This employee sought medical attention for this illness on _________________________ (date)
2. This Employee is Fit to return to regular duties Date of return to work _________________________
3. This employee is TOTALLY DISABLED
Have you discussed the possibility of a modified return to work plan with the employee? Yes No
Expected date of recovery: _________________Expected date of return to regular work: __________________ or Modified duties: ________________
Next appointment date: _______________________________
4. Is this employee receiving ongoing treatment? : Yes No
If yes, please complete the following:
i)Duration of treatment plan: ________________________________________________
ii) Restrictions and/or limitations (COMPLETE SECTION C WHERE APPLICABLE ONLY)
iii) Expected duration of restrictions and/or limitations: _____________________________
5. This employee is fit to return to work or remain at work with accommodations
COMPLETE SECTION C ON PAGE 2 WHERE APPLICABLE
Expected duration of accommodation requirement: _____________________ Next appointment date: ___________________________
6.Comments and signature section:
Provide additional comments and/or information that should be considered in order to assist in a safe and healthy return to work for your patient.
_________________________________________________________________________________
_________________________________________________________________________________
Healthcare Practitioner’s Signature: Date : (MM/DD/YY)
Healthcare Practitioner’s Name: (Please Print) Telephone:
Please complete and return this form to the Employee Wellness & Disability Management Officer, Employee Wellness & Disability
Management Division at the Ottawa-Carleton District School Board within 3 days. Confidential Fax number is 613-596-8798. Thank
You.
Freedom of Information Disclaimer:
Authority: The above information is collected under the authority of the Education Act (Ch.E2), Ottawa-Carleton District School Board’s Disability Management Program; and when work related, the
Workplace Safety and Insurance Board (WSIB).
Users:
Users of this information will be limited to the Employee Wellness & Disability Management Division of the Human Resources Department. The information will be used to assist the employee with a
successful re-entry program and rehabilitation back into the workplace.
PAGE 2 PART C - TO BE COMPLETED BY EMPLOYEE’S TREATING HEALTHCARE PRACTITIONER IF ACCOMMODATIONS REQUIRES
Appendix B
February 2012 revision (ETFO, PVP, Union Exempt)
OTTAWA-CARLETON DISTRICT SCHOOL BOARD
Standardized Medical Certificate
Phone: 613-596-8250 Fax: 613-596-8798
Page 2 of 2
Part C - To Be Completed by Employee’s Treating Healthcare Practitioner – if accommodations required
1. This employee is capable of:
Walking:
Full abilities
Up to 100 metres
100 - 200 metres
Other (please specify)
Standing:
Full abilities
Up to 15 minutes
15 - 30 minutes
Other (please specify)
Sitting:
Full abilities
Up to 30 minutes
30 minutes - 1 hour
Other (please specify)
Lifting from floor to waist:
Full abilities
Up to 5 kilograms
5 - 10 kilograms
Other (please specify)
Lifting from Waist to
Shoulder:
Full abilities
Up to 5 kilograms
5 - 10 kilograms
Other (please specify)
Stair Climbing:
Full abilities
Up to 5 steps
5 - 10 steps
Other (please specify)
Travel to Work:
Ability to use public transit Ability to drive car
Yes Yes
No No
2. This employee has the following physical restrictions/limitations:
Bending/twisting
repetitive movement of
(please specify):
Work at or above
shoulder activity:
Chemical exposure
to:
Limited use of hand(s):
Left Right
Gripping
Pinching
Other (please specify)
3. Please circle the appropriate descriptor and provide any additional comments that may apply based on the cognitive demands for
the employee’s current position. Indicate length of time for any limitations or restrictions, where appropriate.
TASKS COMPETENCY LEVEL COMMENTS
Level 1 Level 2 Level 3 Level 4
Supervision
Required
Needs constant
supervision
Needs frequent
supervision
Needs limited
supervision
Requires no
supervision
Supervision of
Others
Not able to
supervise others
Can give direction to
1-2 staff or up to 10
students
Can give direction
up to 5 staff, or up to
20 students
Can meet demands
of full supervision
Tolerance to
Deadlines
Cannot deal with
deadline pressures
Occasionally deal
with deadlines
Can deal with
deadlines that are
reoccurring
Can deal with strict
deadlines
Attention to
Detail
Concentration on
details is severely
limited
Concentration on
detail is limited
Can concentrate on
details, needs
occasional breaks of
non-detailed work
Able to concentrate
intensely on detailed
work
Performance of
Multiple Tasks
Can deal with one
task at a time
Can handle more
than 1 task but
requires cues as to
when to do task
Can handle multiple
tasks, requires
some time
management
assistance
Fully able to handle
multiple tasks without
difficulty
Tolerance to
External
Stimulus
Needs quiet, non-
distracting work
environment
Can cope with small
degree of distraction
Can cope with
distracting stimuli for
portion of day
Fully able to cope
with multiple stimuli
without negative
effect
Memory Cannot recall recent
events
Can recall remote
events
Can recall recent &
remote sequences
& events
Can recall recent &
remote complex
sequences & events
Learning Cannot learn new
skills
Can learn some new
basic skills
Can learn new skills Can learn complex
new skills
Ability to Work
with Others
Cooperatively
Tolerates working
alone
Can tolerate others
within vicinity, but
needs to perform
independent tasks
Can work with
others cooperatively
when required
Fully able to work in
close cooperation
with others
Ability to Cope
with
Confrontational
Situations
Unable to cope with
confrontational
situations
Can cope with
exposure to
confrontational
situations with back-
up available
Moderate ability to
cope with
confrontational
situations
Able to deal with
confrontational
situations with tact
and control
Responsibility &
Accountability
Errors in judgement
or attention likely to
occur
Can exercise a
moderate level of
responsibility with
occasional need for
support
Can accept
responsibility
including the
responsibility for the
safety of others
Can accept a high
level of responsibility
including sensitive
situations
Healthcare Practitioner’s Signature:
Date : (MM/DD/YY)
Healthcare Practitioner’s Name: (Please Print)
Telephone:
OSSTF ABILITIES FORM (2 pages)
Ottawa-Carleton District School Board
133 Greenbank Road, Ottawa, K2H 6L3
FAX COMPLETED FORM TO: 613-596-8798 or 613-596-8726
Employee Group: Requested By:
WSIB Claim: Yes No WSIB Claim Number:
To the Employee: The purpose for this form is to provide the Board with information to assess whether you are able to perform the essential
duties of your position, and understand your restrictions and/or limitations to assess workplace accommodation if necessary.
Employee’s Consent: I authorize the Health Professional involved with my treatment to provide to my employer this form when complete. This
form contains information about any medical limitations/restrictions affecting my ability to return to work or perform my assigned duties.
1.Health Care Professional: The following information should be completed by the Health Care Professional
Please check one:
Patient is capable of returning to work with no restrictions.
Patient is capable of returning to work with restrictions. Complete section 2 (A & B) & 3
I have reviewed sections 2 (A & B) and have determined that the Patient is totally disabled and is unable to return to work a t this time.
Complete sections 3 and 4. Should the absence continue, updated medical information will next be requested after the date of the follow up
appointment indicated in section 4.
First Day of Absence:
__________________________
General Nature of Illness (please do not include diagnosis):
_____________________________________________________
Date of Assessment:
dd mm yyyy
2A: Health Care Professional to complete. Please outline your patient’s abilities and/or restrictions based on your objecti ve
medical findings.
PHYSICAL (if applicable)
Walking:
Full Abilities
Up to 100 metres
100 - 200 metres
Other (please specify):
Standing:
Full Abilities
Up to 15 minutes
15 - 30 minutes
Other (please specify):
Sitting:
Full Abilities
Up to 30 minutes
30 minutes - 1 hour
Other (please specify):
Lifting from floor to waist:
Full Abilities
Up to 5 kilograms
5 - 10 kilograms
Other (please specify):
Lifting from Waist to
Shoulder:
Full abilities
Up to 5 kilograms
5 - 10 kilograms
Other (please specify):
Stair Climbing:
Full abilities
Up to 5 steps
6 - 12 steps
Other (please specify):
Use of hand(s):
Left Hand Right Hand
Gripping Gripping
Pinching Pinching
Other (please specify): Other (please specify):
Bending/twisting
repetitive movement of
(please specify):
Work at or above
shoulder activity:
Chemical exposure to: Travel to Work:
Ability to use public transit
______________________
Ability to drive car
Yes No
______________
Yes No
Employee Name:
(Please print)
Employee Signature:
Employee ID: Telephone No:
Employee
Address:
Work Location:
Appendix C
OSSTF ABILITIES FORM (2 pages)
Ottawa-Carleton District School Board
133 Greenbank Road, Ottawa, K2H 6L3
FAX COMPLETED FORM TO: 613-596-8798 or 613-596-8726
2B: COGNITIVE (please complete all that is applicable)
Attention and Concentration:
Full Abilities
Limited Abilities
Comments:
Following Directions:
Full Abilities
Limited Abilities
Comments:
Decision- Making/Supervision:
Full Abilities
Limited Abilities
Comments:
Multi-Tasking:
Full Abilities
Limited Abilities
Comments:
Ability to Organize:
Full Abilities
Limited Abilities
Comments:
Memory:
Full Abilities
Limited Abilities
Comments:
Social Interaction:
Full Abilities
Limited Abilities
Comments:
Communication:
Full Abilities
Limited Abilities
Comments:
Please identify the assessment tool(s) used to determine the above abilities (Examples: Lifting tests, grip strength tests, Anxiety
Inventories, Self-Reporting, etc.
Additional comments on Limitations (not able to do) and/or Restrictions (should/must not do) for all medical conditions:
3: Health Care Professional to complete.
From the date of this assessment, the above will apply for approximately:
6-10 days 11- 15 days 16- 25 days 26 + days
Have you discussed return to work with your patient?
Yes No
Recommendations for work hours and start date (if applicable):
Regular full time hours Modified hours Graduated hours
Start Date: dd mm yyyy
Is patient on an active treatment plan?: Yes No
Has a referral to another Health Care Professional been made?
Yes (optional - please specify): ________________________________________________ No
If a referral has been made, will you continue to be the patient’s primary Health Care Provider? Yes No
4: Recommended date of next appointment to review Abilities and/or Restrictions: dd mm yyyy
Completing Health Care Professional Name:
(Please Print)
Date:
Telephone Number:
Fax Number:
Signature:
OSSTF – Central Agreement - 2015