Common use of Waist to Shoulder Clause in Contracts

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) _ Bending/twisting repetitive movement of (please specify): Work at or above shoulder activity: _ Limited pushing / pulling with: Left Arm Right Arm Other (please specify)_ Limited use of hand(s): Left Right Gripping Pinching Other Operating motorized Equipment Environmental Exposure to: (heat, cold, noise) Chemical exposure to: Exposure to Vibration:Whole body Hand/arm Other (Please describe) Prognosis - From the date of this assessment, the above will apply for approximately: 1-2 weeks 3-5 weeks 6-8 weeks 2-3 months 4-6 months 6+ months Unknown Recommendations for work hours and start date: Regular full time hours Modified hours Graduated hours Start Date: (dd/mm/yyyy) Next appointment date to review Limitations and/or Restrictions: (dd/mm/yyyy) Please provide any additional information/comments/findings/limitations (ex. Physical, Cognitive) which you feel would assist our employee in a safe and timely return to work. _ PART B – LOCAL TERMS PREAMBLE/INTRODUCTION The Peterborough Victoria Northumberland and Clarington Catholic District School Board and the OECTA-PVNC Unit Bargaining Unit are committed to improve student achievement, reduce gaps in student outcomes and increase confidence in publicly funded education.

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) _ Bending/twisting repetitive movement of (please specify): Work at or above shoulder activity: _ Limited pushing / pulling with: Left Arm Right Arm Other (please specify)_ Limited use of hand(s): Left Right Gripping Pinching Other Operating motorized Equipment Environmental Exposure to: (heat, cold, noise) Chemical exposure to: Exposure to Vibration:: Whole body Hand/arm Other (Please describe) Prognosis - From the date of this assessment, the above will apply for approximately: 1-2 weeks 3-5 weeks 6-8 weeks 2-3 months 4-6 months 6+ months Unknown Recommendations for work hours and start date: Regular full time hours Modified hours Graduated hours Start Date: (dd/mm/yyyy) Next appointment date to review Limitations and/or Restrictions: (dd/mm/yyyy) Please provide any additional information/comments/findings/limitations (ex. Physical, Cognitive) which you feel would assist our employee in a safe and timely return to work. _ PART B – LOCAL TERMS PREAMBLE/INTRODUCTION The Peterborough Victoria Northumberland and Clarington Catholic District School Board and the OECTA-PVNC Unit Bargaining Unit are committed to improve student achievement, reduce gaps in student outcomes and increase confidence in publicly funded education.