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Home My WebLink AboutUnion 22-04-12IN THE MATTER OF AN ARBITRATION Pursuant to the Labour Relations Act, R.S. 1995 BETWEEN: THE OTTAWA HOSPITAL (“Employer”) - and – OPSEU, LOCAL 464 (“Union”) (Grievance 2017-0464-0040) SOLE ARBITRATOR: Jasbir Parmar On Behalf of the Employer: J.D. Sharp Marianne Abou-Hamad On Behalf of the Union: Darryl Korell This matter was heard on April 12, 2022 by videoconference. [1] I was appointed by the parties to hear and determine a grievance relating to the Employer’s use of certain forms in the context of an attendance support program. [2] Having heard the submissions of the parties, I have determined the Employer may use the attached Attendance Support Program Exclusion Form and Serious Chronic Ongoing Application Form. Dated this 12th day of April, 2022. “Jasbir Parmar” ___________________ JASBIR PARMAR Attendance Support Program Exclusion Form Employee Information Name: Department: Employee ID: Job Title: Dear Doctor, The Ottawa Hospital’s Attendance Support Program (“ASP”) is designed to address and reduce excessive workplace absenteeism by providing employees with health and wellness supports. Placement on the program is triggered when an employee’s absenteeism has exceeded the established attendance thresholds of 90 hours and/or eight (8) occurrences for full time employees, and 60 hours and/or six (6) occurrences for part time employees over a twelve (12) month period. Absences due to certain medical conditions can be excluded from the program. Your patient has indicated that some sick related absences may qualify for exclusion. In order to determine whether this absence would qualify for exclusion, further information is required, as outlined on the second page of this document. Please send the completed form marked “Confidential” by fax to: Civic Campus 1053 Carling Avenue Ottawa, ON K1Y 4E9 Fax: 761-4162 Tel: 798-5555 x14161 General Campus 501 Smyth Road Ottawa, ON K1H 8L6 Fax: 737-8912 Tel: 737-8899 x78391 Riverside Campus 1967 Riverside Drive Ottawa, ON K1H 7W9 Fax: 738-8260 Tel: 738-8400 x88250 Or by e-mail marked “Confidential” to: OccupationalHealth@toh.ca Section A – Patient Authorization (to be completed by employee) I authorize my treating, medically qualified health professional to provide (Name) Occupational Health and Wellness with information regarding my illness and inability to work by completing the contents of Section B of this form. It is understood that any further information that is requested will require additional and separate consent from me. I understand that applying for exclusion is a voluntary process. I understand that The Ottawa Hospital will be using this information for the purposes of determining my eligibility for exclusion from the Attendance Support Program and that my personal health information will be kept private and confidential. Employee signature: Date: DD / MM / YY Section B – Treating Health Care Practitioner Please indicate with a check mark the type of absence that is being assessed for exclusion from the ASP by your patient:  One of the following communicable diseases (of the following list only as per the Ontario Health Association guidelines, as amended): • Acute chickenpox or disseminated zoster • Conjunctivitis (either adenoviral or bacterial) • Fever of 38°C or higher that is related to a communicable disease • Herpetic whitlow • Influenza (suspected or diagnosed) • Group A Streptococcal Infections including streptococcal pharyngitis, impetigo or pyoderma • Measles, Mumps, or Rubella • Meningococcal disease including meningococcemia, meningococcal meningitis, or meningococcal pneumonia • Pertussis • Probable Enteric Bacterial Infection causing diarrhea and/or vomiting (with two or more incidents occurring within 24 hours) • Scabies Date(s) of Total Disability: To DD / MM / YY DD / MM / YY  An ongoing course of serious treatment that renders an individual debilitated and unable to perform activities of daily living during or following the treatment: Date(s) of Total Disability: To DD / MM / YY DD / MM / YY Reasonable and customary amount of time expected to be off work: days per month, OR days per year.  A catastrophic event directly responsible for causing a marked impairment or an extreme impairment affecting activities of daily living and was under the doctor’s care during the dates of absence: Date(s) of Total Disability: To DD / MM / YY DD / MM / YY  Medically necessary surgical interventions: Date(s) of Total Disability: To DD / MM / YY DD / MM / YY  A Chronic Ongoing Condition that has been documented and is approved by Occupational Health and is currently active Date(s) of Total Disability: To DD / MM / YY DD / MM / YY I certify that the above information is accurately depicted as per my records to the best of my knowledge and expertise as it defines my patient’s inability to attend work, as well as the prognosis thereof. Physician’s signature: Date: DD / MM / YY Print name: Phone number: ( ) DD / MM / YY Serious Chronic Ongoing Condition Application Form Employee Information Name: Department: Employee ID: Job Title: Dear Doctor, The Ottawa Hospital’s Attendance Support Program (ASP) is designed to address and reduce excessive workplace absenteeism by providing employees with health and wellness supports. Placement on the program is triggered when an employee’s absenteeism has exceeded the established attendance thresholds of 90 hours and/or eight (8) occurrences for full time employees, and 60 hours and/or six (6) occurrences for part time e mployees over a twelve (12) month period. Certain medical conditions can be excluded from the program. Medically recognized serious chronic ongoing conditions are excluded from our program. Your patient has indicated that some sick - related absences may qualify for such an exclusion from the ASP. In order to determine whether this exclusion for this specific absence is warranted, further information is required, as outlined on the second page of this document. A serious chronic ongoing condition is medically established in consideration of all of the following criteria: • Of lasting duration; • Generally slow progression; • Involving a specialist for consultation and / or management; • Impairs work function in a significant manner. Please send the completed form marked “Confidential” by fax to: Civic Campus 1053 Carling Avenue Ottawa, ON K1Y 4E9 Fax: 761-4162 Tel: 798-5555 x14161 General Campus 501 Smyth Road Ottawa, ON K1H 8L6 Fax: 737-8912 Tel: 737-8899 x78391 Riverside Campus 1967 Riverside Drive Ottawa, ON K1H 7W9 Fax: 738-8260 Tel: 738-8400 x88250 Or by e-mail marked “Confidential” to: OccupationalHealth@toh.ca Section A – Patient Authorization (to be completed by employee) I authorize my treating, medically qualified health professional to provide (Name) Occupational Health and Wellness with information regarding my illness and inability to work by completing the contents of Section B of this form. It is understood that any further information that is requested will require additional and separate consent from me. I understand that applying for exclusion is a voluntary process. I understand that The Ottawa Hospital will be using this information for the purposes of determining my eligibility for exclusion from the Attendance Support Program and that my personal health information will be kept private and confidential. Employee signature: Date: DD / MM / YY Section B – Treating Health Care Practitioner In order to consider the employee’s request, please provide details about the employee’s condition by answering the questions below: 1. As per the above definition, does your patient have a medically recognized serious chronic ongoing condition?  Yes Please identify the nature (but not diagnosis) of the condition causing absence from work. _________________________________________  No 2. Is there a specialist involved in the management of this employee’s condition?  Yes  No 3. What is the current status of the medical condition?  Condition is stable and no further improvements are expected  Condition is stable and is expected to improve  Condition is stable and is expected to deteriorate  Condition is unstable and further treatment is required 4. If the condition is expected to deteriorate, what is the contributing factor?  Natural progression of symptoms  Comorbid medical conditions  Other: 5. Please list the date(s) in which you assessed your patient for this condition in the last year? 6. A) Have there been any changes or additions to the current treatment plan in the past year? ❑ Yes ❑ No B) Is the employee actively participating in the recommended treatment plan? C) Are there any other treatment options available? ❑ Yes ❑ No If yes, are these other treatment options under consideration? ❑ Yes ❑ No If no to the initial question C, has optimal treatment been reached? ❑ Yes ❑ No 7. What restrictions and/or limitations can be implemented to assist the employee in attending work during a flare up or as a result of natural progression of the illness? 8. A) How frequent are the predicted occurrences that would impact the employee’s attendance at work? (Please provide your best prediction based on your assessment as it is important to understand how it may affect their attendance at work.) Expected occurrences per year: B) What is the approximate duration (in days) for each occurrence? Expected number of days of absence per occurrence: 9. Is the employee’s attendance at work:  Expected to improve? If yes, please provide details of expected time frame:  Expected to remain stable?  Expected to worsen? If yes, please provide details of expected time frame: 10. Is there anything else that may assist the employee in attending work on a regular basis? (Please do not include the diagnosis of the condition causing absence from work.) I certify that the above information is accurately depicted as per my records to the best of my knowledge and expertise as it defines my patient’s inability to attend work, as well as the prognosis thereof. Physician’s signature: Date: DD / MM / YY Print name: Phone number: ( )