This documents the workplace adjustments that have been put in place for Charles Sturt employees. See the Charles Sturt Workplace Adjustment Procedure for information about administering, applying and monitoring a workplace adjustment plan.

The links below include resources and information to assist with plan development (hold control to open links):

Accessibility and neurodiversity - People and Culture

Workplace adjustments - People and Culture (including a link to request support with developing a plan)

Employee details

Name: Click or tap here to enter text.	Staff number: Click or tap here to enter text.
School/Section: Click or tap here to enter text.	Faculty/Division: Click or tap here to enter text.
Campus: Click or tap here to enter text.	Work location: Choose an item.
Phone: Click or tap here to enter text.	Email address: Click or tap here to enter text.

Role details

Position: Click or tap here to enter text.	Employment type: Choose an item.
Commencement date: Click or tap to enter a date.	End date (if applicable): Click or tap to enter a date.

Supervisor details

Supervisor name: Click or tap here to enter text.	Supervisor position: Click or tap here to enter text.
School/Section: Click or tap here to enter text.	Faculty/Division: Click or tap here to enter text.
Phone: Click or tap here to enter text.	Email address: Click or tap here to enter text.

Adjustment plan details

Date developed: Click or tap to enter a date.	Developed by: Click or tap here to enter text.
Developer position: Click or tap here to enter text.	Email address: Click or tap here to enter text.

Work related impacts (functional limitations)

Describe any functional limitations placed on the staff member by the disability/condition.

Click or tap here to enter text into this box to describe the work-related impacts experienced by the staff member as a result of their condition or disability.

Agreed adjustments

The University has assessed the following to be reasonable adjustments in accommodating the reported condition(s) and agrees to implement and maintain these items in order to overcome any work-related impacts.

The following will be implemented and maintained unless to continue with an item would cause an unjustifiable hardship for the University, at which time the reasonable adjustments will be reviewed.

Details	Adjustment type	Start date	End date (if temporary)
Click or tap here to enter text.	Choose an item.	Click or tap to enter a date.	Click or tap to enter a date.
Click or tap here to enter text.	Choose an item.	Click or tap to enter a date.	Click or tap to enter a date.
Click or tap here to enter text.	Choose an item.	Click or tap to enter a date.	Click or tap to enter a date.
Click or tap here to enter text.	Choose an item.	Click or tap to enter a date.	Click or tap to enter a date.
Click or tap here to enter text.	Choose an item.	Click or tap to enter a date.	Click or tap to enter a date.

Monitoring/review schedule

As outlined in the Workplace Adjustment Procedure, a follow-up review should be conducted within one month from the date the adjustment plan commences.

Following the initial review, this plan is to be reviewed at least annually by the employee and their supervisor. More regular check-ins (e.g. quarterly or six-monthly) are recommended to ensure adjustments remain suitable and support the staff member and their team as intended.

Review date	Review outcomes
Comments	Additional adjustments	Modified/removed adjustments
Click or tap to enter a date.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.
Click or tap to enter a date.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.
Click or tap to enter a date.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.
Click or tap to enter a date.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.
Click or tap to enter a date.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.
Click or tap to enter a date.	Click or tap here to enter text.	Click or tap here to enter text.	Click or tap here to enter text.

**Send completed plan to EDI@csu.edu.au. It will be stored confidentially with DPC EDI team**

Employee sign-off

I agree with this Workplace Adjustment Plan and that this plan will be accessible to relevant staff within the Division of People and Culture and my supervisor.

Employee name: Click or tap here to enter text.	Employee signature:
Comments (if required): Click or tap here to enter text.

Supervisor sign-off

I agree to support and oversee the implementation and monitoring of this Workplace Adjustment Plan.

Supervisor name: Click or tap here to enter text.	Supervisor signature:
Comments (if required): Click or tap here to enter text.

Treating health practitioner sign-off (if applicable)

I agree to support this Workplace Adjustment Plan.

Practitioner name/contact: Click or tap here to enter text.	Health practitioner signature:
Comments (if required): Click or tap here to enter text.