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Employee Return To Work Form
"I need an Employee Return To Work Form for a staff member returning from extended sick leave in March 2025, including provisions for a phased return over 4 weeks and specific workplace adjustments for a back injury."
1. Employee Information: Basic details including name, employee ID, department, contact information
2. Absence Details: Information about the period of absence including start date, end date, and reason for absence
3. Return Date: Confirmed date of return to work and any specific arrangements
4. Health Status Declaration: Employee's declaration of current health status and fitness to return to work
5. Manager Review: Section for manager's assessment, comments and approval of return to work
1. Phased Return Plan: Details of graduated return schedule including reduced hours or modified duties, to be included when recommended by healthcare provider
2. Workplace Adjustments: Specific modifications required to workspace or duties to accommodate medical conditions or disabilities
3. Follow-up Schedule: Schedule of planned review meetings and check-ins, particularly relevant for longer-term health conditions
1. Medical Certificate: Copies of fit notes or medical certificates supporting the absence and return to work
2. Risk Assessment: Updated workplace risk assessment documentation if required due to health condition
3. Occupational Health Report: Any relevant occupational health recommendations or reports supporting the return to work
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