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  • Return To Work Form: Strictly Confidential

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    dexteraaa
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    An employee completed a return to work form after an absence from work. The form included information about the dates of absence, the reason for absence which was described as an illness, and who the absence was reported to. The employee's superior officer discussed the return to work and whether medical certification was provided. They summarized the discussion and any further actions agreed upon. The form was signed by both the employee and manager.

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    Return to work form

    Original Title

    Return to Work Form

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    © © All Rights Reserved

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    An employee completed a return to work form after an absence from work. The form included information about the dates of absence, the reason for absence which was described as an illness, and who the absence was reported to. The employee's superior officer discussed the return to work and whether medical certification was provided. They summarized the discussion and any further actions agreed upon. The form was signed by both the employee and manager.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    130 views1 page

    Return To Work Form: Strictly Confidential

    Uploaded by

    dexteraaa
    An employee completed a return to work form after an absence from work. The form included information about the dates of absence, the reason for absence which was described as an illness, and who the absence was reported to. The employee's superior officer discussed the return to work and whether medical certification was provided. They summarized the discussion and any further actions agreed upon. The form was signed by both the employee and manager.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    of 1

    Return to Work Form

    Part 1: Self-Certification (to be completed by employee)


    Name: Job Title:
    1
    st
    Day of Absence: Date Returned to Work:
    Number of working days absent: Are you: confirmed / robation !
    !Delete as aroriate
    "tate briefly w#y you were unfit for work (secify nature of illness or in$ury% Words like
    &illness' or &unwell' are not enoug#(
    ) reorted my absence to: on (date(:
    "igned (emloyee(: ************* Date: ********%
    Part 2: Return To Work Discussion (to be completed by superior officer)
    "uerior +fficer,s Name: Date of RTW Discussion:
    -as t#e necessary medical certification been resented. (e%g%/ w#ere
    re0uired/ a fit note/s(
    1es/No
    "ummary of discussion:
    Any ot#er comments or issues raised/ and any furt#er action agreed:
    2eriod of Absence : 2aid/3naid
    (Contract should be referred to as to staff that are on probation or
    confirmed)
    "igned (emloyee(: ************* Date: ********%
    "igned (manager(: ************* Date: ********%
    Strictly Confidential

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