UK Sickness Absence SOP app 10 – return to work interview

MARRIOTT RETURN TO WORK INTERVIEW

Full Name
Department
Date absence started:
Date returned to work:
Number of days absent:
Address stayed where absent e.g. hospital,
home, other

Symptoms of illness:

Did you see a Doctor?

Doctor’s diagnosis:

Was this a recurring illness?

Are you fully recovered?
If not, will this affect your ability
to do the job?

Did you suffer from any ailment such as

diarrhoea, food poisoning, infestations etc.
that require clearance from a Doctor before
you can work with food?
Total days’ sickness in last 12 months?

Does this meet a trigger point i.e? 3

weeks of absence, 7 days’ absence in
3 months, 3 absences in 3 months, 15
working days in 12 months?
If yes to 15, what action should be
taken now?

Name and address of Doctor:

Has the full absence reporting procedure

been followed by the associate?

Any Other Comments e.g. Follow Up etc.

 UK Sickness Absence SOP app 10 – return to work interview

I understand that if I provide inaccurate or false information about my absence, I may be subject to disciplinary action and
may forfeit my right to sick pay, subject to my service entitlement.

Signature………………………………………………………………. Date …………………………………………………..…

Manager’s comments:

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Signed………………………………………………………………….. Date……………………………………………………..

** Completed form to be placed on personal file **