This template has been created to provide managers with a tool to support the return to work interview following a long period of sick absence or persistent, intermittent, short-term absence.
For guidance on return to work interviews, please contact the People team.
| Name of employee: | |
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| Role: | |
| Name of manager completing the form: |
| Date(s) of absence: | |
|---|---|
| Reason(s) for absence: | |
| Any other sick leave in the past 12 months? (dates + reason if known) |
| Date of return to work: | |
|---|---|
| Date of return to work interview: | |
| Do you feel ready to return to full duties? | yes/no |
| Is there a “Fitness for Work” form indicating adjustments to consider? | yes/no |
| Is there an Occupational Health (OH) report indicating adjustments to consider? | yes/no |
| Are any adjustments needed? (e.g. lighter workload, flexibility, phased return) |
| What support or adjustments have we agreed? How long will these be in place?
| When will we check in again? |
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