Employee Return To Work Form Template UK

The Employee Return To Work Form Template UK is offered in multiple formats, including PDF, Word, and Google Docs, featuring customizable and printable samples to suit your needs.

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Sample

Employee Return To Work Form Template UK

Editable – Printable

PDF – 1 PDF – 2

Employee Return To Work Form Template UK

1. Employee Information




2. Absence Details


3. Medical Clearance


4. Return to Work Plan

5. Adjustments Required

6. Employee Acknowledgment

7. Supervisor/Manager Information


8. Signatures and Date



PDF

WORD

Examples

Employee Return To Work Form Template UK (1)
Employee Details:
[Employee Name]
[Employee ID]
[Employee Department]
[Employee Position]
[Employee Contact Number]
Return Date:
[Date of Return]
Reason for Absence:
[Medical Leave, Personal Reasons, etc.]
Symptoms or Conditions:
[Describe any relevant symptoms or conditions that may affect the employee’s return to work, if applicable].
Completion of Medical Clearance:
I confirm that I have received medical clearance to return to work. (Yes/No)
[Attach Medical Certificate if applicable]
Adjustments Required:
[List any reasonable adjustments needed in the workplace to aid the employee’s return, e.g., modified duties, flexible hours].
Manager’s Comments:
[Space for manager’s comments regarding the employee’s return and any relevant considerations].
Employee’s Acknowledgment:
I acknowledge that I have provided accurate information regarding my health status and return to work readiness.
[Signature of the Employee]
[Date]
Manager’s Verification:
I verify that the above information has been discussed and agree to support the employee’s return to work.
[Signature of the Manager]
[Date]
Employee Return To Work Form Template UK (2)
Employee Information:
[Full Name]
[Employee ID Number]
[Job Title]
[Department]
[Contact Information]
Date of Return to Work:
[Return Date]
Duration of Absence:
[Number of Days/Weeks]
Reason for Absence:
[Type of Leave: Sickness, Maternity, etc.]
Health Status on Return:
[Describe any ongoing health issues or limitations upon returning to work, if relevant].
Doctor’s Notes:
[Attach any notes or recommendations from a healthcare professional regarding the employee’s return to work].
Adjustments If Necessary:
[Specify any work adjustments needed during the transition back to work, if applicable].
Employee Signature:
I confirm that the details above are accurate and agree to the terms of my return to work.
[Signature of the Employee]
[Date]
Manager Review:
I acknowledge the information provided and agree with the plan for the employee’s return to work.
[Signature of the Manager]
[Date]

Printable

PDF – 1 PDF – 2

Employee Return To Work Form Template UK