Template

Back to Work Form Template

by Kelli User, from the Community

10+

This back to work form helps managers capture essential details after an employee has been away from work for more than half a day. Record the reason for absence, dates away, total days off, and whether a doctor’s note is provided. Standardize return-to-work interviews, confirm probation status, brief employees on updates, and agree on next steps. The form includes sections for notes, evidence capture, and signature fields for both the employee and the manager to confirm completion.

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With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Back to Work 2025 Checklist
This back to work form helps line managers conduct return to work interviews after an employee has been out of the business for more than half a day. Capture employee name, reason for absence, first and last day away, total working days off, and whether a doctors note was provided. Record the interview date, pay status, probation status, and any updates or briefings the employee missed. Include notes on treatment or ongoing issues, follow up actions, and ensure both employee and manager sign and date the form.
by Kelli User, from the Community
Downloads: 0
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Template
Back to Work Interview Form
This back to work interview form supports managers and employees returning after an absence of more than half a day. Capture employee name, reason for absence, dates, total days off, whether a doctors note was provided, and if the absence is paid. Confirm probation status, share updates or briefings missed, and document any follow up actions. Finish with signatures from both parties to confirm the return to work discussion.
by Kelli User, from the Community
Downloads: 20+
Get
Template
Back to Work Interview Checklist
Use this Back to Work interview form to manage return-to-work conversations after employee absence. Capture the employee’s name, reason for absence, first and last dates, total working days missed, and whether a doctor’s note was provided. Record matters discussed, confirm employees are up to date on company briefings, offer support, and check for any questions. Document interview completion date, outcomes, and signatures from employee and employer to create an auditable record.
by Kelli Crockard, from the Community
Downloads: 10+
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Template
Return to Work Interview Template
This Return to Work Interview template helps managers and employees document details after a non-holiday absence, including dates away, reason or symptoms, and confirmation of notification procedures. It captures employee and manager details, meeting date, prior absence history, and total days absent over 6 and 12 months. Use the action plan section to agree workplace adjustments, review dates, and next steps that support a safe, timely reintegration. Includes sign-off for employee and manager to confirm accuracy and compliance. Customize to suit your HR policies and jurisdiction.
by Iain MacPherson, from the Community
Downloads: 0
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Back to Work 2025 Checklist

This back to work form helps line managers conduct return to work interviews after an employee has been out of the business for more than half a day. Capture employee name, reason for absence, first and last day away, total working days off, and whether a doctors note was provided. Record the interview date, pay status, probation status, and any updates or briefings the employee missed. Include notes on treatment or ongoing issues, follow up actions, and ensure both employee and manager sign and date the form.

by Kelli User, from the Community

Get

Template

Back to Work Interview Form

This back to work interview form supports managers and employees returning after an absence of more than half a day. Capture employee name, reason for absence, dates, total days off, whether a doctors note was provided, and if the absence is paid. Confirm probation status, share updates or briefings missed, and document any follow up actions. Finish with signatures from both parties to confirm the return to work discussion.

by Kelli User, from the Community

20+

Get

Template

Back to Work Interview Checklist

Use this Back to Work interview form to manage return-to-work conversations after employee absence. Capture the employee’s name, reason for absence, first and last dates, total working days missed, and whether a doctor’s note was provided. Record matters discussed, confirm employees are up to date on company briefings, offer support, and check for any questions. Document interview completion date, outcomes, and signatures from employee and employer to create an auditable record.

by Kelli Crockard, from the Community

10+

Get

Template

Return to Work Interview Template

This Return to Work Interview template helps managers and employees document details after a non-holiday absence, including dates away, reason or symptoms, and confirmation of notification procedures. It captures employee and manager details, meeting date, prior absence history, and total days absent over 6 and 12 months. Use the action plan section to agree workplace adjustments, review dates, and next steps that support a safe, timely reintegration. Includes sign-off for employee and manager to confirm accuracy and compliance. Customize to suit your HR policies and jurisdiction.

by Iain MacPherson, from the Community

Get

Back to Work Form Template

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Back to Work 2025 Checklist

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