Template

Back to Work Interview Form

by Kelli User, from the Community

20+

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.

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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 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
Back to Work Form Template
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.
by Kelli User, from the Community
Downloads: 10+
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Template
Return to Work Interview Form
This return to work interview template guides managers and employees through post-absence discussions after sickness or injury. Capture absence dates, reasons, notification details, previous absences, and awareness of procedures. Agree on adjustments and a reintegration action plan, then record signatures from both parties. Use it to standardize HR compliance and support a safe, timely return to work.
by Iain MacPherson, from the Community
Downloads: 10+
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Back to Work Interview Form

With SafetyCulture you can

Digitize team workflows

Reduce manual errors

Create and share inspection reports

About author

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