Template

Return to Work Assessment

by Sharon Chevis, from the Community

Use this return to work assessment template to evaluate an employee's fitness for duty after illness or injury. Document medical notes, medications, proposed hours, permitted tasks, hazards and controls, and required inductions. Capture acknowledgements and signatures, set review dates, and ensure safe, compliant re-entry to the workplace.

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Confirm accountability and compliance with a digital log

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
Return to Work Checklist
Streamline employee reintegration after illness or injury with a structured return to work checklist for transport and rail teams. Capture location, manager and employee details, dates of sickness and return, reasons for absence, and total days off. Verify reporting procedures, self-certification, and fit notes, and record medical advice, prescribed medication, and notification forms. Assess business impact, reference attendance procedures, and document accidents or annual leave overlaps. Plan rehabilitation steps, welfare or counseling services, and actions to prevent recurrence, with signatures from both employee and manager.
by Ray Upton, from the Community
Downloads: 0
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Template
Return to Work Risk Assessment Form Template
This return to work risk assessment form is intended to be used to list the identified safety implications associated with the return to work process of employees that are high-risk. The risk assessment process should consider the impact of the workplace on the returning employee's ability to work and if there are existing controls to help mitigate the risk to the employee.
by SafetyCulture
Downloads: 100+
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Template
NJS Return to Work Interview
This return to work interview form helps line managers in construction guide structured conversations with employees or subcontractors returning after sickness or workplace incidents. The template captures employee and absence details, dates, fit notes, RIDDOR and HSE reporting, injury or illness information, ability to resume normal duties, required job modifications, and any medication impacts. It includes a declaration and manager review to document next steps and ensure safe, compliant reintegration to work. Created for NJS Scaffolding teams but adaptable to other sites.
by David Kearney, from the Community
Downloads: 10+
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Template
COVID-19 Return to Work Record
Use this COVID-19 Return to Work Record to document employee details, absence history, and a safe return-to-work induction. Capture symptom checks, confirm PPE issued, brief staff on updated COVID-19 safety measures, and complete manager sign-off for HR compliance. This customizable template supports organizations in standardizing their return-to-work process, maintaining records for audits, and promoting a safe, compliant workplace during reopening and ongoing operations.
by Beth Reed, from the Community
Downloads: 200+
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Return to Work Checklist

Streamline employee reintegration after illness or injury with a structured return to work checklist for transport and rail teams. Capture location, manager and employee details, dates of sickness and return, reasons for absence, and total days off. Verify reporting procedures, self-certification, and fit notes, and record medical advice, prescribed medication, and notification forms. Assess business impact, reference attendance procedures, and document accidents or annual leave overlaps. Plan rehabilitation steps, welfare or counseling services, and actions to prevent recurrence, with signatures from both employee and manager.

by Ray Upton, from the Community

Get

Template

Return to Work Risk Assessment Form Template

This return to work risk assessment form is intended to be used to list the identified safety implications associated with the return to work process of employees that are high-risk. The risk assessment process should consider the impact of the workplace on the returning employee's ability to work and if there are existing controls to help mitigate the risk to the employee.

by SafetyCulture

100+

Get

Template

NJS Return to Work Interview

This return to work interview form helps line managers in construction guide structured conversations with employees or subcontractors returning after sickness or workplace incidents. The template captures employee and absence details, dates, fit notes, RIDDOR and HSE reporting, injury or illness information, ability to resume normal duties, required job modifications, and any medication impacts. It includes a declaration and manager review to document next steps and ensure safe, compliant reintegration to work. Created for NJS Scaffolding teams but adaptable to other sites.

by David Kearney, from the Community

10+

Get

Template

COVID-19 Return to Work Record

Use this COVID-19 Return to Work Record to document employee details, absence history, and a safe return-to-work induction. Capture symptom checks, confirm PPE issued, brief staff on updated COVID-19 safety measures, and complete manager sign-off for HR compliance. This customizable template supports organizations in standardizing their return-to-work process, maintaining records for audits, and promoting a safe, compliant workplace during reopening and ongoing operations.

by Beth Reed, from the Community

200+

Get

Return to Work Assessment

About author

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Return to Work Checklist

Return to Work Risk Assessment Form Template

NJS Return to Work Interview

COVID-19 Return to Work Record

You might also like

Return to Work Checklist

Return to Work Risk Assessment Form Template

NJS Return to Work Interview

COVID-19 Return to Work Record