Template

Return to Work Form Template

by Kim Gaston, from the Community

10+

Use this employee return to work form to document absence dates and reasons, confirm notification procedures, review previous sickness records, and plan a safe reintegration. Sections include employee and manager details, dates of absence and return, reason for absence, contact and reporting compliance, prior absences in the last 6 and 12 months, and an action plan outlining agreed adjustments, review dates, and comments. The form concludes with employee and manager signatures to confirm understanding and next steps. Intended as a general example; verify suitability for your workplace and jurisdiction.

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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
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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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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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
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Template
Return to Work Form BCS
This Return to Work form helps managers document employee sickness absence and the steps taken before returning. Capture dates of absence, reasons, medical attention, and any links to previous incidents. Verify compliance with reporting procedures, note accident at work details, and track certificates for absences over seven days. Includes health screening questions, declarations, and signatures for both employee and manager. Built by Bulloughs Cleaning Services and suitable for cleaning operations, yet adaptable across industries.
by Sally Taylor, from the Community
Downloads: 10+
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Return to Work Form Template

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Return to Work Interview Template

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Return to Work Interview Template

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