Template

Return to Work Interview Form

by Iain MacPherson, from the Community

10+

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.

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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 Form Template
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.
by Kim Gaston, from the Community
Downloads: 10+
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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+
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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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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

Template

Return to Work Form Template

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.

by Kim Gaston, from the Community

10+

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

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

Return to Work Interview Form

About author

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Return to Work Interview Template

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Return to Work Interview Template

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