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Return to Work Form
Please fill in the information below as fully as possible. This will ensure that the individual can be ready to work as soon as possible, and notes are recorded for their respective staff files.
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Email
*
Your email
Name
*
First and last name
Your answer
Welcome back - Brief the staff member on what they may have missed during their absence from their role.
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Your answer
Explain that the return to work form is not part of the disciplinary process
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Explained
Required
What is the reason for the staff member's absence?
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Your answer
Ask them how they are feeling now - Some staff may require some emotional support depending on their situation. (Note: Do not ask potentially intrusive questions to an individuals private life or medical circumstances)
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Your answer
Ask the staff member whether there is any support they may require from the company upon their return.
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Your answer
You must ask if their absence was related to a disability (as this is recorded seperately on our system).
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Your answer
Confirm with the staff member the total number of absences they have taken within the last 12 months.
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Your answer
Inform the individual of their Bradford Factor Score (Do not include absences related to disability or maternity)
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Your answer
If they have hit a trigger point, explain the consequences to them clearly. Provide them with the absence management literature.
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Your answer
Date
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