Staff Return to Work Form Updated 01.09.24






    STAFF RETURN TO WORK FORM

    Please complete this form the day before returning to work.

    FULL NAME

    JOB TITLE

    First Day of Illness

    Last Day of Illness

    Please briefly state the specific reason for your absence or inability to work. Avoid generic terms like ‘illness’ or ‘unwell’ and provide detailed information.

    I reported my absence to:

    Date I reported my absence:

    Was your absence unplanned / unexpected? YesNo

    Did your Line Manager approve your absence? YesNo

    By returning to work you are confirming you are fit to return to work. If you wish to have a discussion with your Line Manager for any reason, please indicate in the box below:
    YesNo

    Discussions may be held by telephone.
    Your Mobile Number:

    Please prove you are human

    captcha