Return To Work Form

SECTION 1: ABSENCE DETAILS. Name *
SECTION 1: ABSENCE DETAILS. Name
Date of Return to Work *
Date of Return to Work
Absent From *
Absent From
Unitl *
Unitl
Did the employee follow correct absence reporting procedures? *
Self-Certification or Doctor’s note received? *
Is the employee fit to resume normal duties *
SECTION 2: RETURN TO WORK INTERVIEW. Date of Interview *
SECTION 2: RETURN TO WORK INTERVIEW. Date of Interview
Currently under absence monitoring? *

*Required