Return to Work Form | Ideal Recruit

This form should be completed by colleague during return to work interview with recruitment consultant/branch manager immediately on returning to work after sickness/absence

It should account for

a) every absence from work

Please note that the provision of any false information may result in disciplinary action being taken, including the possibility of dismissal.

SURNAME(Required)

FORENAME(Required)

EMAIL(Required)

WORK DEP/SITE(Required)

I certify that I was unable to attend work due to sickness/absence on

(Please state the actual dates that you were unable to work including Saturdays, Sundays and Bank Holidays)

Date of Absence(Required)

My normal working days/hours during this period were

Normal Working days/ hours(Required)

The reason for my absence was(Required)

(please tick box)

Please state if/what medications

Was this absence caused by an accident at work?(Required)

YES

Did you consult your doctor?(Required)

YES

Did you follow the correct absence procedure?(Required)

YES

Are you fit to work?(Required)

YES

COMMENTS/ OTHER ACTIONS

Name(Required)

Date(Required)

Signature(Required)

Name

Date

Please email to a Team Leader / Shift Manager

All information on this form are regarded as sensitive as classed under the DDA and new GDPR legislation and should be kept confidential and filled safety and secured.