Return to work interview form template
Value bundles that include this:
This form should be used to record the Return to Work Interview between the manager and employee.
Used as part of good absence policy, this form is used to record a brief interview with an employee returning from any period of sick absence to suggest ways in which the employer can help, or if the employee needs any support.
It should be completed by the manager as soon as is practicably possible on the employees first day back at work after illness (in some cases the interview must take place before the employee is allowed back to their usual work location), and signed by both manager and employee.
Why this form is necessary
A Return to Work Interview Form is a document used by employers to gather information from employees who have been absent from work due to illness, injury, or other reasons. The purpose of the form is to document the reasons for the absence and to help the employer identify any issues or concerns that may impact the employee's ability to perform their job duties.
The Return to Work Interview Form is an important tool for employers to gather information on employee absences and to ensure that employees are able to return to work safely and effectively. The form can also help employers identify any patterns or trends in employee absences, which can help them to address underlying issues and improve employee morale and productivity.
Compliance notes
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The Equality Act 2010: The form must not contain any discriminatory language or assumptions, and should not unfairly target certain employees.
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The Data Protection Act 2018 and the GDPR: The form must handle the employee's personal data in compliance with these regulations and should be securely stored and accessible only to authorized personnel.
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The Employment Rights Act 1996: The form should make clear the employee's right to privacy and confidentiality, and should not be used as a tool for disciplinary action.
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The Company's Policies and Procedures: The form should be in line with the company's policies and procedures regarding absence management and return to work processes, and should not deviate from any stated protocols.
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The ACAS Code of Practice on Disciplinary and Grievance Procedures: The form should be written in a clear and concise manner, outlining the purpose of the interview and any actions agreed upon.
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The employee's Contract of Employment: The form should not conflict with any terms of the employee's contract of employment, and any actions agreed upon should be in line with their job description and responsibilities.
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The employee's health and safety: The form should take into account any health or safety concerns that may affect the employee's ability to perform their job duties.
Workflow sequence
Specifications
5 mins
365 words, 2 pages A4
1 November 2024
Return to work interview
Section 1: Absence details
| Employee name: | |
| Job title: | |
| Department: | |
| First day of absence (date): | |
| Last day of absence (date): | |
| Date returned to work: | |
| Total number of days off work: | |
| Reason for absence(Please give a brief description of the illness or other reason for absence): | |
| Is absence due to an accident or injury at work? | Yes | No |
| If the accident was at work, has an accident form been completed? | Yes | No |
| Have you seen a doctor/dentist? | Yes | No |
| Are medical certificates attached? | Yes | No |
| Action Taken(please give a brief description of any action taken to date): | |
| Proposed Course of Action: |
Section 2: Returning after being issued a fit note / medical certificate
| Are you returning to work before the end of a current fit / note medical certificate expiry? | Yes | No |
| If yes, what advice have you sought from a medical professional before returning? | |
| If yes, are you able to carry out your normal duties? | Yes | No |
| If no, what adjustments do you require? |
Section 3: Discussion record
| Is any support required/are there on going issues/are any adjustments required/will there be follow up treatment or appointments/is there any medication which may affect work etc.? | |
| Summary of key points discussed e.g. is the employee fully recovered etc. |
I understand that if I knowingly provide inaccurate or false information regarding my absence it may result in disciplinary action.
| Signed (employee): | |
| Date: | |
| Signed (line manager): | |
| Date: |
Version: [1.0]
Issue date: [date]
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