Neonatal Care Leave return to work checklist form template
Supporting information
A supportive return-to-work form for employees coming back from neonatal care leave, ensuring a smooth transition with wellbeing, flexibility, and reintegration in mind.
Neonatal Care Leave return to work checklist form
Employee Name: ______________________________
Job Title: ____________________________________
Department: _________________________________
Manager: ____________________________________
Date of Return: _______________________________
Section 1: Confirmation of Return
? Return date confirmed and recorded in HR system
? Line manager notified
? Payroll notified (if applicable)
Section 2: Wellbeing Check
? Informal check-in held with employee
? Opportunity given to discuss emotional wellbeing
? Employee signposted to internal or external support services
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What is this for?
This return-to-work form is designed for use after an employee returns from Neonatal Care Leave.
It helps line managers and HR teams support employees by reviewing wellbeing, exploring any flexible working needs, and ensuring that adjustments are made sensitively and appropriately.
The checklist includes confirmation of key return dates, optional reintegration plans, and a forward-looking conversation to ensure the employee feels valued and supported.
Documentation sequence
Neonatal Care Leave request acknowledgement letter template
A clear letter template for acknowledging employee requests for Neonatal Care Leave and outlining next steps, pay eligibility, and available support.
Process timescales
Best practice for using the Neonatal Care Leave return to work checklist form template, including key actions before, during, and after implementation.
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| Step | Description | Responsibility | Timing |
| 1 | Arrange a return-to-work meeting with the employee to discuss their return, any adjustments needed, and update them on any team or business changes. | Line Manager / HR | 1–2 weeks before return date |
| 2 | Complete the Neonatal Care Leave Return to Work Checklist Form during the meeting, covering wellbeing, workload, any ongoing flexibility needs, and reintegration support. | Line Manager | On day of return or first working day back |
| 3 | Discuss and document any reasonable adjustments, phased return options, or continued support required (e.g. wellbeing resources or hybrid working). | Line Manager / HR | During the return meeting |
| 4 | Share a signed copy of the completed checklist with the employee and HR, and securely store for records. | Line Manager | Within 2 working days after the meeting |
| 5 | Schedule a follow-up check-in to monitor wellbeing and support reintegration into the role. | Line Manager | Within 2–4 weeks after return |
