Return To Work Form Template

This return to work form template has 2 pages and is a MS Word file type listed under our human resources documents.

Sample of our return to work form template:

RETURN TO WORK FORM SUMMARY Employee Name: Department: File Number: Date: EMPLOYEE DETAILS This form must be completed after any period of absence, other than holiday, to cover all periods of sickness in the calendar year. Job Title: Employee Number: Contact Number: Manager: DAYS OF ABSENCE This section is to be completed by your manager with you. First Date of Absence: Date Returned to Work: Total Number of Working Days Absent: Reason for Absence (please specify the nature of your illness/symptoms):