Title Page
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BACK TO WORK - to be completed by the Line Manager with the employee when they return to the business
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Employees Name
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Site
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Reason for Absence
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Please make notes around the absence. ie. Treatment given. Ongoing issue etc.
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First day of Absence
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Last day of Absence
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Total working days off
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Has a doctors note been provided? If yes, please take a photo
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Date of Back to Work Interview
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Is the absence to be paid?
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Is the employee still within their probation period?
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Has the employee been brought up to date on any changes, briefings etc.
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Is there any further notes to add? ie. informed about process for calling in, need to catch up again for an update on condition etc.
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Please explain
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This form is to be signed and dated by both the line manager and the employee
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Employee Signature
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Employer Signature
