Graham Roofing (GRE002) Return to work Interview

• Document No.

• Person returning to work

• Conducted on

  Date

• Manager

Return to work Interview

• This form must be completed immediately upon employees return to work with their line manager.

Employee Details

• Name

• Job Title

Absence Details

• First date of absence

  Date

• Date of Return

  Date

• No. Of days Absent

• Who was the absence reported to.

• Method of informing Manager

• Date Reported

  Date

• Has employee provided a self certificate or fit note ?

  Yes

  No

  N/A

• Was absence due to illness?

  Yes

  No

  N/A

• Give details

• Description of symptoms

• Did employee see a Doctor

  Yes

  No

  N/A

• Details

• Was this a recurring illness?

• Is the employee fully recovered?

  Yes

  No

  N/A

• What modifications to their job will be required?

• Will their symptoms/medication affect their ability to do the job?

  Safe

  At Risk

  N/A

Declaration

• I understand that if I provide inaccurate or false information about my absence I may be subject to disciplinary action and may forfeit my right to sick pay,subject to my service entitlement.

  Sign

Review by Manager

• Is any further action required? e.g occupational surveillance or review any patterns of absenteeism

• Managers Signature

  Sign