HS&S Return to Work - duplicate

This document is to support the return to work of an individual and should not be shared publicly. This document should only be shared with the employee, Team Manager, Regional Manager and HR. The disclaimer & confidentiality statement in iAuditor is not valid in the use of this document.

• Engineer name & tech number (this will be document title)

• Payroll number: (Required for HR)

• Visit Date/Time

  Date
• Location
  Address

• Completed By:

Pre - Visit information

Attendance History

• Last six months absence record

• Please include any relevant images:This could be absence summary screen shot.

  Media

Reason for absence

Notified by whom at what time and date

Visit

Please use this section to record your discussions in relation to the individuals absence levels and the implications this may have for them. For SSSL this should include dialogue about where the individual sits in the absence colour coding and what sanctions could apply at each stage Remember to use discretion if the engineer is white less emphasis should be made on the return to work interview, but still advise the outcome of future absence.

After Care Note if the employee was off Long term sick please ensure skills analysis documents is filled in, this can also be used for short term absence at managers discretion! The completed skills analysis will need to be stored and sent with the return to work to all relevant parties.

• Did the employee attend the doctors during absence?

  Yes

  No

  N/A

• If yes did the doctor declare them fit to return to work<br><br>Note Please ascertain if they explained their role to the doctor

  Yes

  No

  N/A

• Is the employee on any medication that could affect their duties I.e driving or working at height?

  Yes

  No

  N/A

• Can you drive whilst taking this medication?<br>

  Yes

  No

  N/A

• What medication and for what period?

• Does the employee need a staged return to work, if yes please detail below

  Yes

  No

  N/A

• Please set out plan with volumes of work and period.

• Did an on site working at height assessment take place<br><br>Note for all Long term absence this must take place and its advisory to carry out if the employees absence could affect their duties for short term at the managers discretion.

  Yes

  No

  N/A

• Details

• Please include any relevant images: Please adhere to Data protection guidelines for images

  Media

Please ensure you CC admin.laserfiche@bskyb.com a copy for your engineers file. Ensure you put your engineers payroll number into the subject line of the email.

• Does this employee require further support I.E Counselling, physiotherapy, future medical appointments, Occupational health referral or any further training?<br><br>Note if long term sick the skills assessment document should be filled in to asses if their any skill gaps, this can also be used for short term at Managers discretion

  Yes

  No

  N/A

• Details

• Does the employee need a staged return to work, if yes please detail below

  Yes

  No

  N/A

• Please set out plan with volumes of work and period.

• Did an on site working at height assessment take place<br><br>Note for all Long term absence this must take place and its advisory to carry out if the employees absence could affect their duties for short term at the managers discretion.

  Yes

  No

  N/A

• Details

• Please include any relevant images: Please adhere to Data protection guidelines for images

  Media

Please ensure you CC admin.laserfiche@bskyb.com a copy for your engineers file. Ensure you put your engineers payroll number into the subject line of the email.

• Engineer

  Sign

• Observer

  Sign