Return to Work Details
This form must be completed after any period of absence, other than holiday, to cover all periods of sickness from the first to the seventh calendar day inclusive.
Name of Line Manager
Total number of Working Days Absent
Reason for Absence (please specify the nature of your illness/symptoms)
Prepare sufficient supply (must last at least for 14 days after last exposure) of face mask to be worn at all times while in the workplace
Employers can issue face masks or can approve employees’ supplied cloth face coverings in the event of shortages.
Maintain 6 feet and practice social distancing as work duties permit in the workplace
Avoid sharing headsets or objects used near face
Avoid congregating in the break room or other crowded places
Measure the employee’s temperature and assess symptoms prior to them starting work
Clean and disinfect all areas such as offices, bathrooms, common areas, shared electronic equipment routinely
Test the use of face masks to ensure they do not interfere with workflow.
Increase air exchange in the building
Increase the frequency of cleaning commonly touched surfaces
Create a plan of staggered breaks and communications that discourage congregation in the break room and sharing of utensils