Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Employees Name

  • Division/Contract

  • Job Title

  • Date RTW carried out

  • Date Sickness started

  • Date returned to work

  • No. of days sick

  • Reason for absence

  • Response and agreed actions (Sickness/Absence to be added to Bradford and reviewed? Sick Note?)

  • Please advise pay;

  • Is the employee fully recovered, able to perform their duties and undertake hours of work?

  • Is this the first occurrence of this type of absence?

  • If the above answer is no how many times has the employee been off in the last 12 months for this type of absence

  • Has the employee sought medical advice?

  • Has the employee been given advice/medication which may have an impact on their ability to do their job?

  • Employee signature

  • Line Managers Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.