What is it?
A return to work form is a detailed form that contains information regarding the ability of an employee to resume and continue their work after a long absence or break from their duties. It also includes any limitations or concerns that apply to their regular duties.
When to use?
Consider using this return to work form template anytime you have an employee that wants to resume work after a long absence. Having this template on hand will help you to easily collect all the information required.
What to include?
- Employee details
- Reasons for absence
- Period of absence
- Managers’ names
- Additional details
- Signatures
1. Date |
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2. Employee details |
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Title |
First name |
Middle name |
Last name |
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Email Address |
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Phone Number |
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3. Reasons for absence (Kindly tick the reasons why you are absent appropriately) |
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Sickness |
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Injury |
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Maternity |
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Other |
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4. Period of absence |
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From |
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To |
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Date to return to work |
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Total number of working days absents |
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Is the employee fit to resume to work? |
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Yes |
No |
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5. Additional information by employee |
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Employee signature |
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6. Manager/Supervisor name |
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First name |
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Middle name |
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Last name |
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7. Manager/supervisor recommendation and comment |
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Manager/Supervisor signature |
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