Free Return to Work Form | PDF | SafetyCulture (2024)

Published 29 Feb 2024

Article byJona Tarlengco

|4 min read

What is a Return to Work Form?

A return to work form is used to document information about employees coming from a prolonged period of absence (e.g. due to injury or sickness) and their ability to return to work and fulfill their job duties. It is either used for self-certification or as a tool during return to work interviews. During the return to work interview, employees complete their form with their manager, and, together, they outline how the employee could be reintegrated back into the workforce as seamlessly as possible.

What is in a Return to Work Form?

Within the return to work form, managers and employees will need to typically provide details relating to their absence, such as:

  • the duration of absence;
  • the method used by employees to notify of their absence;
  • the reason for absence;
  • details about previous absences over the past calendar year (if applicable);
  • a summary of the return to work plan; and
  • reasonable adjustments/accommodations necessary to help the employee go back to work safely

Why is it Important to Go Through the Return to Work Form?

While filling out a return to work form is not legally required in the U.S. and U.K, it is a vital tool for companies to understand employees, identify any patterns in absences, and determine ways how to support them and reduce absenteeism in the long run. Additionally, going through return to work forms help:

  • discourage unauthorized and non-genuine absences;
  • confirm the accuracy of an employee’s absence record;
  • inform employees about the necessary updates that have been taken during their absence;
  • identify any workplace adjustments that may be needed to help the employee adjust during the reintegration; and
  • develop, discuss, and agree on a Return to Work Plan.

Employers may decide to make return to work forms and interviews as requirements of their return to work program to help them ensure proper documentation of the processes.

What is a Return to Work Interview?

A return to work interview is a brief meeting between an employee and the manager on the former’s return to work after an absence. This discussion serves as the manager’s acknowledgment of the employee’s intention to return to work and the method to determine the most suitable return to work plan for the employee.

How to Facilitate an Effective Return to Work Interview

To carry out an effective return to work interview, managers should consider the following:

Before the Interview

  • It would be beneficial to review the employee’s attendance record over the year and the return to work interview notes attached (if applicable). This will allow the manager to have a better foundation of how to support the employee when making the return to work plan.
  • Use a return to work interview form template as a guide for structuring the interview, but make sure to maintain a two-way communication throughout the process.
  • Choose a meeting space where the employee will feel comfortable.

During the Interview

  • Be clear that the purpose of the meeting is to provide support to the individual in his/her return to work.
  • Discuss with the employee the notes from their previous return to work interviews and establish what help the employee is currently receiving.
  • Discuss the cause(s) of absence and the likelihood of the illness recurring and give the employee the opportunity to highlight any relevant issues.
  • Probe if there are any personal or work-related concerns that might affect their attendance. If there are personal issues, discuss whether there are any support mechanisms/actions that the employee or the manager may reasonably take to seek to alleviate the problems, (e.g., access to counseling, staff helpline, etc.). If the problems are work-related. If absences relate to disability, pregnancy, or a work-related accident, undertake a return to work risk assessment.
  • Establish if any ‘reasonable adjustments’ are required to their role or work environment.
  • Remind the employee of the mutual obligations – i.e. that it is the individual’s responsibility/contractual obligation to attend work, and the employer/manager has a corresponding responsibility and concern for the employee’s wellbeing.

After the Interview

  • Both parties should sign the return to work form once the action plan has been agreed upon. This information should remain completely confidential.
  • If appropriate agree on a review period and/or any actions required.
  • Make sure to identify specific actions and inform responsible task owners.
  • Be available to talk to/meet with the employee, should they have any issues following the RTW.

Employee Return to Work Form Example

Here’s a filled-out example that shows what an employee return to work form report looks like:

Employee Return to Work Form | SafetyCulture

Digital Tool to Help Workers Get Back on Track Fast and Safe

Prolonged absences in the workplace can drain a company’s productivity and an employee’s morale. With this, it’s important to understand the ‘why’ of employee absence to be able to help them get back on track as quickly and safely as possible.

Paper-based return to work forms or complicated systems are effective at recording return to work interviews. However, they can cause inefficiencies down the road as paper records can be lost or destroyed, causing the company to lose crucial information about employee attendance. With SafetyCulture (formerly iAuditor), the world’s leading inspection software, managers can do away with paper return to work forms and shift to a digital return to work checklists and forms that can help improve efficiency in performing return to work interviews. Furthermore, managers can:

  • customize return to work templates according to the company’s standards or their country’s best practices;
  • allow collaboration amongst adjusters, medical case managers, risk managers, HR reps, and safety personnel and discuss the best way to get an employee back to work;
  • immediately assign actions (with automated notifications) to assigned personnel to help the employee adjust seamlessly to the return to work process;
  • enable digital sign-off with the employee on the agreed return to work plan; and
  • have access to a dashboard that helps analyze insights from return to work interviews across the department or the entire organization.
  • automatically generate reports after completing a return to work form. Preview a sample return to work pdf report here.

Featured Return to Work Forms

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HSE Return to Work Questionnaire

This HSE Return to Work questionnaire is used to determine work-related stress or outside of work factors which may have caused an employee to underperform and lose motivation to work, thus causing prolonged absence. This template is divided into 7 categories to identify the main causes of stress among the employees.

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Return to Work Interview Template

This Return to Work Interview Form is designed as a guide for the manager when meeting with employees on their return to work from sickness absence. It can help the manager to structure interviews better while still being able to document responses better with open-ended questions.

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Return to Work Plan Template

This Return to Work Plan template can be used, particularly by Australia-based employees, to develop a recovery and return to work strategy if they are likely to be away from work for more than four weeks. The return to work plan aims to include the necessary steps required to achieve the objectives agreed on by the employee and the manager.

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Return to Work Risk Protocol

This return to work risk assessment form is intended to be used to list the identified safety implications associated with the return to work process of employees that are high-risk. The risk assessment process should consider the impact of the workplace on the returning employee’s ability to work and if there are existing controls to help mitigate the risk to the employee.

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COVID-19 Guidance for Businesses and Employers

This interim guidance is based on what is currently known about the coronavirus disease 2019 (COVID-19). The following interim guidance may help prevent workplace exposures to COVID-19, in non-healthcare settings.This guidance also provides planning considerations for community spread of COVID-19.

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Return-to-Work Guidance for Construction Workforce

This return to work guidance can be used as a reference by construction site safety managers when planning for the safe resumption of construction work. You can customize this guidance to include additional and specific guidelines/measures from the CDC and construction industry associations.

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Return-to-Work Guidance for Manufacturing Workforce

This return to work guidance can be used by manufacturing site leaders when planning for the safe resumption of production in manufacturing sites. You can customize this guidance to include additional and specific guidelines/measures from the CDC and manufacturing industry associations.

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Return-to-Work Guidance for Package Delivery Workforce

Leaders from package delivery companies can use this customizable return to work guidance as a reference when planning for the safe resumption of delivery services. Customize it accordingly as new measures are announced by international health authorities (e.g. CDC and WHO) and industry associations (e.g. ASCM and AAPA).

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Return to Work Form Checklist for Critical Workers

This return to work form can be used to assess returning workers from these critical infrastructure sectors:

  • federal, state and local law enforcement;
  • 911 call center employees;
  • fusion center employees;
  • hazardous material responders from government and the private sector;
  • janitorial and other custodial staff; and
  • individuals employed in food and agriculture, critical manufacturing, informational technology, transportation, energy, and government facilities.

Inspection template

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Return to Work Form Checklist for Healthcare Workers

This printable hospital and medical return to work form can be used by public health professionals when assessing whether a healthcare personnel (HCP), who was cleared from having COVID-19, can return to work or not. This tool uses criteria set by the Center for Disease Control and Prevention (CDC) to help determine if a returning HCP meets the set criteria.

Inspection template

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Retail & Hospitality - Covid 19 Return to Work Checklist

BRC-USDAW recommended implementation practices for Non-Food Retail Stores to help manage your employees that are returning to work. A guide for retailers on how to implement Government advice based upon recommendations from http://brc.org.uk/news/corporate-affairs/social-distancing-in-retail-stores-and-warehouses/. It covers elements including managing your colleagues, limiting the spread of Coronavirus, and protecting staff canteens and rest areas.

Free Return to Work Form | PDF | SafetyCulture (2)

  • Free Return to Work Form | PDF | SafetyCulture (3)
Article by
Jona Tarlengco

SafetyCulture Content Specialist

Jona Tarlengco is a content writer and researcher for SafetyCulture since 2018. She usually writes about safety and quality topics, contributing to the creation of well-researched articles. Her years of experience in one of the world’s leading business news organisations helps enrich the quality of the information in her work.

Free Return to Work Form | PDF | SafetyCulture (2024)
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