You can save your progress at any time by using the orange 'SAVE YOUR PROGRESS AND CONTINUE LATER' button towards the bottom. This will allow you to save your progress and return to complete the form at a later time/date.The aim of the return to work interview is: To ensure the employee is up to date with work or re-allocation of work during their absence. To assist the community support manager to identify where they can help or take action to help prevent a further recurrence of sickness absence. The Interview must be held within two days of the employee returning to work and this form should be forwarded to Administration once completed. Please note: The information on this form is likely to be considered as sensitive data and as such needs to be processed under the provisions of the Data Protection Act. Therefore, information contained in this document will be treated as strictly confidential and kept in the employee’s personnel file.Employee Name:* Location: Self-Certificate/Statement of Fitness for Work attached? Yes No If you have a Self-Certificate/Statement of Fitness for Work you can upload it below.Please upload a Self-Certificate/Statement of Fitness for Work Drop files here or Select files Max. file size: 256 MB. Total days absent from work: First day of absence: DD slash MM slash YYYY Date returned to work: DD slash MM slash YYYY Last recorded absence: Number of absences to date: Reason for absence:Was the absence related to an accident at work? Yes No Was the absence related to an accident at work - CommentsIf yes, was it reported? Yes No If yes, was it reported - CommentsRTW discussion notes – to be completed By Community Care ManagerFirst day of shift/session hand back: DD slash MM slash YYYY Date returned to work: DD slash MM slash YYYY Reason for hand back:RTW discussion notes – to be completed By Community Care Manager:Total number of days sick: Total number of absent periods: Total number of shift hand backs: Bradford Score Record: Further Action Required?Note: If further action is required, please arrange a meeting to discuss the matter with senior management. Yes No Employee Name: Employee Date Signed: DD slash MM slash YYYY Community Support Manager Name: Community Support Manager Date Signed: DD slash MM slash YYYY Please note: The information on this form is likely to be considered as sensitive data and as such needs to be processed under the provisions of the Data Protection Act. Therefore information contained in this document must be treated as strictly confidential and kept in the employee’s personnel file.I certify that the information given is correct and accurate:* I certify Privacy* By using this form you agree with the storage and handling of your data by this website. More information >> NameThis field is for validation purposes and should be left unchanged.
