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?YesNoIf 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 Total days absent from work:First day of absence: Date Format: DD slash MM slash YYYY Date returned to work: Date Format: 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?YesNoWas the absence related to an accident at work - CommentsIf yes, was it reported?YesNoIf yes, was it reported - CommentsRTW discussion notes – to be completed By Community Care ManagerEmployee Name:Employee Date Signed: Date Format: DD slash MM slash YYYY Community Support Manager Name:Community Support Manager Date Signed: Date Format: DD slash MM slash YYYY 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 >> CommentsThis field is for validation purposes and should be left unchanged.
