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1. Employee Information: Full name, position, department, employee ID
2. Medical Confirmation: Statement confirming fitness to return to work
3. Return Date: Specific date of return to work
4. Work Capacity Declaration: Any limitations or restrictions on work duties
5. Data Protection Notice: Statement about how medical information will be processed and stored in accordance with UK GDPR
6. Declaration and Signatures: Employee, healthcare provider, and employer signatures and date
1. Workplace Adjustments: Details of any required workplace modifications or accommodations required for the employee's return
2. Phased Return Plan: Schedule and details for gradual return to full duties, including hours and responsibilities
3. Follow-up Requirements: Schedule and details of any required follow-up medical assessments or reviews
1. Medical Report: Detailed medical assessment from healthcare provider including fitness evaluation
2. Risk Assessment: Workplace risk assessment detailing any hazards and control measures for the returning employee
3. Adjustment Plan: Detailed plan of workplace modifications and reasonable adjustments if required
Employee
Healthcare Provider
Medical Condition
Return to Work Date
Work Duties
Regular Hours
Modified Duties
Workplace Adjustments
Phased Return
Medical Release
Fit Note
Occupational Health Assessment
Work Restrictions
Medical Information
Confidential Information
Risk Assessment
Working Environment
Regular Review
Follow-up Assessment
Personal Data
Special Category Data
Data Protection Legislation
Working Day
Line Manager
Fitness Declaration
Work Capacity
Workplace Adjustments
Health and Safety
Confidentiality
Data Protection
Risk Assessment
Review Period
Return Date
Modified Duties
Working Hours
Monitoring
Occupational Health
Responsibilities
Consent
Medical Privacy
Phased Return
Follow-up Requirements
Declaration of Truth
Signatures and Attestation
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Genie’s Security Promise
Genie is the safest place to draft. Here’s how we prioritise your privacy and security.
Your documents are private:
We do not train on your data; Genie’s AI improves independently
All data stored on Genie is private to your organisation
Your documents are protected:
Your documents are protected by ultra-secure 256-bit encryption
We are ISO27001 certified, so your data is secure
Organizational security:
You retain IP ownership of your documents and their information
You have full control over your data and who gets to see it


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