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Return To Work Certification Form
"I need a Return To Work Certification Form for an employee returning from a 3-month stress-related absence in March 2025, including provisions for a phased return and reduced working hours for the first month."
1. Employee Information: Basic details including name, employee ID, department, contact information
2. Absence Details: Information about the period of absence including start date, end date, and reason for absence
3. Return Date Declaration: Formal declaration of the intended return to work date
4. Fitness Declaration: Employee's formal declaration that they are fit to return to their duties
5. Manager Authorization: Section for line manager's review and approval of the return to work
1. Medical Certification: Section for medical clearance details, required when returning from long-term illness or medical procedure
2. Workplace Adjustments: Details of any required modifications to workplace or duties, used when medical conditions necessitate changes
3. Phased Return Schedule: Detailed plan for graduated return to work, used for employees returning from long-term absence
4. Health and Safety Assessment: Workplace safety evaluation section, required for injury-related returns or when specific risks need assessment
1. Schedule A - Medical Evidence: Attachments of relevant fit notes, medical certificates or doctor's clearance
2. Schedule B - Risk Assessment Documentation: Completed workplace risk assessment forms and related documentation
3. Schedule C - Adjustment Plan: Detailed documentation of agreed workplace modifications and implementation timeline
4. Schedule D - Occupational Health Report: Any relevant occupational health assessments and recommendations
Authors
Absence Period
Authorized Medical Professional
Company
Effective Date
Employee
Employer
Fit Note
Line Manager
Medical Certificate
Medical Evidence
Normal Working Hours
Occupational Health Advisor
Phased Return
Reasonable Adjustments
Return Date
Return to Work Interview
Risk Assessment
Statement of Fitness for Work
Workplace Adjustments
Working Pattern
Workstation
Absence Details
Medical Certification
Fitness Declaration
Health and Safety
Workplace Adjustments
Return Conditions
Data Protection
Confidentiality
Risk Assessment
Manager Approval
Employee Acknowledgment
Medical Evidence
Phased Return
Working Hours
Support Measures
Occupational Health
Review Period
Declaration of Truth
Signatures
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