Return to Work Form Template for Netherlands

A Return to Work Form helps employees and employers manage the transition back to work after sick leave in the Netherlands. Dutch employers use this document to record important details about an employee's recovery, any ongoing medical restrictions, and needed workplace adjustments in line with the Wet Verbetering Poortwachter (Gatekeeper Law).

The form plays a key role in preventing future health issues and ensuring a smooth return to duties. It typically includes the agreed working hours, specific tasks the employee can perform, and a timeline for gradually resuming full responsibilities. Both the company doctor (bedrijfsarts) and employee must approve these arrangements before work resumes.

Use a Return to Work Form whenever an employee returns from sick leave lasting more than six weeks in the Netherlands. This timing aligns with Dutch reintegration requirements and helps document the mandatory consultation between the employee, employer, and company doctor (bedrijfsarts).

The form becomes especially important when planning gradual returns, implementing workplace adjustments, or managing complex health situations. Complete it during the return-to-work meeting, before the employee's first day back. This creates clear agreements about modified duties, working hours, and support measures - protecting both employer and employee under Dutch labor law while promoting successful workplace reintegration.

• Basic Medical Clearance Form: Standard version documenting the company doctor's approval and basic return conditions
• Phased Return Plan Form: Details gradual increases in working hours and responsibilities over time
• Workplace Modification Form: Focuses on specific workplace adjustments and accommodations needed
• Full Reintegration Agreement: Comprehensive form covering all aspects of return including long-term monitoring
• Industry-Specific Forms: Tailored versions for high-risk sectors like construction or healthcare, with additional safety protocols

• Employer/HR Manager: Initiates and maintains the Return to Work Form, coordinates the return process, and ensures compliance with Dutch labor laws
• Employee: Reviews, provides input, and signs the form, agreeing to the outlined return conditions and modifications
• Company Doctor (Bedrijfsarts): Assesses medical fitness, recommends work adjustments, and approves the return plan
• Direct Supervisor: Helps plan work duties, implements recommended adjustments, and monitors progress
• UWV Representative: May review the form for compliance with Dutch social security regulations in long-term cases

• Medical Documentation: Collect the company doctor's assessment and recommendations for work modifications
• Employee Details: Gather information about previous role, current capabilities, and preferred working hours
• Workplace Analysis: Review available accommodations and necessary equipment modifications
• Timeline Planning: Map out gradual return phases, including specific dates and milestones
• Stakeholder Input: Consult with direct supervisor about departmental capacity and task allocation
• Legal Compliance: Ensure alignment with Dutch Gatekeeper Law requirements and UWV guidelines

• Personal Information: Employee details, company position, and relevant medical absence dates
• Medical Clearance: Company doctor's approval and specific work-related restrictions
• Return Schedule: Detailed phasing plan with dates, hours, and progression timeline
• Workplace Adjustments: Specific modifications to duties, equipment, or environment
• Monitoring Plan: Schedule for progress reviews and evaluation criteria
• Signatures Section: Space for employee, employer, and company doctor signatures with dates
• Privacy Statement: GDPR-compliant clause about handling medical information

People often confuse a Return to Work Form with a Sick Pay Form, but they serve distinct purposes in Dutch employment law. While both relate to employee illness, they handle different aspects of absence management.

• Timing and Purpose: Return to Work Forms focus on future arrangements and workplace reintegration, while Sick Pay Forms deal with financial compensation during the illness period
• Required Information: Return to Work Forms detail workplace modifications and gradual return schedules; Sick Pay Forms concentrate on absence duration and salary continuation details
• Key Stakeholders: Return to Work Forms need input from the company doctor, supervisor, and employee about work capabilities; Sick Pay Forms primarily involve HR and payroll departments
• Legal Framework: Return to Work Forms align with the Wet Verbetering Poortwachter requirements; Sick Pay Forms follow Dutch social security and sick pay regulations