Free Return to Work Form Template for New Zealand

A Return to Work Form helps employees and employers manage the process of coming back to work after an illness, injury, or extended leave in New Zealand. It's a key document that outlines any medical restrictions, needed workplace adjustments, and gradual return arrangements to ensure a safe transition back to work.

Under NZ's Health and Safety at Work Act 2015, employers must use these forms to document their support for returning workers and show they're meeting their duty of care. The form typically includes sign-offs from healthcare providers, details about modified duties, and specific timeframes for increasing work hours or responsibilities.

Use a Return to Work Form any time an employee needs to resume work after taking more than seven consecutive days of medical leave in New Zealand. This includes recovery from workplace injuries, extended illness, surgery, or ACC-related absences where the employee's health could affect their job performance.

The form becomes essential when medical professionals have specified work restrictions or when a gradual return schedule is needed. It's particularly important in physically demanding roles, safety-sensitive positions, or when an employee's duties need temporary modification. Having this documentation protects both employer and employee under NZ workplace safety laws.

• Return To Work Letter: A formal document from employers confirming return arrangements and any workplace modifications.
• Return To Work Interview Form: Records discussions between manager and employee about the return process and support needed.
• Return To Work Medical Certificate: Medical provider's detailed assessment of work capacity and restrictions.
• Medical Return To Work Form: Comprehensive health clearance with specific duty limitations and accommodations.
• Back To Work Form: Simplified version for straightforward returns without major medical restrictions.

• Employers/HR Managers: Create and customize the form, coordinate the return process, and ensure compliance with health and safety obligations.
• Employees: Complete their sections, provide medical documentation, and agree to any modified duties or gradual return plans.
• Healthcare Providers: Assess work capacity, specify restrictions, and sign off on medical clearance for return to work.
• ACC Case Managers: Review and approve return plans for injury-related cases, ensuring appropriate support and rehabilitation.
• Health and Safety Representatives: Consult on workplace modifications and monitor compliance with safety requirements during the return period.

• Medical Documentation: Collect detailed medical certificates and any specialist recommendations about work restrictions.
• Employee Details: Gather absence dates, health condition summary, and proposed return date.
• Job Requirements: List essential duties, physical demands, and any potential risks in the role.
• Workplace Modifications: Document specific adjustments needed, including equipment, schedule changes, or duty modifications.
• Return Timeline: Create a clear schedule showing gradual increase in hours or duties if needed.
• Support Plan: Our platform helps outline monitoring arrangements and regular check-ins, ensuring your form meets all NZ legal requirements.

• Personal Details: Employee name, position, department, and relevant contact information.
• Medical Information: Health provider's clearance, specific work restrictions, and duration of limitations.
• Return Plan: Proposed return date, hours, duties, and any gradual increase schedule.
• Workplace Adjustments: Required modifications, equipment needs, and support measures.
• Review Schedule: Planned check-in dates and progress assessment timeline.
• Authorisation Section: Signatures from employee, manager, and medical provider, plus privacy consent under NZ Privacy Act.
• Health & Safety Statement: Confirmation of compliance with the Health and Safety at Work Act 2015.

A Return to Work Form differs significantly from a Sick Pay Form in both purpose and timing. While both relate to employee absence management, they serve distinct functions in New Zealand's workplace health and safety framework.

• Purpose and Timing: Return to Work Forms focus on future work arrangements and safety measures, while Sick Pay Forms document past absences and process payment entitlements.
• Medical Detail Level: Return to Work Forms require comprehensive medical clearance and specific workplace modifications, whereas Sick Pay Forms typically need only basic medical verification.
• Legal Requirements: Return to Work Forms must comply with Health and Safety at Work Act obligations for safe workplace reintegration; Sick Pay Forms primarily address Holidays Act requirements.
• Stakeholder Involvement: Return to Work Forms need input from healthcare providers, managers, and sometimes ACC, while Sick Pay Forms usually only require employee and manager sign-off.