Return to Work Form Updates Return to Work FormFirst NameLast NameJob TitleFirst Date of AbsenceReturn to Work DateLast Date of AbsenceTotal Number of Days AbsentDid you Contact the Company at the Start of your Absence Yes NoWho Did you InformWhat was the Reason for thisReason for AbsenceWas your absence work related? Yes NoDid you see your GP for your condition? Yes NoWere you issued long term medication? Yes NoYou Must Complete a New Employee Health and Safety Questionaire (On the Staff Page).Will this be an ongoing condition? (i.e. life long condition) Yes NoAre there any work adjustments we need to put in place to support you?Signature Submit Form
