Templates
Back to work form

Back to work form

Streamline the return-to-work process with a comprehensive back to work form. Ensure thorough documentation and compliance for a smooth employee reintegration.

Use this template
or download pdf
Back to work form

Streamline the return-to-work process with a comprehensive back to work form. Ensure thorough documentation and compliance for a smooth employee reintegration.

Use this template
or download pdf

About the Back to work form

A back to work form template is invaluable for managing employee returns after an absence. This template captures essential information such as the reason for absence, medical clearance, and any necessary accommodations, ensuring a smooth reintegration process.   Using a back to work form template enhances consistency. By standardizing the return-to-work process, you ensure that all cases are handled uniformly, minimizing the risk of miscommunication and incomplete documentation. This helps maintain an organized and efficient workflow.   Another key benefit is time-saving and error reduction. With a pre-designed template, you avoid the hassle of creating new forms from scratch each time. This ensures that all critical details are included, speeding up the process and reducing the likelihood of errors.   Customize your back to work form template to meet your specific needs. Add fields relevant to your industry or company policies to ensure it fits seamlessly into your operations. This tailored approach helps you maintain high standards and improve overall efficiency in managing employee returns.  

Key elements of a back to work form template

A well-designed back to work form template includes several crucial elements that ensure a smooth and effective return-to-work process. Here are some key components that help you capture all necessary information and improve your documentation process.  
  1. Reason for absence: This section captures the reason for the employee's absence, whether it’s due to illness, personal reasons, or other factors. Documenting this information helps you understand the context and manage future absences more effectively.
  2. Medical clearance: Including a section for medical clearance ensures that the employee is fit to return to work. This is particularly important for absences due to health issues. It helps you comply with health and safety regulations and ensures the well-being of your staff.
  3. Required accommodations: This section identifies any accommodations the returning employee may need, such as modified duties or flexible hours. Addressing these needs helps you support the employee’s transition back to work and maintain productivity.
  4. Employee and manager signatures: Signatures from both the employee and the manager confirm that the form has been reviewed and agreed upon. This ensures mutual understanding and accountability, reducing the risk of future disputes.
 

How to use a back to work form template

Using a back to work form template effectively can streamline the return-to-work process for your team. Here’s a step-by-step guide to help you and your team make the most of this template:  
  • Customize the template: Begin by tailoring the back to work form template to fit your specific needs. Add fields relevant to your industry, such as specific medical requirements or company policies. This ensures the form captures all necessary information.
  • Assign roles: Use the role assignment feature to designate specific tasks to team members. This ensures everyone knows their responsibilities and helps prevent any steps from being overlooked. Clear assignments improve accountability and efficiency.
  • Implement logic and action management: Set up conditional actions within the template. For example, if an employee requires accommodations, automatically schedule a follow-up meeting to discuss their needs. This helps maintain a smooth and organized process.
  • Train your team: Ensure your team understands how to use the template effectively. Provide training on how to fill out forms, complete checklists, and follow the procedures outlined in the template. Clear instructions and training reduce errors and improve compliance.
  • Monitor and review: Regularly review the completed forms to track progress and identify any issues. Use Lumiform’s analytics features to monitor task completion and make informed decisions. This helps you continuously improve your return-to-work process and maintain high standards.

Categories

  • Health and safety management templates
  • Operational excellence templates
  • General templates
  • Workforce management and HR templates
  • Workplace safety templates
Preview of the template
Details of Resumption of Work
This form must be completed after each absence, except for holidays, to cover all periods of sick leave from the first to the seventh calendar day inclusive.
Employee data
Job description
Employee number
Department
Contact Number
Name of Line Manager
Date of meeting
Day/s of Absence (to be completed by your line manager with you)
First Date of Absence
Letzter Tag der Abwesenheit
Date returned to Work
Total number of Working Days Absent
Enter percentage of total absence
Supporting information (if applicable), e.g. doctor's letter
Add media
Contacting the company
Did you properly notify the employer of your absence?
Who did you speak to?
When did you contact the company?
Previous sickness absence (to be completed by your line manager if applicable)
Previous Absences - List each separate occasion, with number of days and reason.
Total number of days absent in the last 6 months:
Total number of days absent in the last 12 months :
Number of periods in current year
Are you aware of the absence reporting procedures?
Details of the absence
Has the employee consulted a doctor during her absence?
Referral from the occupational medicine department?
Will this absence trigger an absence hearing?
Will this absence period be paid?
Support / action ( if applicable )
Details of the discussion when returning to work (welcome)
Employee feedback
Sign-Off
Action Plan (Agreed adjustments, Review dates and Comments)
Employee signature
Managers signature
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This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.