Return to Work Form

  • Return to Work Form

  • This form is to be completed on your return to work, following any period of absence.

    'Absence', for the purposes of this form, is defined as an occasion or period of being away from work. This form is to be submitted for any reason as to why work commitments were missed (eg. sickness, car troubles...)

    Should you be absent for a period of 7 days or less, you are only required to submit this form. 

    If you are returning to work after sickness for a period of more than 7 days, you are required to provide us with a medical certificate. You are able to attach an image of this below, but will also need to provide your manager with a physical copy.

  • Date/time absence commenced*
     - -
  • Date/time absence ended*
     - -
  • Was your absence in relation to sickness?*
    • Sickness sctn 
    • Did you consult a medical practitioner*
    • medical details 
    • Date of the visit*
       - -
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    • Data Protection


      The information that you have provided above will be used to process your self-certification of absence/self-certification of sickness absence. This information will remain confidential and will not be divulged to third parties, except where required by law, or where we have retained the services of a third-party representative to act on your/our behalf.

    • Declaration

      I certify that I have been incapable of work for the reason and date(s) stated above, and that this information is true and accurate.
      I acknowledge that false information will result in disciplinary action.
      Authorisation
      I have read the Data Protection notification and understand and agree to the use of my personal data, in accordance with the Data Protection Act 1998.
      I hereby give my employer permission to verify the above.

      *      

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