| Source: XpertHR P&D |
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Date: 03/04/2007 |
Publisher: XpertHR |
Sickness and sick pay: Form for return to work interview after sickness (form)
TOPICS:| terms, conditions and employee rights | working time and leave
| | employee relations | employee relations challenges and tools
| | health and safety | employee health
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Form wording:
| Return to work interview record |
| Name of employee |
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| Job title |
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| Name of employee's manager |
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| Date of return to work interview |
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| Length of employee's absence |
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| First date of employee's absence |
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| Date of employee's return to work |
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| Reason employee gave for absence: |
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| Did the employee properly notify the employer of his/her absence? |
Yes |
No |
| Did the employee consult his/her GP? |
Yes |
No |
| Did the employee indicate that factors at work may have caused or contributed to the absence? |
Yes |
No |
| If so, please explain: |
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| If so, what action is to be taken to support the employee? |
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| Is this absence part of an overall pattern? |
Yes |
No |
| If so, please explain: |
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| Does the employee have any type of disability? |
Yes |
No |
| Any further comments from the manager: |
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| Signature (manager): |
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| Date form completed: |
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When to use this document
Use this form to create a record of an employee's sickness absence. It
may also be used to record other types of ad hoc absences. |
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