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.

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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 with Lumiform

  • Customize this template or build your own
  • Fill out templates via mobile app
  • Get reports and analyse your data
Prices start from ░░░ per month
Book a demo
Learn more
or Download template as PDF

The back to work form template provides a framework for welcoming employees back after absence while fulfilling your documentation requirements. Beyond simply recording dates and reasons for absence, this template guides meaningful conversations about workplace readjustment and necessary accommodations. You can use it to document medical clearance, identify patterns in absences, and create personalized return plans that support employee wellbeing.

According to research from the CIPD, organizations with structured return to work processes see 35% faster reintegration times and higher employee satisfaction. This template helps you transform what could be an uncomfortable conversation into a productive dialogue focused on support rather than scrutiny.

Related categories

Created by

Author Name Inioluwa Ademuwagun
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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Frequently asked questions

What should I include in a back to work form?

Your back to work form should include employee details, absence dates and reasons, health status confirmation, discussion points about workplace adjustments, and action plans for supporting the return. Include space for both employee and manager signatures, documentation of any medical clearance, and follow-up meeting schedules. Keep the form concise while capturing all essential information.

How do I conduct an effective return to work interview?

Begin by welcoming the employee back in a private setting. Review the form together, discussing the absence without judgment. Ask open-ended questions about their readiness to return and any support needed. Listen actively, document agreements, and focus on forward-looking solutions rather than dwelling on the absence itself. Conclude with clear next steps and a follow-up plan.

What are the legal requirements for return to work documentation?

Legal requirements vary by jurisdiction, but generally include documenting the absence reason, duration, any medical clearance for return, and reasonable accommodations discussed. Keep records confidential and compliant with privacy laws. For disability-related absences, document the interactive process of determining accommodations. Consult local employment law for specific requirements in your region.

Author
Inioluwa Ademuwagun
Inioluwa is a freelance content writer with a passion for words and everything marketing. She has worked closely with B2B SaaS and e-commerce brands creating product-led content. She loves to read fiction and would describe herself as an introverted nerd who desires to travel around the world. She currently doing that with her words till she can with her eyes
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.