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Return To Work Authorisation Form
"I need a Return To Work Authorisation Form for an employee returning from long-term sick leave due to surgery, with provisions for a phased return starting March 2025 and specific workplace adjustments for reduced mobility."
1. Employee Information: Basic details including name, employee ID, department, role
2. Absence Information: Reason for absence, duration, return date
3. Health Declaration: Employee's confirmation of fitness to return
4. Manager Authorization: Approval section for line manager
5. Data Protection Statement: Information about how health data will be processed and stored
1. Medical Certification: Required for absences over 7 days or specific health conditions
2. Phased Return Details: Used when employee requires graduated return to work
3. Workplace Adjustments: Required when modifications to workplace or duties are needed
4. Occupational Health Review: Used for long-term absence or specific health conditions
1. Risk Assessment Form: Detailed assessment of workplace risks and mitigations
2. Medical Certificate: Attached when provided by healthcare professional
3. Phased Return Schedule: Detailed timeline of graduated return to full duties
4. Workplace Adjustment Plan: Specific modifications required for safe return
Authors
Authorised Personnel
Company
Confidential Information
Employee
Employer
Fit Note
Health Data
Line Manager
Medical Certificate
Medical Professional
Normal Working Hours
Occupational Health Provider
Phased Return
Reasonable Adjustments
Return Date
Return to Work Interview
Risk Assessment
Supporting Documentation
Workplace
Workplace Adjustments
Working Pattern
Absence Details
Health Declaration
Risk Assessment
Medical Certification
Workplace Adjustments
Data Protection
Confidentiality
Health and Safety
Working Hours
Return Conditions
Authorization
Occupational Health
Performance Requirements
Support Measures
Review Period
Compliance
Monitoring
Emergency Contact
Declaration and Signature
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