Return To Work Restrictions Form Template for England and Wales

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Key Requirements PROMPT example:

Return To Work Restrictions Form

"I need a Return To Work Restrictions Form for an employee returning from long-term sick leave in February 2025, with specific provisions for reduced hours and ergonomic workspace requirements for an office-based role."

Document background
The Return To Work Restrictions Form is a critical document used when employees resume work following extended absence, injury, or illness. This form, compliant with English and Welsh law, serves multiple purposes: it protects both employer and employee by clearly documenting agreed workplace restrictions, ensures compliance with health and safety regulations, facilitates appropriate workplace adjustments, and creates a clear record of return-to-work arrangements. The document is particularly important in fulfilling employers' duty of care obligations and maintaining compliance with the Equality Act 2010 and Health and Safety at Work Act 1974.
Suggested Sections

1. Employee Information: Basic details including name, employee ID, department, and role

2. Absence Details: Information about the reason for absence and duration

3. Medical Clearance: Confirmation of fitness to return to work

4. Work Restrictions: Specific limitations or modifications required

5. Duration of Restrictions: Timeline for temporary restrictions or adjustments

6. Signatures: Employee and manager acknowledgment

Optional Sections

1. Phased Return Schedule: Detailed timeline for gradual return to full duties - use when employee requires graduated return to work

2. Workplace Adjustments: Specific modifications to workplace or equipment - use when physical workplace changes are needed

3. Review Schedule: Planned check-in dates to assess progress - use for long-term or complex returns

Suggested Schedules

1. Medical Certificate: Copy of fit note or medical clearance

2. Risk Assessment: Detailed workplace assessment for return

3. Occupational Health Report: Professional recommendations if applicable

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant Industries
Relevant Teams
Relevant Roles
Industries

Health and Safety at Work etc. Act 1974: Primary legislation covering employer duties for employee safety, risk assessment requirements, and safe working environment obligations

Management of Health and Safety at Work Regulations 1999: Regulations detailing risk assessment requirements, special considerations for vulnerable workers, and return to work procedures

Equality Act 2010: Legislation protecting against discrimination, requiring reasonable adjustments for disabled employees, and ensuring pregnancy and maternity protections

Data Protection Act 2018 and UK GDPR: Laws governing the processing of health data, medical information confidentiality, and data storage/sharing requirements

Access to Medical Reports Act 1988: Legislation covering consent requirements for medical information and employee rights regarding medical reports

Employment Rights Act 1996: Act protecting employment terms, right to return to work after illness/injury, and unfair dismissal provisions

Working Time Regulations 1998: Regulations governing maximum working hours, rest break requirements, and special considerations for returning workers

RIDDOR 2013: The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations covering reporting requirements and record keeping obligations

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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