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Return To Work Interview Form
"I need a Return To Work Interview Form for our manufacturing facility that includes enhanced safety protocols and physical capability assessments, specifically designed for employees returning from long-term medical leave, with particular attention to OSHA compliance and gradual return-to-work schedules."
1. Employee Information: Basic details including employee name, ID, department, and position
2. Absence Details: Information about the period of absence, including start and end dates, and type of absence (e.g., illness, injury, other)
3. Return to Work Discussion: Documentation of the conversation regarding the employee's wellbeing and readiness to return
4. Work Capability Assessment: Evaluation of the employee's ability to perform their regular duties and any limitations
5. Required Accommodations: Details of any workplace adjustments or accommodations needed for the employee's return
6. Action Plan: Specific steps and measures agreed upon to support the employee's return
7. Sign-off Section: Signatures from employee, manager, and date of the interview
1. Medical Certification Review: To be included when medical clearance is required for return to work
2. Phased Return Schedule: Used when the employee requires a gradual return to full duties
3. Performance Monitoring Plan: Include when specific monitoring of the employee's progress is needed
4. Health and Safety Risk Assessment: Required for returns involving workplace injuries or ongoing health concerns
5. Occupational Health Referral: Include when occupational health assessment is needed
1. Schedule A - Phased Return Timeline: Detailed schedule of graduated return to work, if applicable
2. Schedule B - Workplace Adjustments Checklist: List of specific accommodations and modifications required
3. Schedule C - Follow-up Meeting Schedule: Timeline for review meetings to monitor progress
4. Appendix 1 - Medical Guidelines: Reference guidelines for specific medical conditions and recommended accommodations
5. Appendix 2 - Contact Information: List of relevant support contacts (HR, occupational health, employee assistance program)
Authors
Reasonable Accommodation
Essential Job Functions
Fit for Work
Modified Duty
Light Duty
Phased Return
Return to Work Plan
Work Restrictions
Regular Duties
Medical Certification
Occupational Health Assessment
Workplace Adjustments
Follow-up Review
Risk Assessment
Temporary Modifications
Full Capacity
Restricted Duty
Support Measures
Gradual Return Schedule
Absence Details
Medical Privacy
Health and Safety
Workplace Accommodations
Work Capability
Confidentiality
Return Conditions
Performance Monitoring
Review Period
Support Measures
Risk Assessment
Occupational Health
Compliance
Documentation Requirements
Sign-off and Authorization
Healthcare
Manufacturing
Retail
Professional Services
Education
Technology
Construction
Financial Services
Transportation
Hospitality
Government
Non-profit
Energy
Telecommunications
Agriculture
Human Resources
People Operations
Employee Relations
Occupational Health
Legal
Compliance
Benefits Administration
Workers Compensation
Health and Safety
HR Manager
Human Resources Director
HR Business Partner
Employee Relations Manager
Occupational Health Manager
Department Manager
Line Manager
Supervisor
HR Coordinator
Benefits Administrator
Leave Administrator
Workers Compensation Coordinator
HR Compliance Officer
People Operations Manager
Disability Management Specialist
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