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Return To Work Clearance Form
"I need a Return To Work Clearance Form for an employee returning from long-term stress leave, with provisions for a phased return starting March 2025 and specific accommodations for reduced workload during the first month."
1. Employee Information: Basic details including name, employee ID, department, and role
2. Absence Details: Dates of absence and nature of illness/injury (if appropriate to disclose)
3. Medical Clearance: Confirmation of fitness to return to work
4. Work Arrangements: Details of return date and any modified duties or adjustments
5. Data Protection Notice: Information about how health data will be processed and stored
1. Phased Return Plan: Details of graduated return to work, used when recommended by medical professional
2. Workplace Adjustments: Specific modifications needed, used when reasonable adjustments are required
3. Follow-up Schedule: Plan for review meetings, used for monitoring complex returns
1. Medical Certificate: Attached GP fit note or specialist medical report
2. Risk Assessment: Workplace assessment for modified duties or adjustments
3. Occupational Health Report: If occupational health assessment was conducted
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