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The Employee Return to Work Form is a crucial document used in New Zealand workplaces to facilitate and document an employee's return to work following an absence due to illness, injury, or other circumstances. This form is designed to comply with New Zealand's workplace health and safety legislation, including the Health and Safety at Work Act 2015 and ACC requirements. It should be used whenever an employee is returning to work after a significant absence, particularly when medical clearance is required or workplace modifications are necessary. The document captures essential information including medical clearance details, any required workplace modifications, graduated return schedules, and specific health and safety considerations. It serves as both a planning tool and a formal record of the agreed arrangements between employee and employer, ensuring a safe and well-managed return to work process.

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

2. Absence Details: Information about the reason for absence, duration, and type (injury/illness/other)

3. Medical Clearance: Details of medical clearance to return to work, including any restrictions or accommodations required

4. Return to Work Schedule: Proposed date of return and whether it's a full or graduated return to work

5. Workplace Modifications: Any required modifications to workplace, equipment, or duties

6. Health and Safety Considerations: Specific health and safety requirements or risk management measures

7. Authorization: Signatures from employee, supervisor, and relevant health professionals