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Medical Leave Return To Work Form

Medical Leave Return To Work Form Template for New Zealand

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Key Requirements PROMPT example:

Medical Leave Return To Work Form

"I need a Medical Leave Return to Work Form for an employee returning from surgery who requires a gradual return to work plan starting March 2025, with modified duties and reduced hours for the first month."

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Document background
The Medical Leave Return To Work Form is a crucial document used in New Zealand workplaces when employees are returning to work following a period of medical leave. It serves as a formal record of the return-to-work process, ensuring compliance with New Zealand's workplace health and safety regulations, employment laws, and privacy requirements. The form is designed to capture essential information including medical clearance details, any necessary workplace modifications or accommodations, and the agreed terms of return. It helps protect both employer and employee interests by clearly documenting the return-to-work arrangements and any ongoing requirements or restrictions. This document is particularly important in cases where modified duties or gradual return arrangements are necessary, and it helps ensure proper communication between all relevant parties including healthcare providers, management, and HR personnel.
Suggested Sections

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

2. Leave Details: Information about the medical leave period, including start date and expected/actual return date

3. Medical Clearance: Healthcare provider's confirmation that employee is fit to return to work, including any restrictions or modifications

4. Return to Work Plan: Outline of the return arrangement (e.g., full duties, modified duties, gradual return)

5. Health and Safety Considerations: Specific workplace safety requirements or modifications needed

6. Authorization: Signatures from employee, healthcare provider, and employer representative

Optional Sections

1. Temporary Workplace Modifications: Details of any temporary changes to workplace setup or equipment, used when physical modifications are required

2. Gradual Return Schedule: Detailed timeline for stepped increase in hours/duties, used for progressive return to work cases

3. Follow-up Requirements: Schedule of follow-up medical appointments or assessments, used when ongoing monitoring is needed

4. Accommodation Plan: Specific long-term workplace accommodations, used when permanent modifications are required

5. Risk Assessment: Evaluation of workplace risks related to the medical condition, used in cases involving ongoing health concerns

Suggested Schedules

1. Schedule A - Medical Certificate: Attached medical certificate from healthcare provider

2. Schedule B - Workplace Modification Checklist: Detailed list of required workplace modifications and equipment

3. Schedule C - Progressive Return Schedule: Detailed weekly schedule for gradual return to full duties

4. Schedule D - Health and Safety Assessment: Workplace health and safety evaluation related to the return to work

Authors

Alex Denne

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

alex.den.21@genieai.co
Relevant legal definitions


















Clauses















Relevant Industries

Healthcare

Manufacturing

Construction

Education

Retail

Professional Services

Government

Technology

Transportation

Hospitality

Mining

Agriculture

Financial Services

Relevant Teams

Human Resources

Health and Safety

Occupational Health

Operations

Risk Management

Employee Relations

Compliance

Medical Services

Workers Compensation

People & Culture

Relevant Roles

HR Manager

Health and Safety Manager

Occupational Health Nurse

Return to Work Coordinator

HR Business Partner

Line Manager

Department Supervisor

Workplace Health Coordinator

Employee Relations Manager

Operations Manager

Risk Management Officer

Compliance Officer

Industries






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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