¶¶Òõ¶ÌÊÓƵ

All Countries
Employment
Return To Work Certification Form

Return To Work Certification Form Template for New Zealand

Create a bespoke document in minutes,  or upload and review your own.

4.6 / 5
4.8 / 5

Let's create your Return To Work Certification Form

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

Get your first 2 documents free

Your data doesn't train Genie's AI

You keep IP ownership of your information

Key Requirements PROMPT example:

Return To Work Certification Form

"I need a Return To Work Certification Form for a construction worker returning after a back injury, with specific focus on graduated return to work over 4 weeks starting March 2025, including detailed physical activity restrictions and safety protocols for operating machinery."

Celebrated by
Collaborations with
Investors
Document background
The Return To Work Certification Form is a crucial document used in New Zealand workplaces when employees resume work following an absence due to illness, injury, or other health-related circumstances. This form, developed in accordance with New Zealand's Health and Safety at Work Act 2015 and ACC requirements, provides a standardized method for documenting medical clearance and establishing safe return-to-work conditions. It captures essential information including medical assessments, work capabilities, required accommodations, and graduated return arrangements. The document serves multiple purposes: ensuring legal compliance, protecting both employer and employee interests, facilitating clear communication between all parties, and establishing a documented plan for successful workplace reintegration.
Suggested Sections

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

2. Absence Information: Details of the absence period, including start date and nature of illness/injury (within privacy constraints)

3. Medical Certification: Healthcare provider's assessment of fitness to return to work, including any relevant diagnoses and prognosis

4. Work Capacity Assessment: Detailed evaluation of current capabilities and limitations regarding work duties

5. Return to Work Schedule: Specific dates and hours for graduated return to work, if applicable

6. Required Workplace Modifications: List of necessary accommodations or modifications to enable safe return to work

7. Authorization and Signatures: Sign-off sections for employee, healthcare provider, and employer representative

Optional Sections

1. ACC Claim Details: Required only if the absence was related to an ACC claim

2. Rehabilitation Plan: Needed for complex cases requiring ongoing rehabilitation support

3. Follow-up Appointments: Schedule of future medical appointments or assessments, if ongoing monitoring is required

4. Risk Assessment: Detailed workplace risk assessment for cases involving significant health and safety considerations

Suggested Schedules

1. Schedule A - Physical Demands Analysis: Detailed breakdown of physical requirements of the role and current capabilities

2. Schedule B - Workplace Modification Checklist: Specific equipment, modifications, or accommodations required

3. Schedule C - Medical Restrictions Form: Detailed medical provider's notes on specific workplace restrictions and duration

4. Appendix 1 - Employee Rights and Responsibilities: Information sheet outlining the employee's rights and responsibilities during the return to work process

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

Manufacturing

Construction

Healthcare

Mining

Agriculture

Retail

Hospitality

Transportation

Logistics

Professional Services

Education

Public Sector

Information Technology

Financial Services

Relevant Teams

Human Resources

Health and Safety

Occupational Health

Risk Management

Operations

Employee Relations

Legal

Compliance

Relevant Roles

Human Resources Manager

Health and Safety Manager

Occupational Health Nurse

Return to Work Coordinator

HR Business Partner

Operations Manager

Line Manager

Department Supervisor

Risk Manager

Compliance Officer

Employee Relations Manager

Workplace Health Coordinator

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

Find the exact document you need

Back To Work Form

A New Zealand-compliant form documenting an employee's return to work process, including health clearances and workplace adjustment requirements.

find out more

Medical Return To Work Form

A New Zealand-compliant form documenting medical clearance and conditions for an employee's return to work following medical leave.

find out more

Return To Work Letter

A New Zealand-compliant formal letter documenting arrangements for an employee's return to work after extended absence, including terms, conditions, and any necessary modifications.

find out more

Return To Work Medical Certificate

A New Zealand-compliant medical certificate documenting an employee's fitness to return to work, including any necessary workplace modifications or restrictions.

find out more

Return To Work Offer Letter

A New Zealand-compliant formal letter outlining terms and conditions for an employee's return to work following absence, including specific arrangements and accommodations.

find out more

Return To Work Clearance Form

A New Zealand-compliant form documenting medical clearance and conditions for an employee's safe return to work after illness or injury.

find out more

Employee Return To Work Form

A New Zealand-compliant form documenting an employee's return to work arrangements following absence, including medical clearance and workplace safety considerations.

find out more

Return To Work Interview Form

A New Zealand-compliant form documenting the agreed terms and conditions for an employee's return to work following absence, including necessary adjustments and support measures.

find out more

Return To Work Certification Form

A New Zealand-compliant certification form documenting an employee's fitness and conditions for returning to work after illness or injury.

find out more

Medical Leave Return To Work Form

A New Zealand-compliant form documenting an employee's return to work arrangements following medical leave, including medical clearance and workplace modifications.

find out more

Download our whitepaper on the future of AI in Legal

By providing your email address you are consenting to our Privacy Notice.
Thank you for downloading our whitepaper. This should arrive in your inbox shortly. In the meantime, why not jump straight to a section that interests you here: /our-research
Oops! Something went wrong while submitting the form.

³Ò±ð²Ô¾±±ð’s Security Promise

Genie is the safest place to draft. Here’s how we prioritise your privacy and security.

Your documents are private:

We do not train on your data; ³Ò±ð²Ô¾±±ð’s AI improves independently

All data stored on Genie is private to your organisation

Your documents are protected:

Your documents are protected by ultra-secure 256-bit encryption

Our bank-grade security infrastructure undergoes regular external audits

We are ISO27001 certified, so your data is secure

Organizational security

You retain IP ownership of your documents

You have full control over your data and who gets to see it

Innovation in privacy:

Genie partnered with the Computational Privacy Department at Imperial College London

Together, we ran a £1 million research project on privacy and anonymity in legal contracts

Want to know more?

Visit our for more details and real-time security updates.

Read our Privacy Policy.