Return To Work

Return to work interview

Connection Flooring Ltd. The Future Business Park, Shildon. DL4 2RB
Return to work interview
Employee Name *
Job title and location *
Person filling out this form *
Your line manager *
First date of absence *

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Date absence ended *

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Reason for absence *
Did you correctly notify the employer *

Yes No
Did you consult a GP *

Yes No
Any evidence provided? *
Was your absence work related *

Yes No
If your previous answer was (Yes) give details
Do you have any type of disability *

Yes No
Do you believe you are now fit for work *

Yes No
HR recommendations
E Signature

By ticking this box you agree that to the best of your ability you have given true and correct answers and that you are fit for work
Employee Signature

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Return to work interview