HAS THE EMPLOYEE SUBMITTED YES NO THE NECESSARY CERTIFICATION? WAS THE REASON FOR ABSENCE YES NO LINKED TO AN INJURY AT WORK? IF YES, HAS THE EMPLOYEE COMPLETED THE NECESSARY YES NO ACCIDENT REPORTING DOCUMENTATION? Details of Issues Discussed during the Return to Work Interview: Details of Support Offered to Employee: Actions Agreed (Including Timescales): Managers Date: Signature: Employee Date: Signature:
HAS THE EMPLOYEE SUBMITTED THE NECESSARY CERTIFICATION? YES NO WAS THE REASON FOR ABSENCE LINKED TO AN INJURY AT WORK? YES NO IF YES, HAS THE EMPLOYEE COMPLETED THE NECESSARY ACCIDENT REPORTING DOCUMENTATION? YES NO Details of Issues Discussed during the Return to Work Interview: Details of Support Offered to Employee: Actions Agreed (Including Timescales): Managers Signature: Date: Employee Signature: Date:
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