If yes please detail here: Is a referral to Occupational Health required (will Yes No this provide new information or support)? Is a referral to the Staff Physio Service required? Yes No Advise staff can refer themselves to the service. Is an informal or formal review now required as triggers have been met or targets breached? Where level of sickness absence has hit the trigger and persistent absences are not due to a chronic underlying medical condition, a stage 1 informal ill health review meeting should take place. In most cases this will take place at the return to work meeting however the employee may wish to take advice from a staff side representative prior to attending a meeting and in these circumstances the employee will be given a minimum of 7 calendar day’s written notice of the date and time of the meeting. Where targets have been breached at informal stages advise employee that a stage 2 formal review meeting will be arranged and seek advice from your HR Advisor. stage 1 informal ill health Target set: Date targets review meeting takes place at effective from: ………………. / or…….episodes return to work meeting please ……..days record targets set here: (Please End date: ……………………. (i.e. whichever is exceeded refer to target setting guide on sooner days or episodes) Health Monitoring Form). Review Date: ………………… Possible adjustments to current role discussed detail here: – Does the employee have a Toughbook that Yes requires a new battery? Please liaise with HIS No N/A Date return to work meeting recorded on ESR: Any comments from employee: Any comments from manager: I declare that the information given is complete and correct and that I have not worked during the period stated. I understand that if I knowingly provide inaccurate or false information about my absence it will render me subject to action under the Trust’s Disciplinary Policy and Procedure and/or investigated under Counter Fraud. Employee’s Signature: Date: Managers Signature: Date: Manager print name: Job Title: Please retain this completed form on employees personal file and give a copy to employee
If yes please detail here: Is a referral to Occupational Health required (will this provide new information or support)? Yes No Is a referral to the Staff Physio Service required? Advise staff can refer themselves to the service. Yes No Is an informal or formal review now required as triggers have been met or targets breached? Where level of sickness absence has hit the trigger and persistent absences are not due to a chronic underlying medical condition, a stage 1 informal ill health review meeting should take place. In most cases this will take place at the return to work meeting however the employee may wish to take advice from a staff side representative prior to attending a meeting and in these circumstances the employee will be given a minimum of 7 calendar day’s written notice of the date and time of the meeting. Where targets have been breached at informal stages advise employee that a stage 2 formal review meeting will be arranged and seek advice from your HR Advisor. stage 1 informal ill health review meeting takes place at return to work meeting please record targets set here: (Please refer to target setting guide on Health Monitoring Form). Target set: ……..days / or…….episodes (i.e. whichever is exceeded sooner days or episodes) Date targets effective from: ………………. End date: ……………………. Review Date: ………………… Possible adjustments to current role discussed – detail here: Does the employee have a Toughbook that requires a new battery? Please liaise with HIS Yes No N/A Date return to work meeting recorded on ESR: Any comments from employee: Any comments from manager: I declare that the information given is complete and correct and that I have not worked during the period stated. I understand that if I knowingly provide inaccurate or false information about my absence it will render me subject to action under the Trust’s Disciplinary Policy and Procedure and/or investigated under Counter Fraud. Employee’s Signature: Date: Managers Signature: Date: Manager print name: Job Title: Please retain this completed form on employees personal file and give a copy to employee
Appendix2bReturntoWorkDiscussionMay18.docx