Use this form to conduct supportive return to work conversations after sickness absence.

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Return to Work Interview Form

Confidential

Detail	Information
Employee Name
Position
Department
Manager/Interviewer
Interview Date
First Day Back at Work

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Section 1: Absence Details

Information	Details
First day of absence
Last day of absence
Total days absent
Working days lost
Was this:	Self-certified / Fit note provided

Reason for absence:

• Cold/flu
• Stomach bug/food poisoning
• Migraine/headache
• Back/musculoskeletal problem
• Stress/anxiety/mental health
• Accident/injury
• Medical appointment
• Hospital treatment
• Post-operative recovery
• Chronic condition flare-up
• Other: ________________

Brief description (in employee's words):

[Space for notes]

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Section 2: Current Fitness

Are you fully recovered and fit to return to all duties?

• Yes, fully fit
• Mostly recovered but still have minor symptoms
• Not fully recovered but able to work
• Have ongoing health issues

If not fully fit, please describe:

[Space for notes]

Do you have a fit note or medical documentation?

• No - self-certified only (7 days or less)
• Yes - fit note attached/on file
• Yes - fit note recommends workplace adjustments (see below)

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Section 3: Phased Return or Adjustments

Did your GP or specialist recommend any adjustments?

• No adjustments needed
• Yes - see fit note recommendations

Recommended or agreed adjustments:

Adjustment	Details	Duration
[ ] Reduced hours	[e.g., 4 hours per day]	Until [date/review]
[ ] Amended duties	[Avoid: lifting, screens, etc.]	Until [date/review]
[ ] Workplace changes	[e.g., ergonomic equipment]	Until [date/review]
[ ] Flexible schedule	[e.g., later start time]	Until [date/review]
[ ] Work from home	[Days per week]	Until [date/review]
[ ] Other	[Specify]	Until [date/review]

Who will monitor these adjustments? [Name]

Review date for adjustments: [Date]

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Section 4: Work During Absence

Were you able to hand over work before your absence?

• Yes, fully handed over
• Partially - some urgent items remained
• No - absence was sudden
• N/A - no urgent work

Has cover been arranged during your absence?

• Yes - covered by [name/team]
• Partially covered
• No formal cover
• Work held until return

Anything urgent we need to brief you on?

[Notes on key developments, deadlines, changes during absence]

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Section 5: Support and Wellbeing

How are you feeling about being back at work?

• Confident and ready
• A bit anxious but okay
• Worried about workload
• Concerned about health relapse
• Other concerns

Comments:

[Space for employee to share feelings]

Is there anything work-related that contributed to your illness?

• No, entirely unrelated to work
• Workload/stress may have been a factor
• Work environment issue (e.g., desk setup, temperature)
• Relationship issue with colleague/manager
• Other work factor

If work-related, please explain:

[Space for notes]

Action needed: [Any immediate steps to address work-related factors]

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Section 6: Underlying or Ongoing Health Issues

Do you have any ongoing health conditions we should be aware of?

• No
• Yes (details below - only if employee wishes to disclose)

If yes, please provide details voluntarily:

[Space for notes - remind employee this is confidential]

Could this condition be a disability under the Equality Act 2010?

• No
• Possibly - needs further discussion
• Yes, already recorded

If disability or long-term condition:

• Would you like to discuss reasonable adjustments?
• Would Occupational Health referral be helpful?
• Any other support we can provide?

Actions agreed:

[Notes on any adjustments, referrals, or support]

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Section 7: Absence History

Absence in last 12 months:

Period	Occasions	Total Days	Pattern Notes
Last 3 months
Last 6 months
Last 12 months

Is there a pattern to your absences?

• No clear pattern
• Recurring condition (e.g., chronic illness, migraines)
• Stress/mental health related
• Injury-related
• Mondays/Fridays
• Particular times of year
• Other pattern observed: ________________

If pattern identified, discuss:

[Notes on discussion about pattern and any underlying causes]

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Section 8: Trigger Points and Formal Process

Has absence triggered any policy thresholds?

• No triggers
• First trigger: [X] days/occasions in [period]
• Second trigger: [X] days/occasions in [period]
• Third trigger: requires formal absence meeting

Company trigger points:

[State your policy thresholds, e.g., "3 occasions or 10 days in 12 months"]

Action required:

• No action - record only
• Informal monitoring - check in again in [X] weeks
• Referral to Occupational Health
• Formal absence review meeting to be arranged
• Other: ________________

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Section 9: Employee Comments

Do you have any concerns or questions about your absence or return?

[Space for employee comments]

Is there anything else you'd like to discuss?

[Space for employee comments]

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Section 10: Actions and Follow-up

Actions agreed:

Action	Who	By When
[e.g., Order ergonomic equipment]	[Name]	[Date]
[e.g., OH referral]	[HR/Manager]	[Date]
[e.g., Review workload]	[Manager]	[Date]

Next review/check-in: [Date]

Any referrals needed?

• Occupational Health
• Employee Assistance Programme
• HR support
• Other: ________________

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Section 11: Manager Notes

Overall assessment:

[Manager's confidential notes on the discussion, any concerns, observations about employee's demeanor/fitness]

Concerns or red flags:

• None - satisfied employee is fit to return
• Some concerns about full fitness
• Concerns about absence pattern
• Concerns about work-related stress
• Safeguarding/wellbeing concerns
• Other: ________________

Recommended actions:

[Notes on any further action manager recommends]

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Section 12: Declaration

Employee:

I confirm that:

• The information I have provided is accurate
• I understand my responsibility to inform my manager if my condition worsens
• I understand the company's absence policy and procedures
• I have been offered support and the opportunity to discuss concerns

Employee signature: _________________ Date: _________

Manager:

I confirm that:

• This interview has been conducted sensitively and supportively
• I have explained any actions or monitoring required
• The employee has been given opportunity to raise concerns
• I will follow up on agreed actions

Manager signature: _________________ Date: _________

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Guidance for Managers

Conducting the Interview

DO:

• Conduct within 24 hours of return (ideally same day)
• Be supportive and welcoming
• Listen without judgment
• Express concern for wellbeing
• Keep it confidential
• Focus on support, not blame
• Document the discussion

DON'T:

• Be confrontational or accusatory
• Diagnose medical conditions
• Question legitimacy of illness
• Make the employee feel guilty
• Share medical details with others
• Skip the interview (even for short absences)

When to Refer to HR or Occupational Health

• Frequent or long-term absence
• Disability or potential disability
• Work-related stress or mental health issues
• Conflicting medical information
• Suspected capability issues due to health
• Employee requests help or adjustments
• You're unsure about appropriate adjustments

Data Protection

• Medical information is sensitive personal data
• Store securely and separately from general HR files
• Only share on need-to-know basis
• Don't discuss with other staff without consent
• Follow GDPR principles

Following Up

After the interview:

• Complete actions promptly
• Monitor agreed adjustments
• Check in regularly if phased return
• Update absence records
• Refer to OH or HR if needed
• Follow your absence policy triggers