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Hospital Return To Work Form
"I need a Hospital Return To Work Form for a senior nurse returning from a three-month sick leave in March 2025, including provisions for a phased return and specific workplace adjustments due to mobility issues."
1. Employee Information: Basic personal and employment details including name, employee ID, department, role
2. Absence Details: Dates of absence, reason for absence, any hospital treatment received
3. Medical Clearance: Confirmation of fitness to return to work from medical professional
4. Work Capability Assessment: Assessment of current capability to perform regular duties
5. Return Date: Confirmed date of return to work
1. Phased Return Plan: Details of graduated return to work schedule, used when employee requires gradual reintegration following extended absence or complex medical conditions
2. Workplace Adjustments: Specific modifications needed to accommodate medical condition, required when reasonable adjustments are necessary under Equality Act
3. Occupational Health Referral: Details of referral to occupational health services, used for complex cases requiring specialist assessment
1. Medical Certificate: Copies of relevant medical certificates or fit notes
2. Risk Assessment: Workplace risk assessment related to return to work
3. Adjustment Plan: Detailed plan of workplace modifications if required
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