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Return To Work Claim Form

Return To Work Claim Form Template for England and Wales

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Key Requirements PROMPT example:

Return To Work Claim Form

"I need a Return To Work Claim Form for an employee returning from long-term stress leave, including provisions for a phased return over 4 weeks starting March 2025, with specific focus on reduced hours and workload adjustments."

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Document background
The Return To Work Claim Form serves as a crucial document in English and Welsh employment practice, designed to manage the process of employees returning to work after periods of absence. It is required whenever an employee returns from extended sick leave, medical absence, or other significant time away from work. The form includes critical information about the nature of absence, medical clearance, required workplace adjustments, and planned return arrangements. This documentation helps ensure compliance with employment law, supports duty of care obligations, and provides a clear record of the return-to-work process for both employer and employee.
Suggested Sections

1. Employee Information: Basic details including name, employee ID, department, role, contact information and line manager details

2. Absence Details: Information about the period of absence including start date, end date, reason for absence, and details of any medical certificates provided

3. Return Details: Proposed return to work date, whether return is full or phased, and any modified working patterns

4. Health Declaration: Current health status, fitness to work declaration, and details of any ongoing health conditions or medications that may affect work

5. Workplace Adjustments: Details of any required workplace modifications, equipment needs, or support measures needed for safe return

Optional Sections

1. Occupational Health Assessment: Required for absences over 4 weeks or where complex health conditions need specialist evaluation

2. Risk Assessment: Required when specific workplace hazards need evaluation or when returning with modified duties

3. COVID-19 Declaration: Required during pandemic-related returns, including health screening questions and workplace safety measures

4. Benefits and Pay Information: Required when changes to pay or benefits occurred during absence period

Suggested Schedules

1. Medical Certificates: Copies of fit notes, medical certificates or other healthcare provider documentation

2. Occupational Health Reports: Any specialist assessments, recommendations or reports from occupational health professionals

3. Return to Work Plan: Detailed schedule for phased return including hours, duties and review dates

4. Risk Assessment Forms: Completed workplace risk evaluations and control measures

5. Reasonable Adjustments Form: Documentation of agreed workplace modifications and support measures

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok³ÉÈË°æ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co
Relevant legal definitions




















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Relevant Industries
Relevant Teams
Relevant Roles
Industries

Health and Safety at Work Act 1974: Primary legislation governing workplace health and safety in the UK, setting out employers' duties to ensure employee safety and health

Management of Health and Safety at Work Regulations 1999: Regulations requiring employers to assess and manage risks to their employees' health and safety

Employment Rights Act 1996: Core employment legislation outlining fundamental rights of employees, including provisions for sick leave and return to work

Equality Act 2010: Legislation protecting against discrimination, particularly relevant for disability-related workplace adjustments during return to work

UK General Data Protection Regulation (UK GDPR): Regulations governing the processing and protection of personal data, including medical information in return to work documentation

Data Protection Act 2018: UK's implementation of data protection standards, crucial for handling personal and medical information in return to work processes

Access to Medical Reports Act 1988: Legislation governing access to medical reports and information, relevant for return to work medical assessments

Statutory Sick Pay (General) Regulations 1982: Regulations detailing the administration and payment of statutory sick pay, important for return to work documentation

Statutory Sick Pay (Medical Evidence) Regulations 1985: Specifications for medical evidence required to support sick pay claims and return to work processes

The Health Protection (Coronavirus) Regulations 2020: Specific regulations related to COVID-19 workplace safety and return to work procedures during the pandemic

Social Security (Medical Evidence) Regulations 1976: Regulations governing the medical evidence required for social security benefits and return to work processes

The Social Security (Medical Evidence) and Statutory Sick Pay (Medical Evidence) (Amendment) Regulations 2010: Updated regulations on medical evidence requirements for sick pay and return to work documentation

Safety Representatives and Safety Committees Regulations 1977: Regulations on workplace safety representation and consultation, relevant for return to work safety assessments

Health and Safety (Consultation with Employees) Regulations 1996: Requirements for consulting employees on health and safety matters, including return to work arrangements

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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