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Back To Work Form

Back To Work Form Template for Ireland

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Key Requirements PROMPT example:

Back To Work Form

"I need a Back to Work Form for an employee returning from a 6-month maternity leave in March 2025, including provisions for a phased return over 4 weeks and specific workplace adjustments for nursing breaks."

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Document background
The Back to Work Form is a crucial document in Irish employment practice, designed to facilitate and document an employee's return to work following an extended absence. It is required whenever an employee returns from long-term sick leave, maternity leave, disability-related absence, or other extended periods away from work. The form ensures compliance with Irish legislation, particularly the Safety, Health and Welfare at Work Act 2005 and Employment Equality Acts 1998-2015, while also addressing GDPR requirements for handling personal health information. It captures vital information about the absence period, any medical clearances required, necessary workplace adjustments, and agreed terms for return, serving as both a legal record and a practical tool for managing the return-to-work process effectively.
Suggested Sections

1. Employee Information: Basic details including name, employee ID, department, and role

2. Absence Details: Information about the period of absence, including start and end dates, and nature of absence (e.g., illness, injury, maternity leave)

3. Return to Work Information: Specific details about the return date and any modified working arrangements

4. Health and Safety Declaration: Employee's declaration about their fitness to return and any ongoing health considerations

5. Workplace Adjustments: Details of any required modifications to workplace, equipment, or working patterns

6. Manager Review: Section for line manager to review and approve the return to work arrangements

7. Sign-off Section: Signatures from employee, manager, and where relevant, HR representative, with date

Optional Sections

1. Medical Certification: Section for medical clearance details - required when returning from illness/injury absence of more than 7 days

2. Risk Assessment: Detailed assessment of workplace risks - required for returns from serious illness/injury or pregnancy-related absence

3. Phased Return Schedule: Detailed timeline for graduated return to full duties - used when employee requires phased return

4. Occupational Health Review: Details of occupational health assessment - required for complex cases or long-term absences

5. COVID-19 Declaration: Specific health declarations related to COVID-19 - required during pandemic-related returns

Suggested Schedules

1. Schedule A: Phased Return Timeline: Detailed week-by-week schedule for phased return to work, if applicable

2. Schedule B: Workplace Modifications Checklist: Checklist of required workplace adjustments and equipment modifications

3. Appendix 1: Medical Certificate: Attached medical certification from healthcare provider

4. Appendix 2: Risk Assessment Form: Completed workplace risk assessment documentation

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
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