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Medical Return To Work Form Template for Ireland

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Key Requirements PROMPT example:

Medical Return To Work Form

"I need a Medical Return to Work Form for our manufacturing company with 500+ employees, incorporating specific health and safety protocols for heavy machinery operators and including sections for phased return arrangements."

Document background
The Medical Return to Work Form is a crucial document used when employees are returning to work following medical leave or extended absence due to health issues. This form, designed specifically for use in Ireland and compliant with Irish employment law and GDPR requirements, serves as an official record of an employee's fitness to resume work duties. It requires input from qualified medical professionals and includes essential information about any necessary workplace accommodations or restrictions. The document helps organizations manage the return-to-work process effectively while protecting both employer and employee interests, ensuring appropriate documentation of medical clearance, and maintaining compliance with relevant health and safety regulations. It is particularly important in contexts where occupational health and safety requirements are stringent or where specific workplace adjustments may be necessary.
Suggested Sections

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

2. Absence Information: Details of the absence period, including start date and return date

3. Medical Clearance: Clear statement from the medical practitioner regarding fitness to return to work

4. Work Capacity Assessment: Evaluation of the employee's ability to perform their regular duties

5. Required Workplace Modifications: Any necessary adjustments or accommodations needed for the return to work

6. Medical Professional Details: Information about the certifying medical professional, including name, qualification, and contact details

7. Authorization and Consent: Employee's consent for sharing medical information and authorization for return to work assessment

8. Signatures: Space for required signatures from employee, medical professional, and employer representative

Optional Sections

1. Phased Return Plan: Detailed schedule for gradual return to full duties, used when employee requires graduated return to work

2. Follow-up Requirements: Details of any required follow-up appointments or assessments, included when ongoing medical monitoring is needed

3. Risk Assessment: Specific workplace risks that need to be considered, included when returning employee has specific health vulnerabilities

4. Additional Health and Safety Measures: Special health and safety requirements, included when specific precautions are needed

5. Medication Details: Information about medication that may affect work performance, included when relevant to workplace safety

Suggested Schedules

1. Schedule A - Duties Assessment Checklist: Detailed checklist of regular job duties and employee's capacity to perform each

2. Schedule B - Workplace Accommodation Form: Detailed form specifying required workplace modifications and implementation timeline

3. Appendix 1 - Medical Information Release Form: Standard form for employee's consent to share specific medical information

4. Appendix 2 - Occupational Health Guidelines: Reference document outlining company's occupational health policies and procedures

Authors

Alex Denne

Head of Growth (Open Source Law) @ tiktok³ÉÈ˰æ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions

























Clauses














Relevant Industries

Healthcare

Manufacturing

Construction

Education

Retail

Financial Services

Technology

Transportation

Public Sector

Pharmaceuticals

Food and Beverage

Energy

Mining

Agriculture

Hospitality

Relevant Teams

Human Resources

Occupational Health

Health and Safety

Legal

Compliance

Employee Relations

Operations

Risk Management

Relevant Roles

HR Manager

HR Director

Occupational Health Nurse

Health and Safety Manager

Risk Manager

Employee Relations Manager

HR Business Partner

Workplace Health Coordinator

Return to Work Coordinator

Operations Manager

Line Manager

Department Head

Compliance Officer

Medical Officer

Occupational Health Physician

Industries







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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