Form D - Return to Work Interview

Data

Data

Name of Employee
Date of Meeting
Meeting conducted by
Job Title
Name of Company
First Day of Absence
Last Day of Absence
Return to work date
Number of days absent from work
Did the employee comply with company procedure for notifying absence?
When, how and to whom was absence originally notified?
What was the reason for absence?
Was absence due to a long term medical condition?
If applicable, Has a GP medical note been received?
Comments and Agreed action.