Return to Work Form

{{company_name}}

{{company_address}}

Phone: {{phone}} | Email: {{email}} | Web: {{website}}

Employee

Name: {{employee_name}} | Date of Return: {{date}}

Confirmation

• I am fit to resume my normal duties
• I require the following accommodations:
• Medical clearance attached

Scope

Applies to all employees, contractors, and visitors of {{company_name}} while at Company premises or engaged in Company business.

Definitions

• "Occupational Health" means health risks arising from or related to work.
• "Reasonable Accommodation" means any modification to enable performance of essential duties.
• "Health Information" means medical, fitness-for-work, and related personal data.

Roles & Responsibilities

Risk Categories & Controls

Fitness for Work & Accommodations

1. Employees with a medical condition affecting work shall notify HR in confidence.
2. An occupational health assessment may be arranged at Company cost where required.
3. Reasonable accommodations are agreed in writing with the employee and manager.
4. Confidential medical records are stored separately from personnel files.

Incident & Injury Reporting

Confidentiality of Health Data

Health information is processed only on a legitimate basis under applicable data protection law. Access is restricted to authorized health and HR personnel, and disclosure to managers is limited to fitness-for-work conclusions.

Document Control