{{company_name}}
{{company_address}}
Phone: {{phone}} | Email: {{email}} | Web: {{website}}
Employee & Leave Details
| Field | Detail |
|---|---|
| Name | {{employee_name}} |
| Type of Leave | {{leave_type}} |
| Leave Start | {{start_date}} |
| Leave End | {{end_date}} |
| Actual Return Date | {{return_date}} |
Fitness for Duty
- Fully fit to resume normal duties
- Fit subject to restrictions (detail below)
- Not yet fit — extension of leave required
Restrictions or Accommodations
Detail any medical restrictions, accommodations, or phased return arrangements agreed with HR and the line manager.
Reintegration Plan
- Catch-up briefing on key developments during absence
- Handover from cover
- Updated objectives for the next 30 days
- Wellness check-in scheduled for {{checkin_date}}
Acknowledgement & Signatures
By signing below, both parties confirm they have read, understood, and agreed to the terms of this document.
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