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Return to Work Form
Please complete this form to help us support your return to the workplace.
Employee Full Name
*
First day of absence
*
Return date
*
Are you fit to return to your full duties?
*
A
Yes, I am fully fit to return.
B
I am fit, but require some adjustments.
Would you like to meet with your manager to discuss your return?
*
A
Yes, please arrange a meeting.
B
No, I am comfortable with returning without a meeting
Submit
