Free return to work form template
A structured form for planning a safe, sustainable return after injury, illness or extended absence. Capture medical clearance, suitable duties, a graded schedule and the support an employee needs to come back well.
Return to work form
PDF format • Ready to print
No signup required. Print or fill in digitally.
This return to work form is a general HR template and is not legal or medical advice. Customise it to suit your workplace and any relevant awards, legislation, insurer or rehabilitation requirements, and confirm your obligations with Fair Work and your workers compensation authority. It does not constitute legal, HR, or professional advice and should not be relied on as a substitute for advice specific to your business, workforce, or circumstances.
What's in this form
Everything you need to plan a safe return
Medical clearance
Confirm fitness to return with certificate of capacity details and the date cleared by the treating doctor.
Absence details
Record the reason for absence (illness, injury, workers compensation), the dates off and total time away.
Work restrictions
Capture medical restrictions on duties, hours, lifting or work environment so the return stays safe.
Graded return plan
Set out reduced hours, modified duties and the schedule for building back up to a full role.
Support and modifications
List workplace adjustments, equipment, training or assistance the employee needs to return well.
Review schedule and sign-off
Book follow-up review dates and capture sign-off from employee, manager and HR.
How to create a return to work plan
Four steps to a safe, graded return
1. Review medical advice
Start with the medical certificate or certificate of capacity. Note what the employee can and cannot do, and any restrictions on hours, duties or lifting.
2. Identify suitable duties
Focus on what the employee can do. List modified or suitable duties that fit the medical restrictions rather than their full pre-injury role.
3. Set a graded schedule
Map a graded hours schedule that starts reduced and builds back up, with appointment allowances, breaks and a clear start date and goals.
4. Agree and review
Discuss and agree the plan with the employee, schedule regular review dates, and capture sign-off from the employee, manager and HR.
A return to work plan is built with the employee and their treating doctor — never imposed. Once the plan is agreed, store it alongside the certificate of capacity in your digital HR records. For the full walkthrough, read our guide on managing return to work.
When to use this form
For any return that needs planning and care
After injury or illness
Re-integrate staff returning from serious illness, surgery or injury.
Workers compensation
Meet return-to-work obligations and cooperate with rehabilitation providers.
Extended or mental health leave
Support a planned, sustainable return after a longer absence.
Many returns follow a period of sick or personal leave — see how to handle the lead-up in our guide to managing sick leave requests.
Manage returns without the paperwork
A PDF form is a great start, but tracking certificates, restrictions, graded hours & review dates across a team gets messy fast. RosterElf's HR software keeps return-to-work plans, leave records & documents in one secure place — and rosters returning staff onto suitable duties and reduced hours automatically.
HR guides
Manage absence and return to work the right way
How to manage return to work
A step-by-step guide to running a safe, supportive return after illness or injury.
Read the guideHow to manage sick leave requests
Handle sick leave fairly, request medical certificates and stay on top of records.
Read the guideDigital HR records
Store return-to-work plans, certificates and reviews securely in one place.
See the featureRelated templates
Use this form alongside these free HR templates
Incident report form
Document workplace incidents that may lead to absence and return-to-work needs.
View templateLeave application form
Capture personal and medical leave that may require a return-to-work plan.
View templateAll HR forms
Browse the full library of free HR form templates.
Browse allReturn to work form FAQ
-
Build it in collaboration with the employee and their treating doctor. Start by reviewing the medical certificate or certificate of capacity, then identify suitable (modified) duties focused on what the employee can do, set a graded hours schedule that builds back up over time, and document the start date, goals, tasks to avoid, breaks and appointment allowances. Agree the plan with the employee and book regular reviews. Our guide on managing return to work walks through the full process.
-
Record the employee details, the dates and reason for absence, confirmation of medical clearance with any restrictions, the graded return plan (reduced hours and modified duties), workplace modifications and support measures, a communication plan with medical providers or insurers, review dates, and sign-off from the employee, manager and HR. The free template above includes a section for each of these.
-
At a minimum: the suitable duties the employee will perform, a graded schedule of hours building back to full capacity, tasks to avoid, allowances for medical appointments and breaks, clear goals and a start date, and the dates the plan will be reviewed. Base every item on the medical advice in the certificate of capacity.
-
A return to work letter confirms the agreed plan in writing. Address it to the employee, restate the return date, summarise the suitable duties and graded hours, note any restrictions and review dates, and invite them to raise concerns. Attach the completed return to work form so the detail and the letter stay consistent.
Before you download
General information only — not legal advice
This document is a general HR template provided for informational purposes only. It is not legal advice and may not reflect the latest changes in legislation or apply to every workplace situation. RosterElf Pty Ltd and the template provider accept no liability for any loss arising from reliance on this document. Users should seek independent legal advice and customise the template to ensure it complies with all relevant laws, awards and workplace requirements.