Return to work form template
A structured form for managing employee return to work after illness, injury or extended absence. Supports safe and sustainable return with proper planning and documentation.
Return to work form
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Why you need a return to work form
A return to work form helps manage the transition when employees come back after illness, injury or extended absence. It ensures medical restrictions are understood, appropriate support is provided and the return is safe and sustainable.
Proper return to work planning reduces the risk of re-injury, supports employee wellbeing and demonstrates your duty of care. For workers' compensation cases, having a documented return to work plan is often a legal requirement.
The form helps communication between the employee, their manager, HR and medical providers to create a coordinated return strategy.
Key features of this form
Designed to support safe and successful return to work
Health assessment
Record fitness to return and any medical restrictions or limitations.
Absence details
Document the reason for absence and duration of time off work.
Return plan
Outline phased return arrangements and any workplace modifications needed.
Support requirements
Identify what assistance the employee needs during their return.
Medical clearance
Section to confirm medical certificates and fitness for duty.
Review schedule
Set dates for follow-up meetings and ongoing support check-ins.
What's included in this form
Comprehensive sections for managed return to work
Employee details
Name, position, department and date of return to work.
Absence information
Dates of absence, reason (illness, injury, personal leave) and total time off.
Medical clearance
Confirmation that employee has medical clearance to return, with certificate details.
Work restrictions
Any medical restrictions on duties, hours, physical activities or work environment.
Phased return plan
Details of any gradual return arrangements (reduced hours, modified duties).
Workplace modifications
Adjustments needed to accommodate medical restrictions or help return.
Support measures
Additional assistance, training or resources the employee needs.
Communication plan
How and when to communicate with medical providers, insurers or rehabilitation coordinators.
Review schedule
Dates for follow-up meetings to assess progress and adjust support.
Signatures
Sign-off from employee, manager and HR to confirm agreement on return plan.
How to use this form
Best practices for return to work planning
When to complete the form
Complete this form before the employee returns to work, ideally during a meeting with their manager. For workers' compensation cases, it should be completed in consultation with the rehabilitation provider or case manager.
The form should be based on medical advice about the employee's fitness to return and any restrictions. Ensure you have received and reviewed any medical certificates or clearance documents.
Phased return arrangements
For longer absences or serious injuries, a gradual return is often appropriate. This might involve reduced hours initially, modified duties, or working from home for part of the week.
The return plan should be flexible and reviewed regularly. Schedule follow-up meetings to assess how the employee is coping and adjust arrangements if needed.
Workers' compensation requirements
If the absence is related to a workplace injury, return to work obligations apply under workers' compensation laws. You must make reasonable efforts to provide suitable duties and cooperate with rehabilitation providers. Keep detailed records of all return to work planning and communications.
Looking to automate this process? RosterElf's HR software and leave management features handle return-to-work planning digitally, eliminating paper forms and manual tracking.
Who should use this form?
Essential for any business with employees
Legal disclaimer
This template is designed to reflect Australian workplace standards and workers' compensation principles at the time of publication. It is provided as a general guide only and does not constitute legal or medical advice.
You should review and tailor this template to suit your business, industry and specific circumstances. For workers' compensation cases or complex medical situations, seek advice from your insurer, rehabilitation provider or legal advisor.
Regulatory sources
This template is aligned with Australian employment requirements.
Ready to support returning employees?
Download our Return to Work form template and ensure smooth transitions back to the workplace.
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Related templates
Use this form alongside these related templates
Incident report form
Document workplace incidents that may lead to absence and return to work needs.
View templateLeave application form
Request personal and medical leave that may require return to work planning.
View templateGrievance form
Raise workplace concerns that may require support during return to work.
View templateDisclaimer
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.