[{"id":"2cbf8229-815c-4636-94f1-1d20f2f480b6","order":1,"text":"RETURN TO WORK INTERVIEW","fontSize":"22","textAlign":"center","bold":true,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"be074467-2537-4764-9aaf-fcc7f639db26","order":2,"text":"Sickness Absence Management — Record of Return to Work Discussion","fontSize":"16","textAlign":"center","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"7145751e-bc82-4535-a842-075b6f7fdb59","order":3,"text":"Organisation: [Organisation name]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"858d1fd9-cee9-419d-9f97-f6d7d58aec69","order":4,"text":"Site / location: [Site / location]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"533023d2-0fde-43c4-b557-9438d6253123","order":5,"text":"Purpose and status of this document","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"10"},{"id":"235795cb-8160-4c08-96f7-e5a86c5e7918","order":6,"text":"This document records the return to work discussion held between the employee and their line manager following a period of sickness absence. It supports the fair, consistent and supportive management of attendance, the welfare of the employee on their return, and the operational planning of the team. It forms part of the employee's confidential absence record.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"427d746a-c7ce-4edb-b2aa-feff57dfd5e2","order":7,"text":"The return to work discussion is a normal and supportive management practice. It is not, of itself, a disciplinary process. It enables the manager to confirm the employee's fitness to return, to identify any support or workplace adjustments that may be required, to confirm the agreed dates in writing for payroll, handover and planning purposes, and to record any matters arising. Where a pattern of absence reaches a defined trigger, it may also serve as the point at which the next stage of the absence procedure is considered.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"6a89b2e2-8bd2-4b23-8a68-48e69ae3aac4","order":8,"text":"Confidentiality and data protection","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"e7e9d410-5a0a-4d73-b691-3fca7a6ad3ca","order":9,"text":"Information recorded in this form, including any reference to the reason for absence or to health, constitutes personal data and (where it concerns health) special category data under the UK General Data Protection Regulation and the Data Protection Act 2018. It will be processed lawfully and fairly, held securely, restricted to those who need it to manage the employee's attendance and welfare, and retained only for as long as is necessary for that purpose and to comply with the organisation's legal obligations.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"6d271428-7ce1-405a-a9aa-2f3369ad32cd","order":10,"text":"The employee","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"4fd10913-8cec-4945-9c44-753f57ce9e7c","order":11,"text":"Name: [Title] [Employee full name]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"ddc4da0f-bc39-491d-a7a6-2cbf3addaea9","order":12,"text":"Job title: [Job title]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"e4d9c697-e1fd-41dd-ae14-83e5867ad91c","order":13,"text":"Department / team: [Department / team]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"75efd993-6ba7-4d96-a2ee-9dac7d51e1bc","order":14,"text":"Payroll / employee reference: [Payroll / employee reference]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"0daf7133-6a5d-4523-9936-18db87315a46","order":15,"text":"The manager conducting the interview","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"273fb282-9e45-4671-994d-b15bff65acb1","order":16,"text":"Name: [Title] [Manager full name]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"b64f0d2f-6b6f-4ba5-9159-0ef73b3ffd35","order":17,"text":"Job title: [Manager job title]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"4ba3f009-1ffc-4d5a-be92-c14912f0684a","order":18,"text":"Meeting held on [Meeting date] at [Meeting location].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"810f2dda-1f1e-4ee6-9167-6a2f4b9d3e2c","order":19,"text":"Details of the absence","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"c6f67e88-541c-4119-b95c-12d808a78e0c","order":20,"text":"The employee was absent from work from [First day of absence] to and including [Last day of absence], representing [Working days lost] working day(s) lost.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"fd6aba2b-d0c3-4f75-b6c2-8478c6463a42","order":21,"text":"Category of absence: [Reason category].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"869c5b96-7fa9-4288-87b4-fb6432312d95","order":22,"text":"Reason given by the employee: [Reason given].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"37e8edb7-356c-4820-a11c-4d0355140353","order":23,"text":"The employee has indicated that the absence is considered to be work-related: [Work-related].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"54c8e1a1-e942-488b-a937-0ca4cf479ddc","order":24,"text":"Where an absence is, or may be, work-related, the manager will ensure that any relevant risk assessment is reviewed, that the matter is recorded in accordance with the organisation's health and safety procedures, and that any reportable incident is dealt with under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) where applicable.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"94536954-bead-443b-8896-3610b4170766","value":"Yes","type":"add","operator":"="}]},{"id":"8000a25c-188a-49f0-8de4-55eb3866908e","order":25,"text":"Certification of the absence","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"c8dfe71b-1bed-4ca6-b4f6-c13d8d001071","order":26,"text":"Certification provided for the absence: [Certification], covering the period from [From] to [To] where applicable. The employee confirms that any self-certification or fit note required by the organisation's absence procedure has been or will be provided.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"6c2acbf9-5828-41f0-9dce-986bfe933156","order":27,"text":"Fitness to return to work","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"27e0ad70-63ec-47ad-bb4d-c8cb7fe73bf3","order":28,"text":"Following discussion, the position regarding the employee's fitness to return is recorded as: [Fitness].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"d95dd806-3406-4c51-8963-50f42fa70ea3","order":29,"text":"Occupational Health referral: [OH referral].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"41a1f9d2-a6c6-49c2-b7b8-dc72ee98fca1","order":30,"text":"A referral to Occupational Health will be made so that an independent assessment of the employee's fitness for work, and any recommended adjustments, can be obtained. The employee's consent to the referral will be sought and the purpose of the referral explained to them. Any report obtained will be treated as confidential health information.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"eed0c718-b530-4897-aa71-98e4d52e0ea1","value":"Yes","type":"add","operator":"="}]},{"id":"15c2e6f4-ae75-4ad5-8de1-cd5bfe4453ac","order":31,"text":"Phased return and workplace adjustments","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"1656ed2a-7ce5-4e71-86bc-61897dbd6e5e","order":32,"text":"Phased return to work: [Phased return].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"6b49fc15-05e3-4593-8ceb-1388be86ac49","order":33,"text":"The agreed phased return arrangements are as follows: [Phased return detail]. The phased return will be kept under review and is expected to conclude on [Phased return end date], by which date the employee is expected to have returned to their normal hours and duties unless otherwise agreed.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"dba63919-3fd7-4775-b548-b70a0b53cae1","value":"Yes","type":"add","operator":"="}]},{"id":"d552917e-6f8d-459e-aedf-76669532cc7c","order":34,"text":"Reasonable adjustments to the role or workplace: [Adjustments].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"20983963-29df-4e20-98e8-a2817c212ba2","order":35,"text":"The following adjustments have been discussed and agreed: [Adjustments detail]. Where the employee has, or may have, a disability within the meaning of the Equality Act 2010, the organisation will give proper consideration to making reasonable adjustments to enable the employee to remain in or return to work.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"3a3906e4-2453-4c87-91c7-77a9ea1430dc","value":"Yes","type":"add","operator":"="}]},{"id":"fb8e1805-9fb2-463d-96aa-45514fa96c0f","order":36,"text":"Review of attendance and absence triggers","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"92b844c2-ec0e-43b8-b131-f2d106ad2a45","order":37,"text":"Has the employee's level or pattern of absence reached a trigger point under the organisation's attendance management procedure: [Trigger reached].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"bcd7777e-431e-4d1e-9556-97915e18b010","order":38,"text":"Bradford Factor score recorded at the date of this discussion: [Bradford Factor score]. The Bradford Factor is calculated as the number of separate spells of absence squared, multiplied by the total number of days of absence, over a rolling twelve-month period. It is used as an objective indicator and not as an automatic trigger for any sanction.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true,"displayConditions":[{"field":"71d99ad8-eb89-44d8-a05c-171b0c903d6d","value":"Yes","type":"add","operator":"="}]},{"id":"c383f4ea-7093-4326-8268-394518994c66","order":39,"text":"Action taken in consequence of the trigger having been reached: [Trigger action]. The employee has been informed of the trigger, the reasons for it, and any next stage of the procedure that may follow, and has been given the opportunity to explain the circumstances of their absence.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"71d99ad8-eb89-44d8-a05c-171b0c903d6d","value":"Yes","type":"add","operator":"="}]},{"id":"bfc05d06-716f-4c03-be6b-a943990aab2e","order":40,"text":"Support discussed and confirmation of arrangements","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"45ef055d-76e3-4351-b5a9-eae6ea5c62f9","order":41,"text":"Support discussed with the employee on their return: [Support discussed].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"b74553e1-4de1-4525-bb44-777d8a3f7e80","order":42,"text":"The manager has confirmed to the employee, and records here in writing, the dates of the absence set out above, the date of return to work, and any phased return, adjustments or review arrangements agreed. This written confirmation is provided so that payroll, handover and operational planning may proceed on a settled basis and to avoid any subsequent dispute as to what was agreed.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"609942f7-e8ad-4765-9936-3e0b247a72c2","order":43,"text":"Outcome and next review","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"578ee65e-e6ca-4d35-9040-d5fbecc80913","order":44,"text":"Outcome of this return to work discussion: [Outcome].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"12a3a041-a4a4-47c9-a1f2-cbec3b7759e8","order":45,"text":"The employee's attendance and any arrangements recorded above will next be reviewed on or around [Next review date].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"0ff43255-4b9b-4cd3-b6f9-0e23a853c537","order":46,"text":"Employee comments","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"895a2d31-cb51-48a7-8117-904697bd1729","order":47,"text":"The employee has had the opportunity to add their own comments to this record. Comments of the employee: [Employee comments]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"b2a6eb7e-2722-4ea0-919b-b46605112894","order":48,"text":"Declarations","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"e5e24256-900b-4da0-8e3b-b418a346ccc7","order":49,"text":"Employee: I confirm that the matters recorded above reflect the discussion held with my manager, that I have had the opportunity to comment, and that I understand the arrangements agreed for my return to work. I understand that the information recorded will be processed in accordance with the organisation's data protection obligations.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"6ed6ac08-cf5a-4d8c-bba5-31cd4a8b74e6","order":50,"text":"Signed (Employee): [Employee full name]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"f4975dc4-ff0c-4a0c-b6e5-e227f320c7ff","order":51,"text":"Date: [Employee signature date]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"93c378f8-0044-456f-89d2-d8dc5a9c8c7e","order":52,"text":"Manager: I confirm that I have conducted this return to work discussion fairly and consistently with the organisation's attendance management procedure, and that the matters recorded above are an accurate record of that discussion and of the arrangements agreed.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"d116a6ad-405e-463e-8a9e-da81e45ce253","order":53,"text":"Signed (Manager): [Manager full name]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"5","cflou":false,"active":true},{"id":"b8265ee4-6889-48fa-9398-3108251b87fe","order":54,"text":"Date: [Manager signature date]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"fc8efaa3-dc5f-4dcd-8685-5616743eaad6","order":55,"text":"For and on behalf of [Organisation name].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true}]