Template · UK · .docx
Return-to-work interview form (UK)
A structured form for the conversation a line manager has with an employee returning from any sickness absence. Includes self-cert / fit-note check, Bradford-Factor section, and reasonable-adjustments prompt.
Direct download. No email required. Last reviewed 2026-06-11 against gov.uk and Acas.
WagePerks does not provide legal advice. This template is a starting point only.
Before using it for an employee, review the wording with your solicitor or HR advisor and update
it for your specific role, industry and circumstances.
What this template covers
- Employee + line-manager details and the dates of absence
- Reason for absence in the employee's own words
- Self-certification (up to 7 days) and fit-note status from day 8 (gov.uk)
- Bradford-Factor calculation reference (see /learn/bradford-factor-uk-hr/)
- Workplace adjustments offered under Equality Act 2010 s.20
- Phased return and occupational-health referral
- EAP signposting prompt
- Sign-off boxes for employee and manager
What this template doesn't cover
- A statutory form — there is no statutory return-to-work form in UK law
- A substitute for the conversation itself — the form supports the conversation, it doesn't replace it
- A trigger for disciplinary action on its own — patterns may justify formal review, but every case needs an individual reasonable-adjustments check
- A medical record — keep medical information separate per ICO guidance
Sources behind this template
- Acas — Sickness absence
- gov.uk — Taking sick leave — self-cert and fit notes
- Equality Act 2010 s.20 — reasonable adjustments duty
- ICO — Health data at work
Sources verified 2026-06-11. We re-verify quarterly.
How WagePerks fits
Use this template to draft the policy. Then store the signed final version inside the WagePerks document management module — with version history, e-signatures and read receipts — as part of the £4.50 per employee per month all-in price. White-label included. Rolling monthly.