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Get and Sign pdfFiller Return to Work 2011-2022 Form
Record Over Last 12 Months: (including this period of sick absence)
Number of occurrences: _______________
Total Hours Lost: ___________________
Section 2 – Return to Work Interview
Issues to Address & Employee Response
How are you feeling now? Do you feel that you are in a position to carry out your normal hours & duties?
Did you seek medical attention for your sick absence?
What was the possible cause of your sick absence? What action have you taken to avoid any similar...
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