RETURN TO WORK INTERVIEW FORM

(Guidance on conducting this interview can be found in the Effective Management of Sickness Absence handbook)

Date:

Employee Details Manager’s Details

Name: Name:

Job Title/Band Job Title:

Service Area:

Date returned to work Number of days sick (this episode)

Medical Certificate provided (tick box)

YES NO NOT

APPLICABLE Nature of Illness

Is employee fully recovered?

(tick box)

YES NO

Detail reason below

Is support required ?(tick box) YES Detail reason

below

NO

Number of sickness episodes in last 4 month period

Number of sickness episodes in last 12 month period

Has individual reached any other trigger point?

Trigger Points

• 3 episodes of sickness absence during a continuous 4 month period

• 30 days continuous sickness absence

• 5 episodes of sickness absence during a continuous 12 month period

• A Bradford Factor Score of 80 or above

e.g. Three absences totalling 9 days (i.e. 3 x 3 x 9 = 81)

• Sickness patterns that cause managerial concern, e.g. key holidays such as Christmas, School Breaks.

Have contributory

factors/underlying causes been discussed ?(tick box)

YES Detail below

NO

Are there any trends to sickness episodes ?(tick box)

YES Detail below

NO

Has occupational health referral been discussed ?(tick box)

YES Detail below

NO

Is monitoring period required?

(tick box)

YES Detail below

NO

Monitoring Period:

Review Date:

Any follow up action for employee:

Any follow up action for manager:

Manager’s signature: Date:

Employee’s statement:

I have today discussed all of the details above with the Manager concerned.

Employee’s signature: Date:

Appendix Ka Informal Attendance Meeting

Requirement to attend

PRIVATE & CONFIDENTIAL (name & address)

Dear

Attendance at work

Following your return to work interview on (date) with (name), I require you to attend a meeting with me to review and discuss your sickness absence record.

Attached to this letter is a copy of your return to work interview notes and a copy of your absence record from (date) to (date).

The interview will be held at (location) on (date) at (time).

Please confirm with (name) that you will be attending the meeting.

I enclose a copy of the Trust’s Policy relating to the management of sickness absence for your information.

Yours sincerely

(Name) Enc

Appendix Kb Informal Attendance Meeting

Outcome letter PRIVATE & CONFIDENTIAL

(name & address) Dear

Following our meeting on (date) regarding your attendance at work, I am writing to confirm our discussions.

At the meeting your absence record was discussed and I confirmed that over the past (timescale) you have been absent from work (number of times).

In explanation of your absence you stated that (include detail).

I asked whether you felt the Trust could do anything further to support you and help to improve your attendance at work. You advised XXXX

We discussed a referral to Occupational Health (and I agreed to refer you to establish whether there are any underlying medical reasons for your absence, //or agreed that it was not necessary/appropriate at this point).

I explained that I would be monitoring your sickness/absence over the next 6 months from (date) until (date) and that your record would be reviewed after 3 months and at the end of this period.

During this monitoring period, I would expect to see a significant and sustained improvement in your absence record. As indicated in the meeting, if you reach a Bradford Factor score of 10 or more or hit any of the other trigger points as set out in the Attendance Management Procedure (excluding the original trigger that instigated this meeting and the monitoring period) the next meeting will be held within the formal attendance management process. It was agreed that I would inform you nearer the time of the format under which the next meeting would be held.

Yours sincerely

(name)

Appendix Kc Informal Review Meeting

Requirement to attend

PRIVATE & CONFIDENTIAL (name & address)

Dear

Further to your current sickness monitoring, I require you to attend a meeting with me to review and discuss this monitoring period.

The meeting will be held at (location) on (date) at (time).

Attached to this letter is a copy of your absence record from (date) to (date).

Please confirm with (name) that you will be attending the meeting.

Yours sincerely

(Name) Enc.

Appendix Kd Review Meeting

Outcome letter

PRIVATE & CONFIDENTIAL (name & address)

Dear

I am writing following our meeting on (date) at which we met to review your sickness absence record. You have been on Sickness Absence Monitoring for 3 months within a 6 months monitoring period.

During this period, you have been absent for (number of) days on (number of) occasions.

Or

During this period I am very pleased to confirm that you have had no periods of sickness absence.

Para 1 (slight improvement)

Your attendance at work has therefore improved; however, I shall continue to monitor your attendance for a further 3 months to ensure that the improvement is sustained. The conditions of the monitoring will still apply and should you hit the trigger point of the Bradford factor score of 10 or above or any of the other trigger points, this will result in the instigation of the formal attendance management procedure. However I hope this is not the case and you .will be able to attend work on a regular basis, however, if you encounter any problems, please discuss them with me so that we can try to find a satisfactory solution.

Para 2 (no significant or sustained improvement)

Unfortunately your absence levels during the monitoring period have been a cause for concern and it has triggered the instigation of the Formal Attendance Management Procedure. I am therefore informing you that you are required to attend an attendance hearing in relation to your attendance record.

The meeting will be held on (Date) at (time) at (location). I will be accompanied by (name and title), and you are entitled to be accompanied by your trade union representative/professional organisation or a fellow colleague. You should make the necessary arrangements for them to attend.

Please confirm your attendance with (name and number).

Yours sincerely (name)

Cc Human Resources

Appendix Ke Attendance Hearing Outcome letter