Free Return to Work Plan Template

📝 FILL IN YOUR DETAILS

Employee

Employee Name

Position

Date of Absence Started

Planned Return Date

Medical Details

Condition / Injury

Treating Doctor

Return Certificate

Current Restrictions

Graduated Return Plan

Week 1 Plan

Week 2 Plan

Week 3 Full Return

Support Required

Support / Modifications Needed

Review

First Review Date

Reviewed By

Employee Signature

Date

Manager Signature

Date

Download & Print

💡 Fill in fields → Print / Save PDF → Sign → Keep copy

⚠️ General guidance only. Consult a professional for your specific situation.