PRIVATE & CONFIDENTIAL - Return to Work Form

This form must be completed by a Line Manager after any period of absence other than annual leave.

A copy of the completed form will be retained in line with Royal Docks Waterways' Data Protection Policy.

1Period of Absence > 2Reason for Absence > 3Signatures
Return to work form - Employee Name Return to work form - Employee Name First Last
Department
DATE(S) OF ABSENCE (Non-working days i.e. weekends must be included) First Date of Absence DATE(S) OF ABSENCE
(Non-working days i.e. weekends must be included)

First Date of Absence / DD / MM YYYY
Last Date of Absence Last Date of Absence / DD / MM YYYY
Return to Work Date Return to Work Date / DD / MM YYYY
Total Number of Days Absent:
CONTACTING THE COMPANY Date Royal Docks Waterways was informed of your absence CONTACTING THE COMPANY

Date Royal Docks Waterways was informed of your absence / DD / MM YYYY
Time Royal Docks Waterways was informed of your absence Time Royal Docks Waterways was informed of your absence : HH MM
Who did you speak to?
Was this in line with company procedure?

Was this in line with company procedure? Yes No

If NO, Manager to reiterate company policy to the Employee