Return to work New Return To Work Name(Required) SiteAutoportBearsdenBraesideBridgetonCoatbridgeCrowwoodDumbarton RdRutherglenSauchiehall StStrathclydeWishawHead OfficeDepartmentAccountsDepartment LeadHRIT OfficePackersPurchasingOtherThis form must be completed after any period of absence other than holiday. Employees must complete ALL questions marked in bold type.First Date Of Absence(Required) DD slash MM slash YYYY Last Date Of Absence(Required) DD slash MM slash YYYY Return To Work Date(Required) DD slash MM slash YYYY Total Number Of Working Days Absent(Required)Contacting The CompanyDid You Telephone Your Management/HR At The Commencement Of Your Absence?(Required) Who Did You Speak To? What Time Did You Phone In?(Required) Hours : Minutes AM PM AM/PM Reason For Absence?(Required) Do You Feel Better & Fit To Get Back To Work?(Required) Did The Employee Properly Notify The Employer Of Their Absence?(Required) YES NO Did The Employee Consult With Their GP?(Required) YES NO Did The Employee Indicate That Factors At Work May Have Caused Or Contributed To The Absence?(Required) YES NO If So, Please Explain: If So, What Action Is To Be Taken To Support The Employee? Is This Absence Part Of An Overall Pattern? YES NO If So, Please Explain: Does The Employee Have Any Type Of Disability? YES NO Any Further Comments From The Manager/HR:Employee Signature(Required)Date(Required) DD slash MM slash YYYY Manager/HR Signature(Required)Date(Required) DD slash MM slash YYYY