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Return To Work Doctor Evaluation Form Template for England and Wales

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Key Requirements PROMPT example:

Return To Work Doctor Evaluation Form

"I need a Return To Work Doctor Evaluation Form for a manufacturing employee returning from long-term stress leave, with specific focus on phased return and workplace adjustments for a high-pressure environment."

Document background
The Return To Work Doctor Evaluation Form is a critical document required when employees need to return to work following significant illness, injury, or extended medical absence. This form, compliant with English and Welsh law, serves as an objective medical assessment tool that helps protect both employer and employee interests. It includes detailed medical evaluation, work capability assessment, and specific recommendations for workplace adjustments if needed. The document ensures compliance with health and safety regulations, equality law, and data protection requirements while facilitating a safe and appropriate return to work process.
Suggested Sections

1. Employee Information: Basic details including name, employee ID, department, role, contact information

2. Medical Professional Details: Name, qualifications, registration number and contact details of examining doctor

3. Absence Information: Details of current absence period, including start date, nature of illness/injury, and previous relevant medical history

4. Clinical Assessment: Current health status, examination findings, impact on work capability, and ongoing treatment plans

5. Work Capability Statement: Clear statement of fitness to return to work, including any limitations or restrictions

Optional Sections

1. Specialist Referral Information: Details of any specialist consultations or referrals, to be included when complex medical conditions require specialist input

2. Workplace Adjustment Requirements: Specific workplace modifications or adjustments needed for safe return to work, included when adjustments are necessary

3. Phased Return Schedule: Detailed plan for gradual return to work, including hours and duties progression, used when gradual return is recommended

Suggested Schedules

1. Medical Test Results: Relevant test results, imaging reports, or specialist medical reports supporting the evaluation

2. Risk Assessment: Workplace risk assessment specifically related to the employee's medical condition and return to work

3. Consent Forms: Employee's signed consent for medical examination, data sharing, and authorization for return to work evaluation

4. Follow-up Schedule: Detailed timeline for review appointments and progress assessments post-return to work

Authors

Alex Denne

Head of Growth (Open Source Law) @ ¶¶Òõ¶ÌÊÓÆµ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Relevant legal definitions






























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Relevant Industries
Relevant Teams
Relevant Roles
Industries

UK GDPR: The UK General Data Protection Regulation governing the processing of personal data, particularly relevant for handling sensitive medical information in return-to-work evaluations

Data Protection Act 2018: UK's implementation of data protection requirements, providing specific guidelines for processing medical data and ensuring patient privacy

Access to Medical Reports Act 1988: Legislation governing how medical reports for employment purposes are handled, including patient rights to view reports before they're sent to employers

Equality Act 2010: Key legislation protecting against discrimination, particularly relevant for disability considerations and ensuring reasonable adjustments in the workplace

Health and Safety at Work etc. Act 1974: Primary legislation for workplace health and safety, ensuring safe return to work conditions and appropriate risk assessments

Management of Health and Safety at Work Regulations 1999: Detailed regulations requiring employers to assess and manage risks to their employees' health and safety, including those returning to work after illness

GMC Guidance on Confidentiality: Professional guidelines from the General Medical Council on handling patient information and maintaining medical confidentiality

Medical Act 1983: Fundamental legislation governing medical practice in the UK, including professional standards for medical evaluations

Access to Health Records Act 1990: Legislation governing access to health records and ensuring proper handling of medical information

Working Time Regulations 1998: Regulations governing working hours and conditions, relevant when determining appropriate work schedules for returning employees

Faculty of Occupational Medicine Guidelines: Professional standards and guidelines for occupational health assessments and return-to-work evaluations

NHS Fit Note Guidelines: National Health Service guidelines on issuing and managing fit notes (formerly sick notes) and return to work assessments

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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