Nursery Return to Work Interview Nursery Return to Work Interview "*" indicates required fields Step 1 of 3 33% Name of Staff Member Returning*Name of Person Completing Form*Postion*Nursery Manager / Deputy ManagerDirectorNursery*-Please Select-ShrewsburySusan LawrenceFirst Date of Absence* Day Month Year Last Date of Absence* Day Month Year Total Number of Days Absent*Total Number of Days Off Work*Is absence due to an injury at work?* Yes No Have you seen a doctor?* Yes No Reason for Absence*Please give a brief description of the illness or other reason for absenceAction Taken*Please give a brief description of any action taken to datePrevious Dates of Absence in the Past 12 Months*Stage Review Triggered?* Yes No Proposed Course of Action* I understand that if I knowingly provide inaccurate or false information regarding my absence it may result in disciplinary action* Yes Employee Name*Managers Name*
