What is a return to work agreement?
Coming back after a long absence is easier when everyone knows the plan. A return to work agreement sets out how the employee builds back up to full hours, what they will and won't do in the meantime, what support and adjustments are in place, how they're paid while working reduced hours, and when you'll check how it's going.
This template works after illness or injury, parental or family leave, or an extended leave of absence. It records the first day back and the target date for full hours and duties, a stage-by-stage phased schedule, adjusted duties (or normal duties within the phased hours), workplace adjustments, any medical or occupational health advice the employee chose to share, and a confidential support contact. You pick how pay works during the phase-in — normal full pay, pay for hours worked (with any sick pay and the option to use holiday), or your own arrangement. The agreement keeps health information confidential and says it doesn't limit any right to adjustments or accommodations.
- Best for
- Phased returns after illness, injury, parental leave or a long absence
- Signed by
- The employer (manager or HR) and the employee
- Pay during phase-in
- Full pay, pay for hours worked, or as you set out
- Length
- About 2 pages
When to Use a return to work agreement
- A phased return after surgery or a long illness, following a doctor's or fit note recommendation
- Returning after a back injury with lifting restrictions for a few weeks
- Coming back from parental leave on a gradual schedule
- Returning after extended leave with a refresher period on lighter duties
- Recording workplace adjustments agreed after occupational health advice
What You Fill In
18 blanks, then the name and email of each person who signs: employer, employee.
1 The return
- Company name*
- Date of the agreement*
- Employee's full name*
- Job title
- Manager
- Returning after* illness or injury · parental or family leave · an extended leave of absence · a period of absence
- Absent since
- First day back*
- Expected back to full hours and duties*
2 Hours and duties
- Phased schedule*
- Adjusted duties
3 Support
- Workplace adjustments and support
- Medical or occupational health advice followed
- Confidential support contact
4 Pay
- Pay during the phased return* normal full pay · pay for the hours actually worked · as set out below
- Pay details
5 Review
- Check-ins* every week · every two weeks · every month
- Formal review date
6 Who signs
- Employer signature and date, job title · Usually the employee's manager or HR
- Employee signature and date · The employee returning to work
What the return to work agreement Covers
- The return
- Phased schedule
- Duties
- Adjustments and support
- Pay
- Check-ins and review
- Confidentiality and rights
Using the return to work agreement, step by step
1 Set the dates
Choose what the employee is returning after (kept general on purpose), the first day back and when you expect them to be back to full hours and duties.
2 Write the phased schedule
One line per stage — for example, weeks 1-2 at four hours a day on three days, weeks 3-4 at six hours a day, then normal hours. Add adjusted duties if some tasks are off-limits for a while.
3 Add adjustments, advice and support
List any equipment, breaks or other changes, and summarise medical or occupational health advice only if the employee has agreed to share it. Add an employee assistance programme or other confidential contact if you have one.
4 Choose pay and check-ins, then send
Pick how pay works during the phase-in, set how often you'll check in and an optional formal review date, and send it to the employee to sign.
Tips Before You Send It
- Build the plan with the employee, not for them. The agreement says it was discussed and agreed, and can change by agreement.
- Ask only for the health information you need. A general reason is enough for the document.
- Check whether sick pay rules or a statutory benefit affect pay during a phased return where you are.
- Be ready to slow down or pause the schedule — the agreement allows it — rather than forcing a date.
Sign It Online In Minutes
- Fill in the blanks. Names, dates and amounts go straight into the agreement — the preview shows exactly where.
- Name who signs. Tick “This is me” for your own part. VergeHR builds the PDF with every signature, date box on the right line, and you can check or move anything before sending.
- Send it. Each signer gets a secure link and signs from any device — no account needed. The signed PDF, with an audit trail and a Certificate of Completion, is filed in Files and emailed to everyone.
Return to work agreement: frequently asked questions
What is a phased return to work?
A gradual build-up to normal hours and duties over a few weeks after a long absence. The agreement records each stage so the employee, manager and payroll all work to the same plan.
How is the employee paid during a phased return?
You choose: normal full pay throughout, pay for the hours actually worked (plus any sick pay or other payments they're entitled to for the rest, and optionally holiday), or your own arrangement written out in full. Full pay for normal hours resumes when they're back to normal hours.
Does the employee have to share medical details?
No. The template keeps the reason general and includes medical advice only if the employee agrees to share it. It commits the company to keep any health information confidential.
Can this be signed electronically?
Generally, yes. Electronic signatures are widely accepted for workplace agreements like this in the US (ESIGN Act and UETA), the UK, the EU (eIDAS) and Canada. VergeHR keeps an audit trail with the signed PDF.