Return to Work Form

Return to Work and Statutory Sick Pay (SSP) Declaration

This form must be completed on your return to work following an absence.

Return to work form:

Submit the return to work and statutory sick pay (SSP) declaration form and a member of Birtley House HR team will contact you if required.

Fields marked with an * are mandatory.

If uploading a ‘Fit Note’, please ensure the file is no larger than 5Mb in size and is in one of the following file formats: pdf, jpg or png.

I confirm that the above information is correct and that I am fit and well to return to work.

I understand that if I provide false or inaccurate information about my absence or sickness from work it may, depending on the circumstances, be treated as gross misconduct and result in my summary dismissal from this employment.