RTW Return to Work Interview CARER RETURN TO WORK INTERVIEWDate Report Made:(Required) DD dash MM dash YYYY Report Made By:(Required)Nicola McCaughertyDean FosterCarol SavageRachel DeeryFiona KaneOtherIf other please put your full name here Carers Name:(Required) First Last Operations Manager:(Required)Carol SavageRachel DeeryArea Carer Works for Rachel:(Required) Newcastle Castlewellan Seaforde/Loughinisland Drumaness Ballynahinch Belfast Area Carer Works For Carol:(Required) Downpatrick Crossgar Killyleagh Saintfield Ballygowan Comber Sickness Classification:(Required) 03 Vomiting/Diarrhoea 07 Back Problems 08 Musculo-skeletal Neck 09 Musculo-skeletal Other Joint, Lower Limb 11 Other Known Causes - not elsewhere classified 13 Pregnancy Related Disorders 14 Chest and Respiratory Problems 15 Injury, Fracture 16 Skin Disorders 17 Stress 21 Surgery Related 23 Ear, Nose, Throat (ENT) 24 Eye Problems 25 Infectious Diseases 27 Cold, Cough, Flu - Influenza 29 Other Musculoskeletal Problems 30 Anxiety/Stress/Depression/Other Psychiatric Illnesses 31 Asthma 33 Dental and Oral Problems 34 Headache/Migraine 35 COVID Detail reason for absence:(Required)Date of first absence:(Required) DD slash MM slash YYYY Does the carer confirm they are fit to return to work at normal duties?(Required) Yes No Other Date confirmed able to return to work:(Required) DD slash MM slash YYYY Any additional information for example - anything else not listed on the form.This form will be submitted to the rota co-ordinator for the area and the area manager.
