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Phased Return to Work Plan

A completed fictional employer-employee return plan with review dates, adjustments and pay clarified without treating it as medical certification.

Jurisdiction: England and Wales - completed fictional worked example

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Important: This sample provides general legal information only and is not legal advice. Check the law, prescribed forms and signing requirements that apply to your exact jurisdiction and circumstances before use.

# PHASED RETURN TO WORK PLAN

Date: 16 September 2034

Parties: Moorland Analytics Ltd and Priya Shah

## 1. Purpose and parties

This phased return plan is agreed on 16 September 2034 between Moorland Analytics Ltd, company number 14672031, of 8 Crescent Park, Manchester M1 3HT, and Priya Shah, senior data analyst, whose normal workplace is that office. Priya's planned first day back is 23 September 2034.

## 2. Facts, scope and terms

The plan follows Priya's fit note and occupational-health discussion, but it is not a medical diagnosis or a substitute for further clinical advice. Priya will tell her manager, Daniel Brooks, if the plan is unsafe or needs review; the company will consider updated medical evidence and consult rather than making assumptions.

## 3. Process and responsibilities

For weeks one and two, Priya will work Monday, Wednesday and Friday from 10:00 to 15:00, including a 30-minute break, on data-quality projects with no urgent client deadlines. For weeks three and four, she will work Monday to Thursday from 10:00 to 16:00 with the same break.

## 4. Evidence, records and safeguards

From 21 October 2034 the intended pattern is Priya's contractual 37.5 hours over five days, subject to the review on 18 October. During the phased period she will be paid for hours worked and any statutory or contractual sick pay to which she is entitled; payroll will confirm figures separately and no holiday entitlement is removed.

## 5. Review, escalation and outcome

For the first four weeks the company will provide a quiet desk, screen breaks, a reduced meeting load, written agendas and remote attendance where reasonably practicable. These are trial adjustments, not a permanent contractual variation, and may be changed after consultation or a risk assessment.

## 6. Reservations and practical protections

Daniel and Priya will review progress on 30 September and 18 October, recording attendance, workload and any adjustment needed. The company will keep health information confidential, restrict access to those who need it, and consider reasonable adjustments under the Equality Act 2010 where the legal test is met.

## 7. England and Wales law and completion

This completed fictional plan does not waive either party's rights, guarantee a particular medical outcome or authorise unsafe work. Absence reporting, grievance and sickness procedures continue to apply, and any permanent change to contract or duties must be agreed separately in writing.

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