Return to Work Return to WorkReturn to Work FormName(Required) First Last Date(Required) DD slash MM slash YYYY Smart Horizons Ltd is committed to ensuring your return is as smooth as possible and if you would like to speak about your absence or anything we can do to make your return easier, please contact your line manager or another member of staff in confidence.Please state the reason for your absence. E.g. sickness, bereavement, jury service(Required)Date of first day of absence(Required) DD slash MM slash YYYY Date returned to work(Required) DD slash MM slash YYYY Total number of days away from work(Required)Was your absence caused by an accident or as a result of an incident at work?(Required)NoYesIf yes please give detailsIf you have been unwell, are you now fit to work?(Required)YesNoAre you taking any medication which may affect your performance?(Required)NoYesIf yes please give detailsDo you need any adjustments to enable you to return to work?(Required)NoYesIf yes please give detailsNameThis field is for validation purposes and should be left unchanged.