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1. Employee Information: Basic details including employee name, personnel number, department, and position
2. Absence Details: Information about the period of absence, including start and end dates, type of absence (illness, injury, etc.), and whether proper notification procedures were followed
3. Return to Work Discussion: Record of the conversation about the employee's current well-being and ability to return to full duties
4. Work Capability Assessment: Evaluation of whether the employee can perform their regular duties or requires modifications
5. Required Actions: Documentation of any necessary workplace adjustments, modified duties, or support measures
6. Data Protection Notice: Statement about how the information will be processed and stored in compliance with GDPR and BDSG
7. Signatures: Space for both employee and manager to sign and date the form, confirming the discussion took place
1. Medical Certificate Review: Section for reviewing medical certificates if the absence was due to illness - only included when medical documentation was required
2. Occupational Health Referral: Section for documenting referral to occupational health services if needed for complex cases or long-term absences
3. BEM Process Initiation: Section required when absence exceeded 6 weeks within 12 months, triggering the workplace integration management process under SGB IX
4. Pattern of Absence Review: Optional section for discussing patterns of absence if there have been multiple absences - to be included only when relevant
5. Risk Assessment: Section for documenting specific workplace risks that need to be considered for the returning employee - included when returning from workplace injury or when new risks need to be assessed
1. Absence History Summary: Appendix showing overview of employee's absence history for the past 12 months
2. Workplace Adjustment Plan: Schedule detailing specific modifications to workplace, equipment, or duties if required
3. Follow-up Meeting Schedule: Timeline for follow-up meetings to monitor progress and adjust support measures if needed
4. Health and Safety Checklist: Checklist ensuring all necessary safety measures are in place for the employee's return
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