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Role Chart for Pre-Return to Work Checklist | HR, Health Managers, Department Heads, and Medical Staff
2026.10.20 15:27
Risk Assessment and Safety System
Role Chart for Pre-Return to Work Checklist | HR, Health Managers, Department Heads, and Medical Staff
Procedures before returning to work after health leave HR, health managers, department heads, and medical staff This is an Excel spreadsheet organized for dividing responsibilities. It includes an RยทAยทCยทI role table by task, a progress chart that generates a step-by-step schedule simply by entering the expected return date, records of work coordination agreements, and an information sharing scope table.
What you can do with this material
For the 20 tasks, determine in advance who executes (R) and who is responsible (A), and when a reinstatement case arises One scheduled date of reinstatement Check the scheduled date, delay status, and next tasks for each stage. Work adjustment is not based on the diagnosis name. Restriction Items ยท Period ยท Review Date It was designed to remain as.
For the 20 tasks, determine in advance who executes (R) and who is responsible (A), and when a reinstatement case arises One scheduled date of reinstatement Check the scheduled date, delay status, and next tasks for each stage. Work adjustment is not based on the diagnosis name. Restriction Items ยท Period ยท Review Date It was designed to remain as.
๐ฅ Download Excel Role Chart for Pre-Return to Work Checklist
๐ Use this in these situations
- When the return to work of an employee on sick leave is approaching, but it has not been decided who among HR, Health, or the department will do what
- When you have experienced reinstating someone based solely on a medical opinion but failing to adjust their duties
- When you need a standard on how far to convey the results of a reinstatement interview to the department head
- When you start adjusting work but cannot manage when to finish and check again
๐๏ธ Sheet composition
| sheet | detail | Input method |
|---|---|---|
| Writing Guide | Order of use, meaning of RยทAยทCยทI, personal information precautions, distinction between legal and recommended use | For reading |
| Role Chart | 8-step tasks (Application, Preparation, Judgment, Decision, Sharing, Support, Post-return, Recording) x 20 items ร HR, Health Manager (Occupational Health Physician), Department Head, Medical Staff, Returned Employee | RยทAยทCยทI Selection + Automatic Check |
| Reinstatement Schedule | Step 11 Scheduled Dates, Completion Dates, Status (Completed, Delayed, Imminent, Scheduled), Next Tasks | Enter expected return date + automatic schedule |
| Work adjustment agreement | Adjustment type, details, start date/scheduled end date/review date, who to share with | Input + Remaining Days/Status Automatic |
| Scope of Information Sharing | Whether to share 8 types of information with HR, department heads, colleagues, and health managers (OยทโณยทX) | Select + Count Automatic |
| reason | Links to original documents for the Occupational Safety and Health Act and its Enforcement Rules, the Labor Standards Act, the Personal Information Protection Act, Guidelines for Work Suitability Assessment, etc. | For reading |
โ๏ธ Order of Use
- Modify the [Role Chart] to suit our company. There is one A (responsible person) for each task. If there is no A or there are two or more, '1 A designated' is displayed in red in the inspection column. If your company does not have a health manager, please replace the health manager column with 'Occupational Health Doctor' or 'External Medical Institution'.
- If a reinstatement case arises, copy the [Reinstatement Progress Chart] sheet. Enter the case code (instead of the name) and the expected return date. The scheduled dates for each step are calculated automatically.
- Completion date whenever a step is finished Write it down. If the scheduled date passes, it changes to 'Delayed', and if it is within 3 days, it changes to 'Imminent', and the next task is displayed below.
- After the interview, [Work Adjustment Agreement] Enter the restriction items, period, and review date. Once the review date has passed, it will be displayed as 'Review Passed'.
- [Scope of Information Sharing] Before forwarding to the department head Checks.
๐งฎ Things that are displayed automatically
| item | Calculation method |
|---|---|
| Role sheet check | If there is exactly 1 A and an R or A is present, mark as 'Normal'; otherwise, indicate items to fix. Summarize the number of A, R, and C by role and the number of tasks requiring inspection. |
| Scheduled dates for each stage | Scheduled return date + days relative to reference date (Default: Application -28 days, Receipt of medical opinion -10 days, Job suitability interview -7 days, Department head interview -5 days, Decision/Notification -3 days, 1-week check +7 days, 4-week check +28 days) |
| sledding | Completed if there is a completion date, Delayed if today is past the scheduled date, Imminent if within 3 days |
| Work adjustment status | Days remaining until review, elapsed between scheduled end date and review date |
The default schedule interval is an example. If the leave of absence is short or the company is small, simply change the number of days relative to the base date.
๐ฅ I set the default values โโfor the role table like this.
The default value is Health managers handle health information, department heads assign duties, and personnel make decisions and provide notifications. The responsibilities were divided among them. Out of 20 tasks, 9 were assigned to HR, 7 to health managers and occupational health doctors, and 4 to department heads. Attending physicians only participate in consultation (C) and implementation (R) with their medical opinions and additional comments, and reinstated employees are subject to consultation (C) at most stages.
| step | Representative duties | A (Responsibility) |
|---|---|---|
| application | Guidance on Reinstatement Application Submission and Procedures, Consent to Collection of Health Information | greeting |
| preparation | Summary of Job Requirements / Request and Receipt of Medical Opinion | Department Head / Health Manager |
| judgment | Job suitability interview, request for additional medical opinion / Department head interview | Health Manager / Department Head |
| decision | Finalization of work adjustment plan, decision and notification of reinstatement | greeting |
| share | Communicate work restrictions to department head (excluding diagnosis name) / Scope of colleague guidance | Health Manager / Human Resources |
| After returning | Job adaptation check / Health status reconfirmation / Termination/extension of adjustment | Department Head / Health Manager / Human Resources |
โ Things to decide before writing the file
Internal regulations
โ I checked the deadline for reinstatement applications and the required documents in the employment rules and personnel regulations.
โ I confirmed who has the authority to decide on reinstatement.
Health Information
โ The person and place to store the medical opinion (separated from personnel records) were determined.
โ There is a consent form for the collection and use of health information.
Court confirmation
โ In the case of a disease subject to work prohibition, a physician (a physician-turned-health manager, occupational health physician, etc.) was designated to hear the opinion.
๐ Precautions when using
- Instead of a name in the file Case Code Use [this] and do not include the diagnosis, symptoms, treatment details, or the original text of the medical opinion. Health information is sensitive information under the Personal Information Protection Act.
- As there are no specific legal provisions regarding sick leave and return procedures, internal company regulations are followed. The role allocation and schedule are recommended practical examples.
- This form does not determine eligibility for reinstatement. Please consult a physician for medical assessments, a health manager or occupational health physician for opinions on job suitability, and the companyโs HR procedures for the final decision on reinstatement.
โ FAQ
Q1. Can companies without a health manager use this?
Yes. Please replace the "Health Manager" column with the place where the company obtains opinions, such as an occupational health physician, a specialized health management agency, or an external medical institution. If the disease was subject to a work prohibition, you must obtain the opinion of a physician-turned-health manager, an occupational health physician, or the doctor who conducted the health examination.
Q2. What if there are multiple reinstatement cases?
You can copy the [Reinstatement Progress Schedule] and [Work Adjustment Agreement] sheets for each reinstatement case. Adding a case code to the sheet names makes them easy to distinguish.
Q3. Is the same form used for returning to work after industrial accident?
The internal procedures can be used as is. Please also take care of the task of 'Verifying the Korea Workers' Compensation Service's Workplace Return Support System in Case of Industrial Accident' in the role table.
Recommended Posts
Procedures Before Return to Work for Employees on Health Leave | Distinction in the Roles of Medical Opinions, Interviews, and Assessment of Work Suitability โ Checklist for HR Return Support for Leave of Absence, Industrial Accident, and Reinstatement โ How much support should HR provide when a returning employee continues to complain of fatigue? โ
๐ Source and Verification Criteria
- Article 138 of the Industrial Safety and Health Act
- Article 220 of the Enforcement Rules of the Industrial Safety and Health Act
- Article 23 of the Personal Information Protection Act
- Article 23 of the Labor Standards Act
- KOSHA GUIDE H-195-2021 Basic Guidelines for Professional Suitability Assessment (Search on Industrial Safety Portal)
Date of legal verification: 2026.10.20. This Excel is a practical form to assist in managing reinstatement procedures and is not a statutory form. It does not determine the possibility of reinstatement or the appropriateness of work adjustments.
๐ Prepare support for returning employees, including counseling channels.
If you need EAP counseling or manager guidance available to employees and managers before and after returning to work, please contact Nudge EAP.
Inquire about EAP ImplementationHealth Management | psychological counseling | Safety Management | Organizational culture | greeting
๋์งEAP(๊ด๋ฆฌ์)'s Expert Column
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- Procedures Before Return to Work for Employees on Health Leave | Distinction in the Roles of Medical Opinions, Interviews, and Assessment of Work Suitability
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- 0160026.10.22
- 0260026.10.22
- 03CommentsWe also have a lot of short-term contract workers during peak season, so I get confused every time I have to handle the training for rehired employees. I'm also curious how other places handle cases where contracts are renewed immediately without any gaps.132226.10.21
- 01coach AnswerHello, this is Nudge EAP โบ๏ธ You should group tasks based on whether the actual work type and conditions are the same, rather than the process name. Tasks can be considered the same if the worker posture, number of repetitions and time, handling weight and frequency, movement, and equipment and tools are similar. Therefore, even within the same assembly process, it is better to separate "seated assembly" and "standing assembly while moving materials" into separate tasks. First, list the detailed tasks within the process and compare them using the criteria above; separating only the tasks with significant differences makes organization easier, even with a large workforce. If there are multiple tasks under the same conditions, you can select a representative sample that includes the worker with the highest workload. The KOSHA guide suggests using at least two tasks with high work intensity as a sample when there are 10 or fewer identical tasks. Shifts can be grouped together if the equipment, workload, speed, and personnel are the same, but if the conditions differ, please separate them by shift. For rotation workers, you can make a judgment by recording all detailed tasks performed during the day, along with the time and frequency of each. For the final classification, confirm the opinions of on-site workers, and if you record the basis for the grouping on the survey form, it will be easier to explain during inspections.753326.09.18
- 02CommentsThe distinction between receiving a report and reaching a conclusion is important. Global HR teams should secure immediate protection and confidentiality before trying to decide whether the conduct legally qualifies as harassment.734426.09.02
- 03coach AnswerHello, this is Nudge EAP.โบ๏ธ The simplest method is for employees to simply receive guidance and apply directly, as the company does not transfer personal information. If you want a health manager to forward a name and contact information to an EAP agency for contact, it is safer to explain the receiving agency, purpose, items, retention period, and the right to refuse consent, and to obtain clear consent from the individual. Since checkup results and symptoms are sensitive health information, do not consider them included in the existing health checkup consent; instead, please write down only the content to be conveyed and obtain separate consent. In practice, it is common to separate the options into โ consent for forwarding name and contact information and โก consent for forwarding checkup results and symptoms, ensuring that there is no disadvantage in using the EAP even if the second option is not agreed to. The burden of repeating explanations can be reduced by providing the option for employees to send a summary of their consultation request, written directly by the employee, to the agency. However, since the wording and procedures may vary depending on whether the contract with the EAP agency involves the outsourcing of personal information processing or the provision of information to a third party, please review the contract details with your in-house personal information manager before implementation. It is a good idea to define the scope of responses in advance to the company to prevent unnecessary feedback regarding consultation requests or their content.698926.09.21
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