Return to Work Form (from Furlough)

Employee/Worker Name:

Location/Client/Department:

Date of Birth:

Date: October 10, 2026

All responses are confidential and will allow the Company to prepare a risk assessment and safe working procedures in response to Covid-19.

This form is the first stage of the Return to Work process and should be used in conjunction with the Return to Work Guidance. Managers should call the employee/worker and go through all questions on this form. It should be signed by the Manager on completion and by the employee/worker on their first day back at work. A copy must be sent to compliance@igloodrivers.com

Ask them for an update regarding their personal circumstances. For those considered to be high risk or shielding prior to being placed on furlough or whilst working at home, we have this information available to us, but we want to gather an update on personal circumstances in case anything has changed. Please check through each of the following and record their response.

1. Are you considered very high risk (i.e. shielding because you are clinically extremely vulnerable and have received an NHS letter)?

2. Are you considered high risk i.e. you fall into the following categories: -

• 70 or older
• are pregnant
• have a lung condition that is not severe (such as asthma, COPD, emphysema, or bronchitis)
• have heart disease (such as heart failure)
• have diabetes
• have chronic kidney disease
• have liver disease (such as hepatitis)
• have a condition affecting the brain or nerves (such as Parkinson's disease, motor neurone disease, multiple sclerosis, or cerebral palsy)
• have a condition that means they have a high risk of getting infections
• are taking medicine that can affect the immune system (such as low doses of steroids)
• are very obese (a BMI of 40 or above)

3. Do you have young children at home and therefore have childcare issues?

4. Do you live with someone who is clinically vulnerable/shielding? Note: extremely clinically vulnerable individuals have been strongly advised not to work outside the home.

5. Have you experienced any cold or flu-like symptoms in the last 14 days (including fever, cough, sore throat, respiratory illness, difficulty breathing, loss or change to your sense of taste or smell)?

6. Have you returned from any overseas country within the last 14 days?

7. Have you had close contact with or cared for someone diagnosed with or showing signs of Covid-19 within the last 14 days?

8. Have you been in close contact with anyone who has travelled abroad within the last 14 days to any overseas country?

If the employee/worker answers “yes” to any of the above, please contact compliance@igloodrivers.com before agreeing a return to work date.

Confirm return to work date and let them know what to expect on their first day back. They will receive a full induction and will need to read and sign that they have received copies of the relevant risk assessments.

Confirm when normal pay will resume; if return to work is before payroll cut-off their normal pay will resume in their next salary payment. If they are returning after payroll cut-off then their normal pay will resume the following month but will be backdated to the date that they returned to work.