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    Completing the first-year evaluation form

    The first-year evaluation form (‘eerstejaarsevaluatie’) is part of the return-to-work report (‘re-integratieverslag’). It is a way to record the return-to-work agreements that you have made with your employee so far. You can also use the first-year evaluation form to make any necessary changes to the action plan (‘plan van aanpak’).

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    What do you need to do?

    After 1 year of illness, you and your employee will discuss the action plan. Print the first-year evaluation form and fill it in with your employee. Make sure you both sign the form. Give your employee a copy as they will need it for their return-to-work report. Keep a copy for your own records.

    What happens next?

    There is no need to send the form to us at this point. If your employee needs to apply for a WIA benefit, this form will be sent to us as part of their return-to-work report.

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