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Self Certification Form - All Staff

Staff Sickness Absence Declaration (employee to complete)

You must complete this form after any absence.

In addition, for absences lasting longer than 5 days, you will be invited to a Return to Work meeting.

For absences lasting longer than 7 days (i.e. from the eighth day of absence) a Statement of Fitness to Work Certificate (Drs note) is required.

Please tick the appropriate box to confirm how you followed procedure to report your first day of absence:

DECLARATION

In submitting this form, I confirm that:- I have been incapable of working for the reason and dates shown above and that this information is true and accurate.
I acknowledge that false information will result in disciplinary action.
I hereby give my employer permission to verify the above information.
I am aware that I may be called to discuss this in further detail.