Sickness and Absence Self-Certification Form

This Absence Self-Certification Form should be filled in by the employee to provide details of any sickness absence to their employer. 

This form is used during periods of sickness absence as stated by the requirements of the Sickness and Absence Policy. It is important that the completed form indicates actual days of sickness, even if they include days when you would not normally have worked (e.g. weekends and public holidays).

The Company may conduct a return to work interview to discuss absence and illness.

The Sickness Self-Certification form should be completed for sickness absence of up to seven calendar days.

Under normal circumstances, sickness absence of more than seven calendar days requires a Fit Note/Medical Certificate. Subsequent Fit Notes/Medical Certificates must be produced as necessary to cover the total duration of the Period of Absence.

This form template is in fixed field format. Simply press TAB to jump from one field to the next and SHIFT + TAB to go back. Alternatively, use the mouse to click from one field to the next.

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Sickness and Absence Self-Certification Form is part of Employment. Just £38.50 + VAT provides unlimited downloads from Employment for 1 year.