Sickness Self Certification Form

Reduce sickness absence by completing a Self Certification Form to record the first 7 days of absence from work.

This form provides a framework of questions for an employer to ask their employees about periods of sickness and injury absence from work.

This form also helps employees record and inform their employer of sickness absence, including:

• reasons for and symptoms of sickness absence
• whom within the company was informed of sickness absence
• actual, anticipated or likely return date
  
• what treatment has been sought, prescribed and is ongoing
• overall well being and fitness to return to work
• whether a GPs certificate has been obtained
• declaration that all information is true and correct

This form also helps establish whether a period of absence is due to an accident and injury sustained at work (satisfying employer legal obligations to provide a safe place of work and possible referral to occupational health).

This form is provided as a Microsoft Word document to allow inclusion of additional questions and information which may be required as part of company policy on sickness absence and sick pay scheme.