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GENERAL INFORMATION
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Employee name |
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Job title | |
Supervisor or manager name |
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SICKNESS
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Details of sickness | |
First day of sickness | |
SICKNESS ABSENCE
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First full day of absence due to sickness | |
Last day of work before sickness | |
REPORTING SICKNESS ABSENCE
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I informed my employer of my sickness on .
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DECLARATION
I certify that on the dates stated above, I have been incapable of work because of the sickness stated above. I also certify that the information provided in this form is true and accurate.
I acknowledge that providing false information can result in disciplinary action and I hereby give my employer permission to verify the information provided.
| _________________________________ | _________________________________ |
This Self-Certification Form template covers:
your details
your manager’s details
how long you have been sick
how long you have been absent from work due to being sick
details of the sickness
If you are sick for more than 7 days in a row your employer can ask you to provide a fit note from a medical practitioner. This is an official document from a medical professional (eg a GP) recording their medical opinion on an employee’s fitness for work. For more information, read Fit notes and Managing employee absenteeism.
In this Self-Certification Sickness Form, you should provide details of why you were not able to attend work. For example, because you were suffering from food poisoning or because you had a prolonged fever. Simply stating that you were sick is not enough.
If you were off because of an injury (eg a broken bone or badly twisted ankle), you should provide details of the injury. If you were injured at work this should have been reported and logged in your workplace accident book. If you were injured or became sick because of a workplace accident or illness, you may also be able to claim an Industrial Injuries Disablement Benefit.
Making a Self-Certification Form online is simple. Just answer a few questions and Rocket Lawyer will build your document for you. When you have all of the details prepared in advance, making your document is a quick and easy process.
To make your Self-Certification Form you will need the following information:
Party details
Your details (ie name and job title).
Your manager’s name.
Sickness
When was your first day of sickness?
When was your last day of work before becoming sick?
When did you leave work on your last day?
Absence
When was your first day of absence due to sickness?
Has your sickness ended? If so:
When was your last day of sickness?
When was your last day of absence due to sickness?
How many days were you absent due to sickness?
What are the details of your sickness?
Who did you report your absence to?
Self-Certification Forms are used to confirm an employee's absence from work due to a period of sickness that is less than 8 days. To achieve this, this Self-Certification Form includes:
General information
This section sets out the basic details about the employee who is (or was) absent from work due to sickness. Including this in the Self-Certification Form helps clearly identify who the Form relates to.
Sickness
This section sets out details relating to the employee’s illness, including its symptoms and the period the employee was sick for.
Sickness absence
This section sets out details relating to the employee’s absence from work due to being sick. This includes the first full day of work they missed, their last day of work before falling ill and, if they are no longer sick, their last day of absence due to sickness.
Reporting sickness absence
This section provides details of when the employee reported their sickness and to whom.
Declaration
This section sets out that the employee was incapable of work because of the sickness as detailed in the Form. By completing this section of the Self-Certification Form, the employee certifies that the information they’ve provided is true and accurate.
Make sure to call in sick for work as soon as possible
If you’re feeling under the weather and don’t think you can work, you should contact your employer as soon as possible (eg before or around the start of your working day). You should generally contact your immediate superior (eg line manager or shift supervisor) or the HR department. If you’re unsure how to call in sick (or who to report your absence to), check your employment contract and relevant HR policies (eg an employee handbook or sickness policy) and/or ask your colleagues. For more information, read Managing employee absenteeism.
Keep everyone informed
Not only should you let your manager know that you are too unwell to work, but also any members of your team. This includes any other members of staff you work with (eg if you have a meeting on the day you’re off or a deadline coming up) and anyone who reports to you.
If your sickness is going to last for more than one day, you should let everyone know as soon as possible.
Determine whether you should use a Self-Certification Form or a fit note
A Self-Certification Form should be used to self-certify that you have been unable to work due to a period of illness, provided that this period does not exceed 7 days. This includes any weekends, bank holidays or days you don’t typically work. If you’re sick and unable to work for 8 days or more, you should speak to a medical professional and get a fit note. For more information, read Fit notes.
Understand when to seek advice from a lawyer
Ask a lawyer for advice if:
the document doesn't meet your needs or it doesn’t cover what you want
you have been sick for more than 7 days and need help with fit notes
you’re not sure if you need a fit note from a medical practitioner
