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    Sickness Self-Certification Form

    Uploaded by

    Cynthia Robinson
    This sickness self-certification form collects information about an employee's recent sickness absence from work. It documents the dates of absence, who was notified, and brief details about the illness. It also asks if the employee attended the hospital or saw a doctor, received any medication, and includes declarations about the accuracy of the information and signatures from the employee, supervisor, HR, and payroll. The form is used to process statutory sick pay and record the sickness absence.

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    Sickness Self-Certification Form

    Uploaded by

    Cynthia Robinson
    93 views1 page
    This sickness self-certification form collects information about an employee's recent sickness absence from work. It documents the dates of absence, who was notified, and brief details about the illness. It also asks if the employee attended the hospital or saw a doctor, received any medication, and includes declarations about the accuracy of the information and signatures from the employee, supervisor, HR, and payroll. The form is used to process statutory sick pay and record the sickness absence.

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    Sickness Self-certification Form

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    This sickness self-certification form collects information about an employee's recent sickness absence from work. It documents the dates of absence, who was notified, and brief details about the illness. It also asks if the employee attended the hospital or saw a doctor, received any medication, and includes declarations about the accuracy of the information and signatures from the employee, supervisor, HR, and payroll. The form is used to process statutory sick pay and record the sickness absence.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    93 views1 page

    Sickness Self-Certification Form

    Uploaded by

    Cynthia Robinson
    This sickness self-certification form collects information about an employee's recent sickness absence from work. It documents the dates of absence, who was notified, and brief details about the illness. It also asks if the employee attended the hospital or saw a doctor, received any medication, and includes declarations about the accuracy of the information and signatures from the employee, supervisor, HR, and payroll. The form is used to process statutory sick pay and record the sickness absence.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    CONFIDENTIAL

    SICKNESS SELF CERTIFICATION FORM (This form must be completed for each period of absence)
    First Name: Department: .. .. Surname: Personnel No: .. ..

    Period of Sickness Absence & Notification Date of first day of sickness absence from work: Date of last day of sickness absence from work: Name of person notified: Absence pattern: Number of hours not worked per day due to sickness: M T W Th F S Su FT / PT

    Do you work Full Time or Part Time hours:

    Details of Sickness Absence Please give brief details of your illness:

    Did you attend hospital your doctor Did you receive medication

    Yes/No Yes/No Yes/No

    If Yes, give details of hospital/doctor

    Declaration I understand that this information will be used as a basis of paying Statutory Sick Pay (SSP)and that any false statement may lead to disciplinary action. Employees Signature: Date:..

    Is this employee on their probationary period? Supervisors Signature:.

    Yes / No

    Paid/Unpaid

    Date:...

    Signed by HR: Signed by Payroll (if over 4 days):.

    Date:. Date:..

    SEND FORM TO HUMAN RESOURCES YOUR SICKNESS WILL BE RECORDED.

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