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Self Certification of Absence / Return to Work Meeting

This form must be completed in full on all occasions of sickness/absence and returned to HR on the first day of return to work.

  • Section 1 - To be completed by the employee

    Please note: To give false information may result in disciplinary action. Where this declaration is not accepted, disciplinary action may be considered.
  • (N.B. if absent for 7 days consecutively a doctors note is required)
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Section 2 - To be completed by employee

  • MM slash DD slash YYYY
  • Scroll to the bottom and click 'Save and Send to Manager'

    Do not click Submit, if you do your manager will not receive this form and you will need to fill it out again!
  • Section 3 - To be completed by Department Manager