Self Certification Sickness Form Template UK

The Self Certification Sickness Form Template UK is offered in multiple formats, including PDF, Word, and Google Docs, and features editable and printable versions for your convenience.

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Self Certification Sickness Form Template UK

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PDF – 1 PDF – 2

Self Certification Sickness Form Template UK

1. Employee Information


2. Sickness Details

3. Nature of Illness

4. Medical Practitioner Information (if applicable)


5. Confirmation of Absence

6. Employee Declaration


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WORD

Examples

Self Certification Sickness Form Template UK (1)
Employee Details:
[Employee’s Name]
[Employee’s ID]
[Employee’s Address]
[Employee’s Phone]
[Employee’s Email]
Employer Details:
[Employer’s Name]
[Company’s ID]
[Company’s Address]
[Company’s Phone]
[Company’s Email]
Introduction:
This Self Certification Sickness Form is designed for employees to declare their absence due to illness while ensuring compliance with UK employment regulations.
Section 1: Sickness Details
Date of sickness onset: [Date]
Expected return date: [Date or “unknown”]
Nature of the illness: [Brief description of the illness].
Section 2: Duration of Absence
Number of days absent: [Number of days]
Dates of absence: [Start Date] to [End Date].
Section 3: Certification Statement
I, [Employee’s Name], confirm that I was unable to work due to illness during the specified period mentioned above.
Section 4: Employee’s Declaration
I declare that the information provided above is true to the best of my knowledge.
[Signature of the Employee]
[Date of Submission]
Section 5: Employer’s Acknowledgment
This form should be submitted to the HR department for record-keeping and verifying employee’s sick leave.
[Signature of the Employer]
[Date of Acknowledgment]
Self Certification Sickness Form Template UK (2)
Employee Information:
[Employee’s Name]
[Employee’s ID]
[Employee’s Address]
[Employee’s Phone]
[Employee’s Email]
Company Information:
[Employer’s Name]
[Company’s ID]
[Company’s Address]
[Company’s Phone]
[Company’s Email]
Introduction:
This form is used to formally certify the sickness of an employee as per UK legislation, ensuring proper documentation of absence due to health issues.
Section 1: Illness Information
Date illness began: [Date]
Anticipated date of return: [Date or “unknown”]
Description of the health condition: [Brief description of the illness].
Section 2: Length of Absence
Days absent from work: [Number of days]
Absence period: [Start Date] to [End Date].
Section 3: Self-Certification Statement
I, [Employee’s Name], hereby confirm that my absence was due to illness during the above-mentioned period.
Section 4: Employee’s Declaration
I affirm that the details provided herein are accurate and true.
[Signature of the Employee]
[Date of Submission]
Section 5: Acknowledgment by Employer
To be completed by the employer, confirming receipt of the sickness declaration for record purposes.
[Signature of the Employer]
[Date of Acknowledgment]

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PDF – 1 PDF – 2

Self Certification Sickness Form Template UK