What is included in a Self-Certification Form?

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

What if I’m sick for more than 7 days?

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 .

What details of the sickness should I provide?

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 .

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Other Names: Self-Cert Form Self Certification Sickness Form Self Certification Form Self-Certification Self-Certification Fit Note Employee’s Statement of Sickness Self-Certification for Sickness Absence Self-Certification Sickness Form

Self-Certification Form document preview

What is a Self-Certification Form?

A Self-Certification Form is a document that certifies that you have been sick. Unlike fit notes, which are provided by medical professionals, Self-Certification Forms are completed by employees when they are off work due to sickness for less than 8 days.

When should I use a Self-Certification Form?

Use this Self-Certification Form if you:

have been sick or injured
have been off work for 7 days or less
need to self-certify that you have been sick (eg because your employer asked you to do this)

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SELF-CERTIFICATION FORM

GENERAL INFORMATION
Employee name
Job title
Supervisor or manager name
SICKNESS
Details of sickness
First day of sickness
SICKNESS ABSENCE
First full day of absence due to sickness
Last day of work before sickness
REPORTING SICKNESS ABSENCE
I informed my employer of my sickness on . I reported my sickness absence to.

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.

_________________________________

About Self-Certification Forms

Learn more about making your Self-Certification Form

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How to make a Self-Certification Form
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?
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Common terms in a Self-Certification Form

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.

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Legal tips for making a Self-Certification Form
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
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Self-Certification Form FAQs

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What is included in a Self-Certification Form?
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
What if I’m sick for more than 7 days?

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.
What details of the sickness should I provide?

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.

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Important details
- Keep in mind that you should only use a Self-Certification Form if you have been off work sick for less than 8 days. For longer absences, you will typically need to see a medical professional for a fit note.
- Bear in mind that you do not usually need to provide your employer with a Self-Certification Form unless they request it. Check your employment contract and relevant HR policies (eg a sickness policy) for your employer’s practices, or ask your line manager or an HR manager.

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