Workplace formFree Word download

Sickness self-certification form

Let an employee record dates and the reason for a short sickness absence.

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PRIVATE & CONFIDENTIAL

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Document detailsFields marked required must be completed.

Business name * Employee name * Manager name * First day of absence * Return date * Reason for absence * Meeting notes Support or agreed actions

0 of 6 required fields complete

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Employee-provided reason for the absence.

Key points discussed and any relevant context.

Agreed support, owner and follow-up date.

Employee signature: ____________________ Date: __________

Manager signature: ____________________ Date: __________

Preview uses example information until you complete the fields. Review the downloaded document before use.

Using this resource

1
Confirm the right process
Check your workplace policy, contracts and the facts before creating the document.
2
Replace every prompt
Use accurate names, dates and factual descriptions. Remove sections that do not apply.
3
Review before sharing
Have an authorised person check the document, then store the final copy appropriately.