Inspire ATA - Self-Certification Form

Self-Certification Form

All employees absent from work due to sickness or injury must follow the relevant procedures. Employees who fail to follow the procedure or make a false claim of sickness absence will be dealt with under the terms of Inspire ATA Limited’s Disciplinary Procedure. The Company may also withhold Statutory Sick Pay (SSP) where the correct absence reporting procedure has not been followed.
Notification of Sickness or Other Absence

If you are absent from work for any reason and your absence has not been previously authorised by the Company, you must telephone all relevant parties as early as possible on the first day of absence, no later than one hour before the time you are due to start.

Any absence must be properly explained, and you must inform all relevant parties of your expected length of absence and when you expect to return so that adequate cover can be arranged. Unless you are signed off work for a period by your doctor, you must contact all relevant parties daily for the first five days and if your absence goes beyond five days, you should agree with all relevant parties the frequency of contact required.

If your absence from work due to sickness or injury continues for more than seven consecutive days, you must on the eighth calendar day of absence, provide a Statement of Fitness for Work (Fit Note) from your GP stating the reason for sickness or injury. Thereafter, Fit Notes must be provided to the Company to cover any continued period of absence. You should send a Fit Note to all relevant parties on a weekly basis unless otherwise agreed.

In respect of absence lasting less than seven calendar days, you do not need to produce a Fit Note unless you are specifically requested to do so. However, you will be required to complete this self-certification form on the day you return to work.
Name*

First NameLast Name
Host Placement*
Start Date of Absence*

DayMonthYear
Date
End Date of Absence*

DayMonthYear
Date
Total Working Days*
(*) If the total number of days exceeds 7 days, and your absence was due to illness, please provide a Doctor’s Fit Note.
Reason for Absence*

SicknessInjuryCompassionateBereavementOther
Please expand on the cause of your absence rather than merely stating sick. If your absence was due to sickness you may also be required to attend a Return to Work Interview.*
I have consulted my GP during this absence*

YesNo
GP Name
Surgery Full Address
Date(s) Consulted
I understand that Inspire ATA Limited may require me to be examined by a doctor of its own choosing.
Signature*
Date*

DayMonthYear
Date
Absence & Lateness Policy
Should be Empty: