Employee Sickness - Self Certification

Employee Sickness - Self Certification
In accordance with Hashtag Clean’s absence management and reporting policy, employees are required to complete this form for all sickness absence of seven calendar days or fewer. (For periods of sickness lasting more than seven calendar days, employees should provide a doctor’s certificate/fit note.)

Please complete this form on the day that you return to work.
Name*

First NameLast Name
Job title*
First day of absence*

DayMonthYear
Date
Last day of absence*

DayMonthYear
Date
Brief description/reason for absence*
Person notified of absence*
Number of days away from work owing to absence (excluding regular non-working days)*
Was your sickness caused by an accident at work? If so, give brief details:
Your signature*

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Todays date*

DayMonthYear
Date
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