Employee Sickness Self-Certification Form (SCF)

EMPLOYEE SELF-CERTIFICATION FORM (SCF)
Employees can self-certify their own sickness for up to the first 7 days of absence from work. If the absence lasts more than 7 days, the employee will need to provide a Fit Note from their GP.

This form should be completed and submitted by field staff following any period of sickness-related absence within one week of the end of the period of absence.

Statutory sick pay will only be processed upon receipt of the completed Self-Certification Form.
SECTION 1 – To be completed by the employee
Employee Name
Job Title
Branch / Department
Submission Date

MonthDayYear
Date

The Absence(s) Please list all shifts where absences occurred within the 7-day self-certification period.

Reason for Absence
YesNo
YesNo
E.g. date of accident, injuries, etc.
Staff Declaration
By signing below and submitting this form you are confirming that, to the best of your knowledge, the details you are providing are correct.
Employee Signature
Once submitted, a copy of this form will automatically be sent to Accounts@unitycaresolutions.co.uk. Statutory Sick Pay will be processed within your usual pay.
Version: April 2026 Unity Care Solutions
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EMPLOYEE SELF-CERTIFICATION FORM (SCF)