ATTENDANCE MANAGEMENT POLICY

ATTENDANCE MANAGEMENT POLICY Recommending Committee: Approving Committee: Signature: Human Resources Directorate Human Resources Council Carole Whewell Designation: Vice Chair Date: September 2008 October 2011 Version Number Version 2 Date: September 2008 Review Date: October 2011 Responsible Officer: Director of Human Resources Equality Impact Assessment Outcome Level (high, medium, low) Low Review date Oct 2011

Section and Contents St Helens and Knowsley Teaching Hospitals NHS Trust Index Page Number 1. Introduction 3 2. Principles 3 3. Roles and Responsibilities 3-5 4. Notice and Reporting Procedure 5 5. Action to be Taken by the Employer 5-6 6. Return to Work 6 7. Medical Suspension 6-7 8. Sickness and Annual Leave 7 9. Accidents and Damages 7 10. Additional Points to Remember 7-8 11. Management Short Term Absence and Criteria 8 12. Return to Work Interview 9 13. Stages of Short Term Absence Procedure 9-11 14. Long Term Absence 11 15. Procedure fro Long Term Absence 11-12 16. Possible Actions 12-13 17. Managing Employees with a Disability 13-14 18. Consultation and Approval Process 14 19. Review and Revision Arrangement 14 20. Dissemination and Implementation 14-15 21. Document Control Including Achieving Arrangements 15 22. Monitoring Compliance and the Effectiveness of Procedural 15 Documentation 23. References 15 24. Associated Documents/Appendices 15-18 Page 2 of 17

1. INTRODUCTION St Helens and Knowsley Teaching Hospitals NHS Trust has adopted the following policy in respect to attendance management. The Trust is committed to creating a culture in which equality and human rights are actively promoted and in which, everyone is valued as an individual. Recognising the importance of this positive approach will enable the organisation to operate effectively, provide support to employees and ensure that all staff are treated in a fair and consistent way. The Trust expects 100% attendance and is committed to providing a healthy working environment to support this. Sick pay entitlement is in accordance with Section 14 of the NHS Terms and Conditions Handbook. This policy should be read in conjunction with the Attendance Management Policy - Managers Toolkit. 2. PRINCIPLES The policy is intended to ensure: That resources are used in the most effective way by having consistent and reasonable management of attendance across the Trust. That all employees are aware of their responsibilities in regard to attendance and it s management. That all Trust Line Managers are aware of the policy and confident in carrying out their responsibilities. That all employees understand their responsibilities in regard to attendance and its management and are aware that ill health may be regarded as a fair reason for termination of employment. That the Trust is compliant with legislation including the Disability Discrimination Act 1995 (2005 amended) and will provide reasonable adjustments when required. That all employees adhere to Health and Safety at Work legislation and that incidences and industrial injuries at work at reported as per the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR). 3. ROLES AND RESPONSIBILITIES 3.1 Employees Employees of the Trust are expected to meet the obligations of their contract of employment regarding attendance at work and compliance with Trust policies and procedures. Employees should also acknowledge the impact of their non-attendance on their colleagues and on service delivery. Page 3 of 17

In line with this employees must: Take reasonable steps to maintain a good standard of general health and comply with the Trust Health and Safety Standards policy, in order to minimise absence from work. Maintain contact with their Line Manager, be available for discussions and must attend Occupational Health appointments during any period of absence when referred. Provide accurate and timely information and certification for the purpose of medical assessment and fitness to work. Only report sickness absence for genuine personal sickness and not for any other reason. The Trust has policies for other types of leave including special leave and carers leave and these must be used where appropriate and agreed by the line manager. Inappropriate reporting of sickness may result in Disciplinary action being taken. 3.2 LINE MANAGERS Line Managers have direct responsibility for managing sickness absence and are key to the successful operation of this policy. To ensure that this is done in a consistent and equitable way they must follow the Attendance Management Policy Managers Toolkit which has been produced to guide line managers on the application of this policy. Line Managers must ensure that all employees in their area/areas are familiar with this policy and the absence reporting procedure and that these are explained to all new employees as part of their local induction. Must maintain accurate record keeping for absence management. Repeated failure to implement the policy and undertake return to work interviews may result in disciplinary action being taken. 3.3 OCCUPATIONAL HEALTH: The Occupational Health Department provides support to both employees (by self referral) and their Line Managers by offering professional advice in managing both short and long term sickness. 3.4 HUMAN RESOURCES DIRECTORATE: The Human Resources Directorate is responsible for the monitoring of overall sickness rates and any trends that may be identified. Additionally they will support and advise line managers on particular sickness issues and non compliance of this policy. Page 4 of 17

St Helens and Knowsley Teaching Hospitals NHS Trust Will provide regular reports to line managers to highlight absence rates and performance indicators In long term sickness cases the notification of half and no pay sickness entitlement will be sent to the employee. 4. NOTIFICATION AND REPORTING PROCEDURES 4.1 Failure to report sickness absence in line with Trust procedures may lead to absence being recorded as unauthorised, sick pay being withheld and disciplinary action being taken. 4.2 Line Managers must ensure that all staff are aware of and comply with the following procedures for reporting sickness absence: 5. ACTION TO BE TAKEN BY THE EMPLOYEE Please see flowchart Appendix 1 - Action to be taken by Employee Absent from Work 5.1 One to Three Days Absence: All employees must personally ring / report the sickness to their line managers (or nominated person) on or prior to the first day of absence and before the shift is due to start. Calls from other people, texts and emails are unacceptable except in exceptional circumstances. Within this initial call the employee must provide details of the reason for absence and likely return date. Additionally the following should be confirmed: o Discuss any outstanding work issues and related action plan, if appropriate. o If appropriate, enquire as to whether the absence is RIDDOR reportable The employee must ring the line managers or nominated person, daily, unless agreed otherwise until their return to work. If an employee has not contacted their line managers to state that they are going to be absent from duty the line managers must ring the employee one hour into the shift. The employee must advise the line managers of their fitness to return to work at the earliest opportunity. If this is immediately prior to a weekend, annual leave, days off or any other agreed leave and the employee s return will be immediately after this time. The employee must advise their line managers prior to the weekend or agreed leave, if not these days will be included as sickness absence. On return to work complete and submit an Employee Statement on Absence from work (please see attached appendix 2) Page 5 of 17

5.2 Four to Seven Days Absence: Continue to make contact and advise on return date as agreed above If the sickness absence is likely to continue over seven calendar days, advise the line managers on or before the seventh day. If this falls at a weekend, call on or before the Friday morning prior to the weekend. On return to work complete and submit a self-certificate which can be obtained from the HR section of the Trust Intranet. Employees whose sickness includes a Saturday, Sunday or bank holiday will automatically be regarded as being sick on these days unless they have advised their line manager of their fitness and/ or resumed to work (this is regardless of whether they are scheduled to work on these days.) 5.3 Eight Days or More: If sickness absence continues beyond seven calendar days (includes weekend days) a medical certificate must be produced from the General Practitioner and must be submitted as soon as possible following receipt (no later than 72 hours following the eighth day of absence). Where a medical certificate is extended the employee must notify their Line Manager of the details prior to their previously expected date of return. Subsequent medical certificates must be submitted within 24 hours of expiry of the previous medical certificate Any absence not covered by a medical certificate or any failure to maintain contact, will except in exceptional circumstance result in salary payments being withheld or delayed and/ or disciplinary action being taken. Where there are two periods of related sickness absence which last more than three calendar days, and there is less than fourteen calendar days between the two episodes, a self-certificate must be submitted from the first day of the second period of sickness. 6. RETURNING TO WORK 6.1 Employees wishing to return to work prior to the expiry of their Medical Certificate must produce a further medical certificate to support this. 7. MEDICAL SUSPENSION 7.1 There will be situations during which an employee will be unable to work within their substantive role due to the risk of infection. Each case will be reviewed by the Occupational Health Department and Infection Control Department. 7.2 Temporary redeployment may be found for employees suspended on the grounds of the spread of infection and pay will be as per contract of employment. Page 6 of 17

7.3 Suspension may also be appropriate when concerns are raised regarding an employees health at work and there is a delay before they can attend Occupational Health Department. 8. SICKNESS AND ANNUAL LEAVE 8.1 When sickness absence bridges two annual leave years, a maximum of 5 annual leave days may be carried over at the discretion of the line managers. Bank Holidays falling during sick time cannot be taken at a later stage. 8.2 Where sickness occurs during periods of annual leave, the employee must personally contact their Line Manager on the first day of sickness to advise them of this. 8.3 Providing that the line managers is notified and the full absence is covered by a medical certificate the manager should give approval for the leave to be taken at a future date, subject to the demands of the service. 9. ACCIDENTS AND DAMAGES 9.1 If an employee is absent as a result of a non work related accident and receives damages from a third party they will not be entitled to occupational sick pay. 9.2 Sick pay is not normally payable for an absence caused by an accident due to active participation in sport as a profession, or where contributable negligence is proved. 9.2 Notification procedures and payment of sick pay when injuries are connected with other insured employment will be for local determination. 10. ADDITIONAL POINTS TO REMEMBER: 10.1 Where an employee reports for work and following more than half a shift falls sick which results in the need to be sent home, it should, not be recorded as sick for that day. Line managers should keep a record of all such occasions to identify any patterns of absence, or misuse of the policy. Where an employee is sent home before completing half a shift this will be classed as sickness and will be recorded. (for payroll purposes SSP has to be full day). 10.2 Any absence taken for the purposes of cosmetic surgery can not be taken as time off sick and should be covered by annual or unpaid leave. This time off must be agreed in advance of any appointments being made with the individuals line manager. 10.3 Where an employee is working additional hours and/ or bank shifts and their absence level continues at an unacceptable level, the employee may be prevented from undertaking this additional work. The rationale for this is that if the individual s health condition prevents them from maintaining regular attendance at work, additional work may exacerbate this problem. Page 7 of 17

10.4 If an employee submits a sick note stating stress or muscular skeletal they should be immediately referred to the Occupational Health Department for additional support and advice. 10.5 An employee may inspect his or her own attendance records at any time upon a reasonable request. 10.6 The use of annual leave/ lieu days to cover periods of sickness is not permitted. 10.7 In cases where a G.P. recommends that an individual is fit to return to work but the Occupational Health Advisor does not, discussions will take place between the G.P. and the Occupational Health Advisor to agree a way forward. All options will be explored to find an acceptable solution for all parties i.e. lighter/adjusted duties, if appropriate. Whilst discussions take place the individual will be placed on special leave with full pay (Full pay will include appropriate enhancements). 10.8In cases, where the Occupational Health Advisor recommends that an individual should return to work but is not supported by the G.P. meaningful discussions will take place between the G.P. and the Occupational Health Advisor to agree a way forward. Whist discussions take place the individual will remain on sick pay but after discussions if the Occupational Health Consultant still believes the employee is fit to attend work the employee will be advised in writing and a reasonable return to work date will be given. If the employee does not return to work a formal hearing will be arranged which the employee will be required to attend and a decision will be made as to the continuing employment of the employee. 11. MANAGING SHORT TERM ABSENCE AND CRITERIA 11.1Short term absence refers to situations when a person is absent from work on a frequent basis with a variety of minor ailments, where there is no single underlying medical reason connecting the sickness absences. 11.2 Line managers and staff should be aware that short-term sickness absence is a Contract of Employment issue and centres on whether the individual is fulfilling their contract of employment in regard to regular attendance at work. 11.3 Short term absence is not a matter for the Disciplinary Procedure and disciplinary action will only be taken in situations where an employee consistently fails to follow Trust Attendance Management procedures, or where there are grounds to suggest that sickness is not genuine. 11.4 Employment law recognises that an employer has the right to terminate the contract of employees who have shown themselves to be incapable of maintaining an adequate level of attendance. The law does not define the level and each case must be considered on its own merits. 11.5 This procedure may be appropriate in managing sickness absences where there are periods of both short and long term absence and guidance should be sought from the Human Resources Department on how to manage these situations. Page 8 of 17

12. RETURN TO WORK INTERVIEW It is the line manager s responsibility and central to this policy to discuss the employee s sickness absence on their return to work. The return to work interview must be conducted within 7 days of the return to work regardless of length of absence. In the line managers absence it is essential that deputising arrangements are in place. If appropriate the line manager may conduct a return to work interview over the telephone if it is not feasible to meet within the 7 days. 13. STAGES OF THE SHORT TERM ABSENCE PROCEDURE It must be noted by the employee that once they have been placed on the Procedure they will be closely monitored throughout all stages at 8 weekly intervals (this may be sooner if appropriate) for the next 52 weeks. Copies of all correspondence at each stage of the procedure will be placed on the employee s personal file. 13.1 Stage 1- Informal Review When an employee meets the trigger point criteria the Line Manager will arrange to meet with them. This meeting will follow the guidelines set out in the Attendance Management Policy Managers Toolkit and allows both the line managers and the employee to discuss any underlying causes to ensure that where possible appropriate support can be offered seeking advice from HR or Occupational Health where required to maintain their fitness to work. The line manager must outline the stages of the full procedure and detail the formal action which may be taken if their absence continues at an unacceptable level. It will be outlined that this will be reviewed after 8 weeks. Triggers 3 instances in 12 months 10 days in 12 months 2 instances in 13 weeks 5 days in 13 weeks 13.2 Stage 2: Formal Review Meeting After the 8 week review period if the employees absence is at an unacceptable level the line manager will write to the employee and arrange a meeting. As with all formal meetings the employee must be advised of the option to be accompanied by a Trade Union representative or a colleague employed by St Helens and Knowsley Teaching Hospitals NHS Trust. The line manager will inform the employee the formal action which may be taken if their absence continues at an unacceptable level. It will be outlined that this will be reviewed after 8 weeks. Page 9 of 17

13.3 Stage 3: Formal Review After the 8 week review period if the employees absence is at an unacceptable level the Deputy Director of HR must be advised that a Stage 3 meeting is due to take place and will audit actions to date to ensure that the process has been followed. The line manager will write to the employee and arrange a meeting. If the member of staff has not been referred to the Occupational Health Department this must be done prior to this meeting taking place. Unless there are medical or mitigating circumstances which the Line manager feels prevent him/her from taking further action at this time, the employee will be informed that their level of attendance is unacceptable and will not be tolerated. The employee will be advised that they have been issued with a final warning for 12 months and unless their attendance improves their Contract of Employment will be terminated (this decision will be reviewed at any point within the next 52 weeks and retained on the personal file). A member of the HR team must be present at the meeting. 13.4 Stage 4: Dismissal If the level of attendance does not improve a Stage 4 meeting will be arranged. A referral must be made to the Occupational Health Department and a report received with the latest medical advice. The line manager will invite the employee to the meeting and it should be noted that the employee may be represented by a trade union representative or a fellow employee employed by St Helens and Knowsley Teaching Hospitals NHS Trust. Clarification of the action to be taken must always be sought from the Human Resources Manager when cases reach this stage and a representative from the HR Team MUST be present at the meeting. During the Meeting The Line Manager must enquire whether any circumstances have changed since the last meeting, such as mitigating factors which may warrant the individual not being dismissed and therefore holding the employee at Stage 3 of the Procedure. The Line Manager should bear in mind the purpose is to reduce future absences not to punish past absences. If there are no mitigating circumstances then the employee must be advised that their attendance record is unsatisfactory and warrants the termination of the Contract of Employment (payment in lieu of notice will be given). Following the Meeting Confirmation of the decision will be sent to the employee in writing and detailing the right to appeal Page 10 of 17

13.5 Stage 5: Appeal This will be heard by the appropriate Senior Manager (who will be the next in line manager to the manager who took the decision at stage 4) this will take place at the earliest opportunity and the outcome may be as follows; o to uphold the management decision taken at stage 4 or o reinstate the employee. 13.6 What happens at the end of the 52 week monitoring period? The individual s sickness record will be reviewed by the Line Manager and HR Manager. Based on this information a decision will be made as to whether the individual is: o Removed from the Short Term Absence Procedure o Monitored at a lower level of the procedure o Monitored at the current stage of the procedure for an extended period 13.7 Warnings The term warning in this policy relates to attendance not misconduct. Such warnings will therefore be applied in accordance with the principals and procedures of this policy rather than the Disciplinary Policy and Procedure. 14. LONG TERM ABSENCE This type of sickness absence relates to episodes of 4 weeks or more, (excluding episodes such as planned operations) where there is no immediate prospect of a return to work. It is also appropriate in cases where there are shorter but frequent episodes of illness, which are caused by a chronic debilitating condition. However if an employee submits a sick note stating stress please refer to point 10.4 as they should be referred immediately to the Occupational Health Department. 15. PROCEDURE FOR LONG TERM ABSENCE 15.1 Referral to Occupational Health At no later than 4 weeks the line manager must make a referral to the Occupational Health department, who will provide a confidential report and an anticipated return to work date. If a return date cannot be anticipated Occupational Health will advise the line manager, to enable them to assess the impact of the absence on service provision The line manager and Occupational Health must maintain regular contact at agreed times to assess progress and make decisions regarding the employees return to work and/ or continued employment Joint decisions will be made taking into account the impact of the absence and whether it can be sustained within the department. Page 11 of 17

St Helens and Knowsley Teaching Hospitals NHS Trust When an employee is returning to work from a period of absence (i.e. planned operation) and a phased return would be beneficial then they must be referred to the OH department to be assessed. 15.2 Welfare Meeting At the earliest convenient date and time for both the line manager and the employee a welfare meeting should be carried out. This will provide an opportunity for the line manager to offer support, discuss progress, outline benefits entitlement and agree the level of future contact. The Welfare meeting checklist should be used and completed to ensure that all relevant issues are discussed and a copy of this should be held in the employee s personal file. (Appendix 18 Attendance Management Toolkit A Guide for Managers) 15.3 Maintaining Contact The line manager and employee should keep contact as agreed for the duration of the absence and line managers should undertake ongoing welfare meetings/ meet with staff on a regular basis. These will be on a monthly basis or earlier if required. Identify if the employee wishes to receive team brief or News and Views and it is the line managers responsibility to organise this. If Occupational Health advise that the individual will be able to return to work, but not in the near future, the line manager and Occupational Health will regularly review the case and maintain contact with the employee. This will pay due consideration to entitlements and the subsequent prognosis for any return. 16. POSSIBLE ACTIONS Rehabilitation Identifying appropriate ways of supporting staff to return to work at the earliest opportunity through intervention with appropriate treatment. If the Occupational Health department advises that an employee could return to temporary graduated hours and/ or duties for a time limited period in order to facilitate an early and safe return the line manager will assess the feasibility of this where appropriate and, reasonably accommodate. This must be agreed by all parties involved. (pay arrangements will be agreed as per terms and conditions). Further information is available from the Occupational Health Department. Reasonable Adjustments If Occupational Health recommend that reasonable adjustments might enable an employee to return to work, all reasonable measures will be assessed and managed in accordance with DDA legislation (refer to section 17). Reasonable adjustments may include temporary/ permanent adjustments, for example working reduced hours, or alternative shift patterns. Wherever possible line managers Page 12 of 17

should consider reasonable flexible solutions to enable the employee to return to work given service needs. Where this cannot be achieved and/ or the service or employee cannot withstand the adjustments, redeployment should be considered. Redeployment If Occupational Health advise that the employee is unfit to perform their current role but could possibly undertake an alternative role, the Trusts Management of Redeployment Due to Ill Health Policy will be invoked. Regular review meetings will take place during the redeployment process. The individual will be placed on the redeployment register for a period of three months and will be offered support to find an alternative position within the Trust. If a position is found this will be on a trial basis and will be reviewed (please refer to the policy) There is no onus on the Trust to create a post for any employee and if the employee does not secure an alternative post within the 3 month redeployment period, termination of employment with notice as per contract will be agreed. Risk Assessment Before a member of staff returns to work, where it is identified that there may need to be changes in working practices as a result of the employees condition, the line manager must arrange for an appropriate risk assessment to be undertaken. Following this an action plan should be produced and agreed between the employee and line manager. Further advice can be obtained from the Health and Safety Advisor/ Manual Handling Advisor. Termination of Employment on the grounds of ill-health There will be circumstances where an employee is unable to work due to ill health. In such cases arrangement for termination of employment will be discussed and agreed with a period of notice as outlined in the contract of employment. This is a two stage process to ensure that all options have been considered as an alternative to ill health retirement or termination of contract. Staff must be aware that eligibility for retirement under the NHS Pension Scheme is not determined by the Trust but an outside body. The Human Resource Department will advise employees of the mechanisms for application but termination of employment will not be delayed pending such an application. 17. MANAGING EMPLOYEES WITH A DISABILITY The Disability Discrimination Act (DDA) 1995, (2005 amended) defines disability as: a physical or mental impairment which has a substantial and long-term adverse effect on his/her ability to carry out normal day-to-day activities. Page 13 of 17

Long term means that the condition is likely to last for more than 12 months and the applicants ability to carry out normal day to day activities can be adversely affected in one or more of the following ways: Mobility Manual dexterity Physical Co-ordination Continence Ability to lift or move everyday objects Speech, hearing or eyesight Memory or ability to concentrate, learn or understand Perception of the risk of physical danger Where disability was accepted as part of the contract of employment, advice should be sought from HR and Occupational Health as to if the sickness is a result of the disability significantly affecting the employee s ability to perform their duties. Occupational Health will also provide guidance on any reasonable adjustments which may be made to support the individual in work. Where employees become disabled during their employment with the Trust advice will be taken from Occupational Health on reasonable adjustments and or redeployment to an alternative post. In situations where an individual, whose condition falls within the DDA has reached one of the sickness absence trigger points, line managers should review the number of absences due to the disability and take advice from the HR and Occupational Health departments on appropriate action. In progressing an individual who is covered by the DDA through the Trust sickness procedures line managers must assess the impact of the individual s disability on their ability to attend work and obtain expert advice on suitable adjustments and support from Occupational Health. 18. CONSULTATION AND APPROVAL PROCESS The policy has been developed in consultation with the Occupational Health Department, Trust Managers and has been consulted with staff side (trade unions) at the HR policy sub group and comments included in the document. 19. REVIEW AND REVISION ARRANGEMENTS This policy will be reviewed every three years, unless changes in practice/ legislation necessitate more frequent reviews. 20. DISSEMINATION AND IMPLEMENTATION The Trust acknowledges the importance of awareness training for line managers to ensure the effective dissemination and implementation of this Policy. Working in partnership the Human Resources Department will provide appropriate support including policy briefing sessions, Toolkits, Policy Guides and information at Trust Induction. Page 14 of 17

21. DOCUMENT CONTROL INCLUDING ARCHIVING ARRANGEMENTS This policy will be published on the intranet and be made available within Human Resources. 22. MONITORING COMPLIANCE AND THE EFFECTIVENESS OF PROCEDURAL DOCUMENTS This policy will be reviewed 6 months prior to the review date stated on the front cover of the policy. 23. REFERENCES NHS Terms and Conditions Handbook 2008 Section 14 Attendance Management Policy Managers Toolkit 24. ASSOCIATED DOCUMENTS/ APPENDICES Recruitment and Selection Policy Pre Employment Medical Screening Policy Attendance Management Policy Managers Toolkit Appendix 1 Action to be taken by Employee Absent from Work Appendix 2 Employment Statement on Absence from Work due to Sickness/Injury Page 15 of 17

Action to be taken by Employee Absent from Work One to Three Days Absence 1. Personally ring your Manager (or nominated person) on or prior to your first day of absence before shift is due to start. 2. Provide details of the reason for absence and likely return date. 3. Discuss outstanding work issues if appropriate. Appendix 1 4. Ring your Manager (or nominated person) daily unless agreed otherwise until your return to work. 5. On return to work complete and submit an Employee Statement on Absence from Work Calls from other people, texts and emails are unacceptable except in exceptional circumstances Four to Seven Days Absence 1. Continue to make contact and advise on return date. 2. If absence is likely to continue over seven calendar days, advise manager on or before the seventh day. If this falls at a weekend, call on or before the Friday morning prior to the weekend. 3. On return to work complete and submit a Self-Certificate. Eight Days or More 1. If absence continues beyond 7 calendar days (includes weekend days) a Medical Certificate must be produce (no later than 72 hours following eighth day of absence). 2. Subsequent medical certificates must be submitted within 24 hours of expiry of the previous medical certificate 3. Any absence not covered by a medical certificate or any failure to maintain contact will result except in exceptional circumstances in salary payments being withheld or delayed and/ or disciplinary action being taken. 4. If you wish to return to work prior to the expiry of your medical certificate you must produce a further medical certificate to support this. Return to Work Interview Your return to work interview must be conducted within 72 hours of your return to duty regardless of length of absence. Page 16 of 17

Appendix 2 EMPLOYMENT STATEMENT ON ABSENCE FROM WORK DUE TO SICKNESS/INJURY This form is to be completed for absences lasting 1 3 days For absences of 4 7 days a Self Certificate must be completed For absences for 8 or more days a Medical Certificate must be submitted SURNAME (in BLOCK letters) FIRST NAMES Assignment Location No. Band Department National Insurance No. I hereby certify that I was unable to attend for work by reason of sickness / injury from days, whether rostered or not). Nature of sickness/injury to inclusive (to include all I notified (insert name) on (insert date) at (insert time) of my absence. Please insert a tick if absence was due to accident it caused you to consult a medical practitioner or attend hospital Your injury was due to an accident involving a third party, e.g. road traffic accident SIGNED DATE FAILURE TO COMPLETE AND SUBMIT THIS FORM MAY RESULT IN THE LOSS OF SICK PAY FOR USE BY LINE MANAGERS ONLY I am satisfied that the details inserted above are acceptable. (Please insert tick) IF YOU ARE NOT SATISFIED THAT THE DETAILS ARE ACCEPTABLE PLEASE STATE YOUR REASONS BELOW & REFER MATTER TO HUMAN RESOURCES FOR ADVICE. Seen by Date Countersigned Date *Keep in personal file Page 17 of 17