Cornwall Health Community

Cornwall Health Community Your guide to being pregnant at work and Maternity Leave Including Royal Cornwall Hospitals Trust PCH Dental CIC Kernow Clinical Commissioning Group CFPT (Former PCH employees only) for further information please see our website - http://www.rcht.nhs.uk/royalcornwallhospitalstrust/ourservices/azservices/c/childca recoordination/servicesweprovide.aspx Effective for babies due on or after 5 th April 2015 Produced by Linda Carpenter, Childcare Co-ordinator in liaison with Health & Safety Services 16/05/16 Version 9 Review date 06/01/2019

Congratulations, you are pregnant. So, what are your rights at work? This booklet has been produced to help you through the maternity maze. If you have any questions that remain unanswered, please contact either your Human Resources department or your Childcare Co-coordinator. The information in this Guide, affects the Maternity Leave and Pay of all NHS employees whose babies are due on or after 5 April 2015 and takes into account The Agenda for Change Terms & Conditions of Employment handbook (Section 15), Child and Families Act 2014, Employment Rights Act 1996, Employment Relations Act 1999, Equality Act 2010 Health and Duties on employers under the Management of Health and Safety at Work Act,1974, Section 7(e) in respect of new, expectant or breastfeeding mothers. Please refer to the booklet Your Guide to Family Friendly Rights for information on Paternity leave, Shared Parental Leave, Parental Leave and Emergency Special Leave. Contents Page 3 Pregnancy key dates. 4 Maternity Leave and Pay if you intend to return to work after the birth of your baby (Chart 1). 5 Maternity Leave and Pay if you do not intend to return to work after the birth of your baby (Chart 2). 6 Maternity Leave and Pay Key Dates. 7/10 Frequently asked questions. 11 What are the Trust s responsibilities to you? 11 What are your responsibilities to the Trust? 12 Checklist for employees. 13 Contact Details. 2

14/20 Request for Maternity Leave and Pay application forms. PREGNANCY KEY DATES The timing of your rights and benefits in pregnancy is very complicated, so use the following chart as a guide only. Complete the date of the first day of your last period in the first box. Work along the row with each box representing one week. Write in the dates week by week until you get to the date your baby is due. Insert the date of the first day of your last period here. A Stage 1 Risk Assessment should already have been carried out at your place work to identify any specific risks to women of childbearing age who could become pregnant, or to new or expectant mothers. You must notify your Manager that you are pregnant, by completing the form at the back of this guide, to enable a Stage 2 Risk Assessment that is specifically for you to be carried out. If you receive childcare vouchers, contact the Childcare CO-ordination Team now to discuss your options. You are now 20 weeks pregnant. Request form MATB1 from your Midwife at your next antenatal appointment. Your Stage 2 Risk Assessment should have been carried out by this date. This is based on the initial assessment and any medical advice you provide from your GP or Midwife. Your Manager should continue to review this throughout your pregnancy (Stage 3). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Your Stage 3 Risk. Assessment Reviews should have been carried out by this date. 29 30 31 32 33 34 35 36 37 38 39 40 The Trust will have written to you within 28 days of receiving your application to set out your rights, your expected date of return and your responsibility to advise them of any changes. This is the earliest point at which your maternity leave can start. Advise your Manager of your baby s date of birth, within 4 weeks of the birth. If you are in the Childcare Voucher scheme you may decide to come out by now. Please contact the Childcare Team.. The date your baby is due. If you are absent from work with a pregnancy related illness during the 4 weeks before your due date, you will be required to start your maternity leave from that day. You are now 25 weeks pregnant. This is the latest date by which you should inform your Manager of your pregnancy. Submit your application forms for maternity leave and pay now. 3

Maternity Leave and Pay if you intend to return to work with the same or another NHS employer after the birth of your baby (Chart 1) Bank/Kernowflex staff see ** below Follow the boxes to see what leave and pay you are entitled to. Will you have worked for the NHS (without a break in service) for 12 mths by the time you are 29 wks pregnant? Yes Are you intending to return to work? No Go to Page 5 Yes Yes Have you had 26 wks service with your current employer at the 25th wk of your pregnancy & have paid National Insurance? No No **All Bank/Kernowflex Staff start here. Have you had 26 wks service with your current employer at the 25th wk of your pregnancy & have paid National Insurance? Yes No Have you been employed for 26 weeks during the 66 weeks prior to your baby s due date (including bank/casual work)? Yes No * You are entitled to 8 wks full pay, 18 wks half pay plus SMP (providing this does not exceed full pay), 13 weeks SMP only and 13 wks unpaid leave. You have the right to return to your job. Fill in Form A & F * You are entitled to 8 wks full pay, 18 wks half pay plus MA (providing this does not exceed full pay) 13 weeks MA only and 13 wks unpaid leave. You have the right to return to your job. Fill in Form C & F You are entitled to SMP 6 wks at the earnings related rate (90% of full pay) and 33 wks at standard rate SMP and 13 wks unpaid leave. You have the right to return to your job. Fill in Form B & F If your earnings were sufficient you may be entitled to 39 wks MA which has to be claimed through Job Centre plus & 13 weeks unpaid leave and you have the right to return to your job. Fill in Form E & F You are entitled to 52 wks unpaid leave and you have the right to return to your job. Fill in Form E & F * The above paid Maternity Leave is in excess of Statutory Requirements and each organisation will normally reclaim the additional amount should an individual not return to work for at least 3 months for the same or another NHS employer (excluding Bank) having previously stated their intention to do so. Note: If you do not earn sufficient to pay National Insurance Contributions you will not qualify for Statutory Maternity Pay (SMP) but may be able to claim Maternity Allowance (MA) 4

Maternity Leave and Pay if you do not intend to return to work after the birth of your baby (Chart 2) Bank/Kernowflex staff see ** below Follow the boxes to see what leave and pay you are entitled to. Will you have worked for the NHS (without a break in service) for 12 mths by the time you are 29 wks pregnant? No Are you intending to return to work? Yes Return to Page 4 Yes Have you had 26 wks service with your current employer at the 25th wk of your pregnancy & have paid National Insurance? No **All Bank/Kernowflex Staff start here. Have you had 26 wks service with your current employer at your 25 th week of pregnancy and paid National Insurance? No Have you been employed for 26 wks during the 66 weeks prior to your baby s due date (including bank/casual work) Yes No Yes Yes No You are entitled to SMP 6 wks 90% full pay and 33 wks SMP and 13 wks unpaid leave. Fill in Form B & F You are be entitled to 6 wks 90% full pay and 33 wks MA which has to be claimed through the Benefits Agency (Job Centre Plus) and 13 wks unpaid leave. Fill in Form D & F You are entitled to SMP 6 wks at the earnings related rate (90% of full pay) and 33 wks at standard SMP and 13 wks unpaid leave Fill in Form B & F If your earnings were sufficient you may be entitled to 39 wks MA which has to be claimed through Job Centre Plus & 13 weeks unpaid leave Fill in Form E & F You are entitled to 52 wks unpaid leave. Fill in Form E & F 5

Note: If you do not earn sufficient to pay National Insurance Contributions you will not qualify for Statutory Maternity Pay (SMP) but may be able to claim Maternity Allowance (MA) Maternity Leave and Pay Key Dates Follow the colour that applies to you from the previous charts. The timing of your rights and benefits in pregnancy is very complicated, so use the following chart as a guide only. Complete the date of the first day of your Maternity Leave in the first box. Work along the row with each box representing one week. Write in the date, week by week, until you get to the end. Insert the first day of your maternity leave here. Don t forget to apply for Child Benefit and Child Tax Credit when your baby is born. Full pay will end here. You will then receive half pay plus Statutory Maternity Pay (SMP) or Maternity Allowance (MA) whichever is applicable to you. This cannot exceed your normal full pay. From this week you will receive half pay plus SMP or MA, whichever is applicable to you. This cannot exceed your full pay. From this week you will receive 13 weeks of SMP or MA only whichever is applicable to you. This cannot exceed 90% of your full pay. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 Your 6 weeks at 90% of your salary finishes here. You will now receive 33 weeks of Statutory Maternity Pay or Maternity Allowance If you haven t done so already, you may start to think about your return to work about now. Contact the Childcare Coordination team for any advice required, i.e. childcare, Childcare Vouchers, flexible working etc. If you are only entitled to unpaid maternity leave this ends now. If you wish to return to work before this time you must give your Manager at least 28 days notice 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 SMP (or MA) ends here and you will now start your 13 weeks unpaid maternity leave. Your maternity leave ends and you return to work. If you wish to return to work before this time you must give your Manager at least 28 days notice Your Stage 4 return to work risk assessment should be carried out by your Manager now. 6

FREQUENTLY ASKED QUESTIONS How much notice do I have to give? - You are required to give a minimum of 15 weeks notice but it is advisable to let your Manager know as soon as you feel happy to do so. We ask you to do this because they will then be able to assess your safety in relation to your being pregnant whilst at work (see section on what to expect from your Manager) and give you time off for antenatal appointments (see below). What do I do about my antenatal appointments? - You will be entitled to reasonable paid time off for antenatal care. You may be required to produce your appointment card following your first appointment for your Manager. If your GP or midwife advises attendance at parent-craft and relaxation classes you will be permitted paid time off to attend provided you produce evidence of appointment times if requested by your Manager. What happens if I am on a Fixed Term Contract? - If the contract expires after the eleventh week before your expected week of childbirth and you have 12 months continuous service at your 29 th week of pregnancy, then the fixed term contract will be extended to cover the full 52-weeks maternity leave period. Employees on fixed term contracts who do not meet the twelve months continuous service condition above but whose contracts expire after their 25 th week of pregnancy onwards may still be entitled to Statutory Maternity Pay. You will not have a right to return to employment with the Trust following the end of your maternity leave, as your contract will have expired. What if I m on a rotational Contract? - Where an employee is on a planned rotation of appointments with one or more NHS employers as part of an agreed programme of training, she shall have the right to return to work in the same post or in the next planned post irrespective of whether the contract would otherwise have ended if pregnancy and childbirth had not occurred. In such circumstances the employee s contract will be extended to enable the practitioner to complete the agreed programme of training. When can I go on maternity leave? - The earliest point at which your maternity leave can start is 11 weeks before the baby is due. If your baby is born before you have commenced your Maternity Leave and you have worked during the actual week of the birth, then your Maternity Leave will start on the first day of your absence. Having advised the date that you wish your Maternity Leave to start and you subsequently wish to change the date, then you must give 28 days notice, unless this is not reasonably practicable. You must take a minimum of 2 weeks maternity leave after your baby is born before returning to work. If your baby is born during your annual leave your maternity leave will start the day your baby is born. It is therefore important to notify your manager when your baby is born. How does maternity leave affect my annual leave? - You will accrue annual leave in accordance with your contract throughout the 26-week period of Ordinary maternity leave and 26-week period of Additional maternity leave. Where the amount of accrued annual leave would exceed normal carry over provisions (i.e. One week) it may be mutually beneficial to both yourself and your manager for you to take annual leave before and/or after your maternity leave period. The amount of annual leave to be taken in this way, or carried over, should be discussed and agreed. I am currently in receipt of Childcare Vouchers, what must I do? - If you are currently receiving Childcare vouchers you must advise the Childcare Co-ordination Team immediately to discuss your options. In the event that you take a temporary reduction in salary (e.g. Maternity leave or long term sick leave etc) but do not alter the terms of your agreement, your statutory benefits may be adversely 7

affected. In addition, Maternity pay is calculated on salary on which National Insurance is payable so your Maternity pay will be reduced if you take childcare vouchers at this time. For this reason you may wish to come off the scheme at least 23 weeks before your baby is due (i.e. before you reach your 17 th week of pregnancy). Alternatively, you may continue to receive Childcare Vouchers during your Maternity Leave and receive reduced Maternity pay. What if there is a problem with the baby? - Unfortunately there are a small number of pregnancies where the baby is born before the eleventh week before their due date. It is therefore recognised that the period of leave may need to be adapted to match individual circumstances. If your baby is born this early and has to remain in hospital, you may arrange to 'split' your leave, taking a minimum of 2 weeks immediately after the birth, returning to work and then taking the balance of leave when the baby comes home. If your baby is stillborn after 24 weeks, you are still entitled to maternity pay and leave as if the pregnancy had reached term. What if I am sick before I commence my maternity leave? - If you are sick at any time during the 4 weeks prior to your due date and your sickness is NOT PREGNANCY related you will receive sick leave in accordance with the sick leave scheme of the terms and conditions of your employment. Your intended commencement date is unchanged. If you are sick at any time during the 4 weeks prior to your due date and your sickness IS PREGNANCY related you will commence maternity leave at the beginning of the fourth week before your expected week of childbirth or the beginning of the next week after you last worked, whichever is the later. What about my lease car, any allowances or payments that are made to me in order for me to do my job? - Any allowances you normally receive will not be paid during your maternity leave. If you have a lease car it is advisable to discuss the payments of this with the Lease Car Administrator. (See useful telephone numbers section) How will I know when my pay changes? - Within 28 days from submitting your forms you will receive a letter detailing the dates that you have requested your maternity leave to start and this will tell you when you will be on half pay, SMP and then nil pay. What about my Pensions contributions? - Staff who belong to the NHS Pension Scheme are required to maintain their contributions during the period of paid and/or unpaid maternity leave. During the period of paid absence, contributions will be deducted from pay in the normal way. During the period of unpaid absence, contributions will be accrued and recovered on return to duty. If you are not intending to return to work following your paid maternity leave, this period will not count as pensionable service, unless you request it. For further details please see Form F at the end of this pack. Keeping in touch. - Before you go on leave your manager will discuss any voluntary arrangements regarding keeping in touch with you whilst you are on maternity leave. This may include any developments at work, which you would find helpful. Your Manager may make reasonable contact with you during your maternity leave in this respect. You may, with agreement from your Trust, do up to 10 days paid work, known as Keeping in Touch days under your contract of employment during your maternity leave. The nature and type of work is to be mutually agreed and could also be used for things like attending a team meeting, training activity or conference etc. Payment for Keeping in touch days may not be made until you have returned to work or may be offered as Time off in Lieu of Payment. You will be paid at your basic daily rate for the hours worked less appropriate maternity leave payment for any keeping in Touch Days worked. This should be agreed with your Manager beforehand. Remember, If you are not planning to take your full entitlement of 52 weeks maternity leave you will need to give your Manager 28 days notice of your return date. 8

There are a lot of things to remember, is there anything to help? - Yes. There is a useful checklist included in this pack to inform you of the key dates and things you need to remember to do and when. Please also remember that the Childcare Co-ordination team are here to help you, so please do not hesitate to contact us. Manager to take this into account during your Stage 4 Risk Assessment. The Trust Supports the Health & Safety Executive recommendations to provide a private, healthy and safe environment for nursing mothers to express and store milk. FREQUENTLY ASKED QUESTIONS RISK ASSESSMENT The following has been included to help answer some of the questions you may have about continuing to work while pregnant. Enclosed in your pack is a separate leaflet called Management of Staff Pregnancy & Maternity Leave. Please hand this leaflet to your Line Manager to enable him/her to carry out your Risk Assessments. Do I have to be pregnant before my employer takes action to protect my health and safety? - No. Your Manager is required to conduct a risk assessment for his/her staff members, which should also include any specific risks to women of childbearing age who could become pregnant and any risks to new and expectant mothers (Stage 1). What sort of risks might I be exposed to? - You may be at risk from different physical, biological, and chemical agents, working conditions and processes. These risks will vary depending on your health, and at different stages of your pregnancy. Your Manager will be doing a specific risk assessment. You will be asked to help with this and it is important that any advice you have received from your Doctor or Midwife, that could impact on the assessment, is passed on to your Manager. Some of the more common risks might be: lifting/carrying of heavy loads standing or sitting for long lengths of time What involvement do I have in this risk assessment process? - If any risks are identified, your Manager must inform you and your colleagues directly or through your safety representative. This should include involvement in what is being proposed to reduce, remove or control the risks. Do I have to tell my Manager that I am pregnant? - Yes. While you do not have to inform your Manager that you are pregnant until your 25 th week of pregnancy, it is important (for you and your child s health and safety protection) that you provide them with notification as early as possible by completing the form provided at the end of this guide. Until your employer has received notification from you, they are not obliged to take any action other than those resulting from the risk assessment for all their staff members (Stage 1). Do I have to tell my Manager that I am a new Mother and Breastfeeding when I return to work? - YES. This will enable your exposure to infectious diseases exposure to lead workstations, posture and design exposure to radioactive material other people s smoke in the workplace threat of violence in the workplace certain working hours excessively noisy or Dusty workplaces 9

working with Cytotoxic drugs The outcome of the risk assessment should be made available to you by your Manager. Does the risk assessment get repeated as my pregnancy progresses? - Yes. Your Manager should regularly monitor and review any assessments with you, to take into account possible risks that may occur at different stages of your pregnancy. What action should I expect my Manager to take? - Your Manager should take action to ensure that you are not exposed to any significant risk. The flowchart in the leaflet produced for your Manager provides an outline of the action that he/she must take to do this. I have pregnancy-related medical conditions (e.g. high blood pressure, history of miscarriages etc). How does this affect the risk assessment my Manager has to carry out? - Your Manager must take into account, during your specific risk assessment, any medical advice from your GP or midwife about your health and adjust your working conditions accordingly. Occupational Health are also available to provide support and/or assessment. I have told my GP I think my health problems are due to risks I have been exposed to at work. I am pregnant, so should she or he sign me off sick? - Signing you off sick from work may not resolve the cause of your ill health. In some circumstances this could have some affect on your maternity benefits. Action One: temporarily adjust your working conditions and/or hours of work; or if it was not reasonable to do so or if this would not avoid the risk then take action two. Action Two: offer you suitable alternative work (at the same rate of pay) if available; or if this is not feasible, your Manager must then take action three. Action Three: suspended you from work on paid leave for as long as necessary to protect your health and safety, and/or that of your child. As outlined in the Manager s leaflet in your pack, the risk assessment should be monitored and reviewed on a regular basis. If you think you have been exposed to a risk at work, you need to discuss it with your Manager, so the risk assessment can be reviewed. You may also wish to talk to your safety representative. A note from your GP to your Manager may help. Occupational Health are also available to provide support and/or assessment. Please refer to Your Employing Organisation s Health & Safety Policy, which should be located on the Trust Document Library, or by contacting your Health & Safety Team. Your Manager should have conducted, on receiving written notification from you that you are pregnant, a risk assessment specific to you. If a risk is identified, your Manager should take action to reduce or eliminate the risk. If the risk cannot be reduced or eliminated then he/she should take the following action: 10

To write to employees within 28 days of receiving an application to commence Maternity Leave setting out their rights, expected date of return and responsibility to advise the employer of any changes. Complete the appropriate resignation forms if I decide not to return to work following the birth. WHAT ARE YOUR EMLOYER S RESPONSIBILITIES TO YOU DURING YOUR MATERNITY LEAVE? To conduct all necessary Risk Assessments detailed below. (For further information on Risk Assessments, please refer to the Guidance booklet included with this pack and your Trust Health & Safety Policy). Stage One a Risk Assessment of the Workplace for all employees, which should also include any specific risks to women of childbearing age who could become pregnant and any risks to new or expectant mothers. Stage Two should be carried out when you notify your Manager that you are pregnant. This Risk Assessment is specific to you and is based on the initial assessment and any medical advice you have provided from your GP or Midwife. Stage Three is a system of ongoing review of the assessment carried out at Stage two. Stage Four should be carried out on your return to work. To retain your rights to return to work under your original Contract of Employment provided you have fulfilled all the conditions. To allow reasonable paid time off during working hours for antenatal care. To ensure maternity pay is correct and paid on a weekly/monthly basis. 11

WHAT ARE YOUR RESPONSIBILITIES TO YOUR EMPLOYER? CHECKLIST FOR EMPLOYEES It is advantageous to inform your Manager of your pregnancy at the earliest opportunity and complete appropriate sections from the maternity information pack. Attend regular health checkups and obtain MATB1 from my GP/Midwife. There is a duty not to put yourself in a situation which puts you or your baby at risk (e.g. Management of Health and Safety at Work Amendment Regulation 1994) Advise your Manager if I think you have been exposed to a risk at work to enable your Risk Assessment to be reviewed. Report to your Manager any hazard that may endanger either you or your baby in the work environment. First Trimester of Pregnancy Notify your Manager that you are pregnant if you are happy to do so. A form is provided at the back of this guide for this purpose. This will trigger a Stage 2 risk assessment that is specific to you to take place early. This will enable any specific risks to be identified early in your pregnancy and protect both you and your unborn child. Your Manager should inform you of the results. Advise your Manager of any time off that may be required for antenatal appointments. Second Trimester of Pregnancy If you are in the Childcare Voucher Scheme you may wish to come out of the scheme before you are 17 weeks Pregnant. Contact the Childcare Team now to discuss your options. Advise your Manager of any time off that may be required for antenatal appointments. Obtain form MATB1 from your midwife. At 25 weeks of pregnancy notify your Manager of your pregnancy if you have not already done so. NB - If you have previously notified your Manager that you are pregnant then your Stage 2 risk assessment should have been completed, if you have not notified your Manager previously then your Manager will now complete a Stage 2 risk assessment that is specific to you. Meet with your Manager to mutually agree how and when you are going to take your annual leave. Any annual leave to be taken at the end of your Maternity Leave should be recorded on your application forms at the end of this pack. Complete only one of the forms A to E included in this pack depending on which applies to your individual circumstances. Complete Form F if you pay NHS Pension contributions. 12

Third Trimester of Pregnancy On receipt of your completed forms the Childcare Co-ordination Team will write to you within 28 days setting out your rights, your expected date of return and confirming that it is your responsibility to notify them of any changes. Advise your Manager of any time off that may be required for antenatal appointments. Your Stage 2 risk assessment should be reviewed now and the results discussed with you. This is called Stage 3. Meet with your Manager to agree any voluntary arrangements regarding keeping in touch with you whilst you are on maternity leave. After the birth Within one month of the birth you must notify your Manager of the date of your baby s birth in writing. You must take at least two weeks Maternity Leave after the birth of your baby. If you intend to apply for Shared parental Leave, you will need to give notice to end or curtail your Maternity Leave. Please refer to the booklet Your Guide to Family Friendly Rights for full details If you intend to return to work before the end of your full entitlement of Paid or Unpaid Maternity Leave you will be required to give at least 28 days notice in writing to your Manager. A return to work Risk Assessment should be carried out and the results discussed with you (Stage 4). If you need any help or assistance with the above, please contact the Childcare Co-ordination Team. We can help you source suitable childcare and give information on Tax Credits and Childcare Vouchers to assist with the cost. You will need to start planning this well ahead of your return. The following pages contain the forms you need to complete to request your Maternity Leave and Pay Please complete as necessary and put a line through forms which are not applicable to you Your completed forms should then be detached and handed to your Manager together with your Maternity Certificate (MATB1) Once signed by your manager, forms and matching Certificate should be returned to the Childcare Co-ordinator CONTACT DETAILS LINDA CARPENTER CHILDCARE CO-ORDINATOR C/O OCCUPATIONAL HEALTH PENDEEN HOUSE 13

ROYAL CORNWALL HOSPITAL TRURO TR1 3LJ TELEPHONE: 01872 25 2476 EMAIL: lindacarpenter@nhs.net WEBSITE : Click on the following link http://www.rcht.nhs.uk/royalcornwallhospitalstrust/ourservices/azservices/c/childcarecoordination/servicesweprovide.aspx Or go to: NHS Intranet home page, Select A Z of Services, Select C, Select Childcare Co-ordination, where all guides and information is available to download. 14

CORNWALL HEALTH COMMUNITY FORM A REQUEST FOR MATERNITY LEAVE WITH PAY This form is to be used by employees with over 12 months service at the 29 th week of pregnancy who wish to take paid Maternity Leave and includes the option of unpaid leave following the period of paid leave, and who intend to return to work. NAME ASSIGNMENT NUMBER: HOME EMAIL HOME PHONE DEPARTMENT NHS EMPLOYER NAME HOME ADDRESS I am making application for Maternity Leave with Statutory Maternity Pay in accordance with the Trust s Maternity Policy. My expected date of childbirth is I wish to commence my Maternity Leave with effect from I am currently in the Childcare Voucher scheme YES/ NO Are you a Lease Car/ Regular Car User YES/NO If I wish to return before the end of the 52 weeks Maternity Leave I will give my Manager 28 days notice in writing. I intend to return to duty with the Trust at the end of this leave period. In accordance with the conditions of service I understand that if I should fail to return to work for a minimum of three months, I may be liable to refund the maternity pay received with the exception of Statutory Maternity pay. I attach my Maternity Certificate (MAT B1) signed by my Midwife/GP, indicating my expected date/week of childbirth. I will be taking the following amount of annual leave at the end of my Maternity Leave period Employee s signature Date This form takes the place of a Contract Amendment form and therefore should be authorised at the correct level Manager s signature Print Name Date Produced by Childcare Co-ordination Team in liaison with Risk & Safety Services 16/05/16 15

CORNWALL HEALTH COMMUNITY FORM B REQUEST FOR MATERNITY LEAVE WITH PAY This form is to be used by employees who have had 26 weeks or more service at the 25 th week of pregnancy and are not intending to return to work following the birth or who are employed on a casual basis i.e. Bank or who have had 26 weeks service at the 25 th week of pregnancy but less than 12 months service, whether intending to return to work or not (Please delete the description above which DOES NOT apply to you) NAME ASSIGNMENT NUMBER HOME EMAIL HOME PHONE DEPARTMENT NHS EMPLOYER NAME HOME ADDRESS I am making application for Maternity Leave with Statutory Maternity Pay in accordance with the Trust Maternity Policy, My expected date of childbirth is I wish to commence my Maternity Leave with effect from (must be a Sunday) I am currently in the Childcare Voucher Scheme YES/NO Are you a Lease Car/ Regular Car User YES/NO I will be taking the following amount of annual leave at the end of my Maternity Leave period If I wish to return before the end of the 52 weeks Maternity Leave I will give my Manager 28 days notice in writing. I attach my Maternity Certificate (MAT B1) signed by my Midwife/GP, indicating my expected date/week of childbirth. Employee s signature Manager s signature Print name Date This form takes the place of a Contract Amendment form and therefore should be authorised at the correct level Produced by Childcare Co-ordination Team in liaison with Risk & Safety Services 16/05/16 16 Date

CORNWALL HEALTH COMMUNITY FORM C REQUEST FOR MATERNITY LEAVE WITH PAY This form is to be used by employees who had less than 26 weeks service with the current NHS employer at the 25 th week of pregnancy but have previous other NHS service of 12 months or more by the 29 th week of pregnancy with no more than a 3 month break in service and who are intending to return to work. NAME ASSIGNMENT NUMBER HOME EMAIL HOME PHONE DEPARTMENT NHS EMPLOYER NAME HOME ADDRESS I am making application for Maternity Leave with pay in accordance with the Trust s Maternity Policy. My expected date of childbirth is I wish to commence my Maternity Leave with effect from I am currently in the Childcare Voucher scheme YES/ NO Are you a Lease Car/ Regular Car User YES/NO I am aware that when I decide to return to work I have to provide my Manager with a minimum of 28 days notice in writing of my intended date of return. If I wish to return before the end of the 52 weeks Maternity Leave I will give my Manager 28 days notice in writing. I will be taking the following amount of annual leave at the end of my Maternity Leave period I attach my Maternity Certificate (MAT B1) signed by my Midwife/GP, indicating my expected date/week of childbirth. Employee s signature Date Manager s signature Print Name Date This form takes the place of a Contract Amendment form and therefore should be authorised at the correct level Produced by Childcare Co-ordination Team in liaison with Risk & Safety Services 16/05/16 17

CORNWALL HEALTH COMMUNITY FORM D REQUEST FOR MATERNITY LEAVE /PAY - NOT RETURNING This form is to be used by employees who had less than 26 weeks service with the current NHS employer at the 25 th week of pregnancy but have previous other NHS service of 12 months or more by the 29 th week of pregnancy with no more than a 3 month break in service and who NOT intending to return to work. NAME ASSIGMENT NUMBER HOME EMAIL HOME PHONE DEPARTMENT NHS EMPLOYER NAME HOME ADDRESS I am making application for Maternity Pay in accordance with the Trust s Maternity Policy Conditions of Service. My expected date of childbirth is I wish to commence my Maternity Leave with effect from I am currently in the Childcare Voucher scheme YES/NO Are you a Lease Car/ Regular Car User YES/NO I will NOT be returning to work after my childbirth. I attach my Maternity Certificate (MAT B1) signed by my Midwife/GP, indicating my expected date/week of childbirth. Employee s signature Date This form takes the place of a Contract Amendment form and therefore should be authorised at the correct level Manager s signature Print Name Date Produced by Childcare Co-ordination Team in liaison with Risk & Safety Services 16/05/16 18

CORNWALL HEALTH COMMUNITY FORM E REQUEST FOR STATUTORY MATERNITY LEAVE ONLY This form is to be completed by employees who have less than 26 weeks service at the 25 th week of pregnancy or are employed on a casual basis i.e. bank and have not earned sufficient to qualify for Statutory Maternity Pay. (Please delete the description above which DOES NOT apply to you) NAME ASSIGNMENT NUMBER HOME EMAIL HOME PHONE DEPARTMENT NHS EMPLOYER NAME HOME ADDRESS I am making application for Statutory Maternity Leave. My expected date of childbirth is I wish to commence my Maternity Leave with effect from I am currently in the Childcare Voucher scheme YES/ NO Are you a Lease Car/ Regular Car User YES/NO I attach my Maternity Certificate (MAT B1) signed by my Midwife/GP, indicating my expected date/week of childbirth. I will be taking the following amount of annual leave at the end of my Maternity Leave period Please forward form SMP1 to me for completion and return to Job Centre Plus to enable me to apply for Maternity Allowance. Employee s signature Date This form takes the place of a Contract Amendment form and therefore should be authorised at the correct level Manager s signature Print name Date Produced by Childcare Co-ordination Team in liaison with Risk & Safety Services 16/05/16 19

CORNWALL HEALTH COMMUNITY FORM F NHS PENSION This form is to be completed by ALL employees who pay into the NHS Pension NAME ASSIGNMENT NUMBER HOME EMAIL HOME PHONE DEPARTMENT NHS EMPLOYER NAME HOME ADDRESS An employee is required to pay NHS pension contributions for any period of absence on paid or unpaid maternity leave. During the period of paid maternity leave, NHS pension contributions are deducted from your salary in the usual way. For any period of unpaid maternity leave, this payment is calculated when the employee returns to work and the arrears can be paid in 1 of 2 ways: A. *On return to work, payment by lump sum of the total amount due. B. *By monthly remittances. * Please delete whichever does not apply If you are not intending to return to work following your paid Maternity Leave, this period will not count towards Pensionable Service, unless you request it. If you wish your Paid Maternity Leave to count as pensionable service, please tick the following box Signed Date Produced by Childcare Co-ordination Team in liaison with Risk & Safety Services 16/05/16 20

STATEMENT CONFIRMING PREGNANCY All staff - Please complete this form and return to your supervisor/line manger as soon as possible. Name: Address: Date: Dear [insert line manager s name] Pregnancy Risk Assessment I am writing to inform you that I am pregnant and that my baby is due on the I understand that as I have now informed you of my pregnancy I do have the right to a personal and specific risk assessment as set out in the Management of Health and Safety at Work Regulations 1999. I also understand that you should regularly review my initial assessment as my pregnancy progresses to take into account possible risks that may occur during the different stages of my pregnancy. I am writing to ask you to arrange to see me as soon as possible in order to conduct a risk assessment. Thank you for your time and attention to this matter. I look forward to hearing form you in the near future. Yours faithfully Name (print): Job title: Usual work location: Copy to staff Personnel file Copy to Childcare Co-ordinator Produced by Childcare Co-ordination Team in liaison with Risk & Safety Services 16/05/16 21