SICKNESS SELF CERTIFICATION FORM

TO BE COMPLETED AND SUBMITTED FOR SICKNESS FOR 1 TO 7 DAYS

REMEMBER: You MUST PERSONALLY contact the office on 01527 830454. If you are on a Morning shift then call no later than 1 hour before you are scheduled to begin work. If you are on an Afternoon or Evening shift you MUST PERSONALLY contact the office on 01527 830454 by 12:00pm (lunchtime).

The Sickness Self Certification Form below must be completed for any sickness absence from work from day 1 to day 7. Please complete all sections and submit the form. A Line Manager will be in contact with you to discuss return to work details.

If sickness absence from work is for longer than 7 days, you will need to obtain a Doctors Fit/Sick Note and send this to the R&D Office by email: info@rdcleaning.co.uk or post to R&D Cleaning Services Ltd, Ashtenne Business Centre, Oxleasow Road, East Moons Moat, Redditch, B98 0RE.

If you have any queries regarding sickness absence then please contact the R&D Office on 01527 830454.

SELF CERTIFICATION FORM (TO BE COMPLETED FOR SICK LEAVE)

FIRST NAME & SURNAME:*
EMAIL ADDRESS::*
MOBILE NUMBER::*
DATE OF 1ST DAY OF SICKNESS:
HAVE YOU / DID YOU CONTACT THE OFFICE ON 01527 830454? THIS IS ESSENTIAL AND MAY AFFECT PAYMENT OF YOUR SSP IF THIS PROCEDURE IS NOT FOLLOWED.:*
CLIENT SITES/JOBS YOU ARE UNABLE TO ATTEND DUE TO SICKNESS DAY/S:*
RETURN TO WORK DATE (IF KNOWN)::
PLEASE PROVIDE A REASON FOR YOUR SICKNESS/ABSENCE FROM WORK:*

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