Sickness absence

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Model documents and policies

Downloadable and customisable documents relating to sickness absence.

Table of contents

Forms

Word

Fit note record

 (54 KB)
Last Modified: 20 Feb 2015
Use this form to record the outcome of review meetings with an employee following receipt of a fit note from the employee’s GP. The form also includes a section to note whether the employee has been referred for a Fit for Work assessment.
Word

Form declaring fitness for work

 (56 KB)
Last Modified: 20 Feb 2015
This form is for employees to declare their fitness to return to work following sickness absence, including any advice or recommendations from their doctor or Fit for Work manager.
Word

Form for an employee to consent to a medical examination

 (55 KB) UPDATED
Last Modified: 15 Apr 2016
This form is for an employee to give their consent to a medical examination at the Company's expense, including their rights under the Access to Medical Reports Act 1988.
Word

Form for an employee to give employer access to their medical record

 (57 KB)
Last Modified: 09 May 2014
This form is for an employee to give their consent for their employer to have access to a medical report, and includes their rights under the Access to Medical Reports Act 1988.
Word

Form for return to work interview following sickness

 (54 KB)
Last Modified: 20 Feb 2015
This form is to record the interview of an employee by their manager on their return to work following a period of sickness absence, and to record whether or not this absence is authorised. The form also includes a section to record whether the employee was referred for a Fit for Work assessment and the outcome of any such assessment.
Word

Form for self-certifying sickness absence

 (56 KB)
Last Modified: 01 Jun 2013
This form is for employees to self-certify a period of sickness absence of less than seven days, giving details of the sickness and any effects it may have on their work.

Letters

Word

Letter confirming a meeting with employee during long-term absence

 (54 KB)
Last Modified: 20 Feb 2015
This letter should be sent to an employee who is on long-term absence to confirm a meeting to discuss the reasons for the employee’s absence, its likely duration and to discuss the possible outcomes of an extended absence. The letter confirms the date, time and location of the meeting but also explains that if the employee feels too unwell to attend the meeting can take place in their home. The letter also has an optional clause to ask the employee to provide an update regarding their Fit for Work case manager’s assessment, as well as details of their Return to Work plan if they have been referred to the Fit for Work service.
Word

Letter confirming the outcome of a meeting to discuss long-term sickness absence

 (55 KB)
Last Modified: 20 Feb 2015
This letter can be sent to an employee following a meeting to discuss long-term absence. It covers the details discussed at the meeting and further actions that are planned, including a summary of the medical advice received from the Fit for Work case manager if the employee has been referred to the Fit for Work service.
Word

Letter inviting an employee to attend a meeting on their return to work following a period of sickness absence

 (54 KB)
Last Modified: 20 Feb 2015
This letter invites an employee to a meeting, on their return to work, to discuss their recent sickness absence and any medical report/recommendations, including a Return to Work plan if they had been referred to the Fit for Work service.
Word

Letter requesting an employee attend a medical examination

 (53 KB)
Last Modified: 01 Jun 2013
This letter asks an employee on sickness absence to attend a medical examination at the company's expense. The letter outlines the date, time and location of the appointment and confirms the aim of the medical examination. This letter should be sent with the form asking an employee to consent to a medical examination.
Word

Letter requesting an employee attend a medical examination before returning to work following absence

 (54 KB) NEW
Last Published: 15 Apr 2016
This letter invites an employee to attend a medical examination before returning to work after a period of absence. The letter explains that the aim of the medical examination is to gain a greater understanding of the employee’s current medical condition, to ensure that they are fully fit to return and to assist in the identification of any reasonable adjustments. The letter also asks the employee to complete a pro forma; you can make use of the 'Form for an employee to consent to a medical examination' included on this page for this purpose.
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Letter requesting an employee on sickness absence to indicate an anticipated date of return to work

 (53 KB)
Last Modified: 20 Feb 2015
This letter is to request an employee on sickness absence to indicate an anticipated return to work date, if such date has been given by their doctor, or whether the absence is likely to be prolonged. The letter also asks if they can provide any recommendations arising from a Fit for Work assessment.
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Letter terminating employment due to long-term sickness absence

 (56 KB)
Last Modified: 01 Jun 2013
Where an employee is continually absent due to ill health this letter confirms that their employment is terminated. It refers to meeting(s) held with the employee and that no alternative duties, adjustments or support can be adopted to facilitate a return. The employee is informed that they can appeal.
Word

Letter to a GP requesting a medical report on an employee on long-term sick leave

 (55 KB)
Last Modified: 01 Jun 2013
This letter is to ask a doctor to provide a medical report on an employee with long-term sickness absence, asking their opinion of the medical condition, its likely duration and how it will affect the employee.
Word

Letter to a GP requesting a medical report on an employee who has persistent short-term sickness absence

 (55 KB)
Last Modified: 01 Jun 2013
This letter is to ask a doctor to provide a medical report on an employee with persistent short-term sickness absence, asking their opinion of the medical condition and how it will affect the employee.
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Letter to an employee requesting permission to apply to a medical practitioner for a medical report

 (54 KB)
Last Modified: 01 Jun 2013
This letter requests permission from an employee to apply to a medical practitioner for a medical report regarding their state of health or medical condition.
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Letter to send to employee following discussions relating to a fit note stating "may be fit for work"

 (53 KB)
Last Modified: 01 Jun 2013
This letter should be sent to an employee following a meeting to discuss a fit note that states that they “may be fit for work”. The letter sets out the agreement between employer and employee regarding a return to work and the date of a review meeting. The letter also explains that the employee should not wait until the review date if they are struggling with the arrangements but should inform their line manager immediately.

Policies

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Phased return to work policy

 (57 KB) NEW
Last Published: 15 Apr 2016
This policy should be used to inform employees of the company's policy and procedure for a phased return to work following a period of long-term sickness absence. This policy includes details on eligibility, agreeing a phased return to work plan, review meetings and payment arrangements during a phased return.
Word

Sickness absence policy

 (60 KB) UPDATED
Last Modified: 15 Apr 2016
This policy includes details on notification and certification, private medical certificates, return to work, medical examination, access to medical reports, extended absences, meetings, disability, dismissal, payments and insurance.

Templates

Word

Phased return to work timetable

 (54 KB)
Last Modified: 13 Apr 2016
Use this timetable when a GP has recommended a phased return to work for an employee. The document includes advice on points to consider and an example timetable.