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Welcome
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Self Certification
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Welcome
Self Certification Form
A form for completion by employees when they return to work to confirm they have been off sick for up to 7 days.
Managers Name:
Managers email address:
If you are unsure what this is then please ask your manager.
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Self Certification Form
Employee Name:
Address:
Job Title:
Department:
—Please choose an option—
Food and Beverage
Leisure Club
Housekeeping
Front of House
Facilities Cleaning
Directors
Membership Sales
Sales and Events
Accounts
Facilities Maintenance
Reservations
First Date of Absence:
Last Date of Absence:
Number of Days Absent:
Reason for Absence:
Name and Address of General Practitioner:
Declaration
I have not claimed national insurance / industrial injury benefit for this absence. If my absence was longer than 7 days (including weekends), I attach / have submitted a Statement of Fitness for Work (Fit Note). I have not during this period undertaken any work (paid or unpaid). I declare that the details and statements which I have provided are correct and true.
Signed:
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