Parenting Leave Policy

Parenting Leave Policy

(Maternity, Adoption, Paternity and Partner Leave)

Letter Templates and Standard Documents

This document is a supplement to the Trust Parenting Leave Policy. It contains standard letter templates and documents associated with the policy. Unless otherwise stated these documents MUST be used, this is because many cover requirements set out in legislation for what must be included in letters and other documents associated withMaternity, Adoption, Paternity and Partner Leave. Some forms are electronic and should be completed using the electronic forms where indicated. All letters should use Trust standard headed note paper.

Parental leave and pay and eligibility can be calculated using theGov.UK calculator:

Gov.UK , the government information site, has a web page where you can check if you can get maternity, paternity or shared parental leave and how much pay you are entitled to. This provides details of the legal minimum and is particularly useful for calculating shared parental leave. This can be found at The information provided can be printed out for reference.

CONTENTS

Page

Notification of Intention to Take Maternity Leave

/ 3

SMP/SAP Electronic Form

/ 4

Application Letter for Adoption Leave

/ 5

Keeping In Touch (KIT) Days Agreement Form

/ 6

Keeping In Touch (KIT) Days Agreement Form (SPL)

/ 7

Application for Ordinary Paternity / Partner Leave / Pay and Declaration

/ 8

Risk Assessment Form

/ 9
Shared Parental Leave /Adoption Leave
For the following three sets of Forms the table below indicates which forms are required.
What forms need to be completed?
Both parents want to take SPL / Just the mother wants to take SPL / Just the partner wants to take SPL
Form 1 / YES / YES / YES
Form 2 / YES / YES / NO
Form 3 / NO / NO / YES
Form 4 / YES / NO / YES

Curtailment of Maternity Leave and Pay and Notification of intention to take SPL

Form 1: Curtailment of Maternity Leave and Pay (for Mother's Employer)
Form 2: Notification that Mother is intending to take SPL (for Mother’s Employer)
Form 3: Notice confirming that Partner is taking SPL but mother is not (for Mother’s Employer)
Form 4: Notification that Partner is intending to take SPL (for Partner’s Employer) / 12 -20

Curtailment of Adoption Leave and Pay and Notification of intention to take SPL

Form 1: Curtailment of Adoption Leave and Pay (for Adopters Employer)
Form 2: Notification that Adopter is intending to take SPL (for Adopters Employer)
Form 3: Notice confirming that Partner is taking SPL but Adopter is not (for Adopters Employer)
Form 4: Notification that Adopters Partner is intending to take SPL (for Partner’s Employer) / 21 - 30

SPL forms for parental order Surrogacy

Form 1: Curtailment of Adoption Leave and Pay (for parental order parent's Employer)
Form 2: Notification that parental order parent is intending to take SPL (for parental order parent’s Employer)
Form 4: Notification that Partner is intending to take SPL (for Partner’s Employer)
Form 3: Notice confirming that Partner is taking SPL but the parental order parent is not (for parental order parent’s Employer) / 31 - 38

Confirmation of entitlement to Shared Parental Leave

/ 39

Notice booking a period of continuous Shared Parental Leave (SPL)

/ 40

Notice booking a period of discontinuous Shared Parental Leave (SPL)

/ 41

Notification of Intention to take Maternity Leave

Date

Line Manager Name

Address

Dear

Re: Notification of Intention to Take Maternity Leave

I am writing to advise you that I am pregnant and intend to take maternity leave.

I intend my maternity leave to start from (inset date)

Yours sincerely

Name

Signature

This letter must be sent to your line manager no later than the 15th week before the estimated week of childbirth

SMP/SAP – Electronic Form

Form ESR6 SMP/SAP via the ‘Electronic Links page on the Trust Intranet

Application Letter for Adoption Leave

Date

Line Manager Name

Address

Dear

Re: Adoption Leave

I would like to apply for adoption leave.

It is expected that the child/children will be placed for adoption on (date). I would therefore like my adoption leave to start from this date (or another date to be stated up to 14 days before the expected date of placement).

I can confirm that I will be the primary carer and therefore will be applying to take the majority /all of the adoption leave and pay.

Yours sincerely

Name

Keeping In Touch (KIT) Days Agreement Form

(For employees on Maternity or Adoption Leave)

Women are allowed to work up to a maximum of 10 days during their maternity leave period without losing Statutory Maternity/Adoption Pay (SMP/SAP). These are known as “Keeping In Touch” (KIT) days and can be taken in small blocks of days or as single days. You will be paid at your basic daily rate for the hours worked, less the appropriate maternity leave payment. KIT days are intended to help you keep in touch with your workplace and could also help ease your eventual return to work.

Personal / Assignment Number ………………………………………………………….…………

Surname…………………………………… Forename……………………………………………...

Directorate ……………………………..…..…… Base ……………………………….……......

Address (for correspondence)......

…………………………………………………………………………………………………………..…

Details of KIT days

(Please complete the table below)

Date of KIT day / No. of hours worked / Reason for KIT day / Signed by Manager

NB: Please be aware that if you work more than 10 KIT days, you will lose one week SMP/SAP for each week or part week that you work under your contract.

Employee’s Signature ………………………………….…Date……………………………....

Manager’s Signature ……………………………………. Date ……………………………....

Please complete this form with your manager, photocopy and send the signed original copy to Victoria Pay Services immediately and retain a copy for your personal file

Shared Parental Leave in Touch Keeping In Touch (KIT) Days Agreement Form

Shared Parental Leave in Touch (SPLIT) Days Agreement Form

(for employees on Shared Parental Leave)

Employees are allowed to work up to a maximum of 20 days during Shared Parental Leave without losing Statutory Shared Parental Pay (ShPP). These are known as “Shared Parental Leave In Touch” (SPLIT) days and can be taken in full days or part of a day. You will be paid at full pay for any SPLIT day worked. If a SPLIT day occurs during a week when you are receiving ShPP, this will effectively be “topped up” so that you receive full pay. SPLIT days are intended to effecta gradual return to work or to trial a possible flexible working pattern.

Personal / Assignment Number ………………………………………………………….…………

Surname…………………………………… Forename……………………………………………...

Directorate ……………………………..…..…… Base ……………………………….……......

Address (for correspondence)......

…………………………………………………………………………………………………………..…

Details of SPLIT days

(Please complete the table below)

Date of SPLIT day / No. of hours worked / Reason for SPLIT day / Signed by Manager

Employee’s Signature ………………………………….…Date ……………………………....

Manager’s Signature …………………………………….Date ……………………………....

Please complete this form with your manager, photocopy and send the signed original copy to Victoria Pay Services immediately and retain a copy for your personal file

Application for Ordinary Paternity / Partner Leave /Pay

Application for Ordinary Paternity / Partner Leave / Pay

(up to 2 weeks’ leave)

Name: ………………………………………………...... … Tel No: .….………………………....

Address: ………………………………………………...... …………………………………...….....

……………………………………………………...………….…… Postcode: ...... ….…………..

Job Title: …………………………....……………...... ………. Contracted Hours: .………….....

Department: …………………………..…………………...... ………………………………………

Base: ……………………………………………………………...... …….………………………….

Trust Start Date: ……………...... ………….……. NHS Start Date: …………..….…………….....

Your dates for pay and leave

The baby is due to be born / or adoptive child due for placement on:

..………...……………………………………………………………….…………………………......

I would like my ordinary paternity / partner leave to start on: ......

(must be completed within 56 days of the date of birth / placement)

I wish to be away from work one/two* weeks (*delete as appropriate)

Your declaration

Signature………………………….………………………………………....

National Insurance (NI) Number…………………..………………………………......

Name of Manager...... ……………………..………………………………………

Manager’s Signature...... ……………………………………………………………..

You must be able to tick one of the three boxes below to qualify for Occupational Paternity Pay and paternity / partner leave.

Please tick one of the following options:

I declare that I am:

The baby’s biological father

Married or in a civil partnership to the mother

One member of a couple who have jointly adopted a child

The nominated carer or legal guardian with parental responsibility

I have the responsibility for the child’s upbringing.

I will be taking time off work to support the mother or care for the child.

Signature ………………………………………………. Date ……...... ……………

Please note: A “partner” is a person, whether of a different sex or the same sex, who lives with the mother and the child in an enduring family relationship but is not a relative of the mother. A “relative” for these purposes includes the mother’s parents, grandparents, sisters, brothers, aunts or uncles.

This form must be sent to Victoria Pay Services no later than 28 days before the chosen start date, or within 7 days of being matched with the child.

Risk Assessment form for New & Expectant Mothers

New Mother – has given birth within the previous 6 months

and/or is breastfeeding

Directorate:………………………………………………………….
Site:………………………………………………………………………………
Ward/ Department:……………………………………………………………………………………………………………
Name of Employee:………………………………………………………………………………………………………………
Job Title:…………………………………………………………
Hours Worked:…………………………………………………………
Manager:…………………………………………………………
This form should be completed in conjunction with Guidance on the Completion of a Risk Assessment
(Available from the Risk Department)
5 STEPS TO RISK ASSESSMENT

Identify the Hazards
Assess the Risks identified
Evaluate the Risk- prioritise
Record findings and action to be taken

5. Monitor to ensure it works
The following should be taken into account when identifying Hazards:
Aspects of Pregnancy:

Morning Sickness
Backache
Varicose Veins
Haemorrhoids
Frequent visits to the toilet
Increasing size of employee
Tiredness
Balance
Comfort
Dexterity, agility, co-ordination, speed of movement, reach may be impaired because of increasing size

/ Factors in Work:

Early shift work
Exposure to nauseating smells
Standing/ manual handling/ posture
Standing/ sitting
Working in hot conditions
Difficulty in leaving job/site of work
Use of protective clothing
Work in confined areas
Manual handling
Overtime
Evening work/ night work
Problems of working on slippery, wet surfaces
Problems of working in tightly fitting workspaces
Exposure to dangerous chemicals
Risk of physical assault

RISK ASSESSMENT

HAZARD (Potential to cause harm)

e.g.: Steps used in job / 2. RISKS (likelihood of harm occurring)
e.g.: used regularly
3. EVALUATE (Safe/Not Safe)
e.g.: Employee may fall / 4. ACTION TAKEN (Record findings)
e.g.: advised not to undertake task requiring steps
5. REVIEW DATES (At Managers Discretion)
Risk Assessment undertaken by:
Print Name: …………………………………………………………………….
Signature:………………………………………………………………
Date:………………./………./……………. / Discussed with employee:
Print Name:………………………………………………………………………….
Signature:…………………………………………………………………
Date:………………/………./………………..

* Please retain this form on employees Personal File

Curtailment of Maternity Leave / Pay and Notification of intention to take SPL

Form 1: Curtailment of Maternity Leave and Pay (for Mother's Employer)

SECTION A: General (must be completed)
Please accept this as my notice to curtail my maternity leave and/or SMP. This form is accompanied by notification that either I intend to take SPL and/or ShPP or that my partner intends to take SPL and/or ShPP. I understand that my maternity leave will end on the date given in Section B and that my SMP will end on the date given in Section C. I understand that I can only reinstate my maternity leave if I revoke this notice before the curtailment date given in Section B. I understand that if I am eligible for myself or my partner to opt into SPL and ShPP I can only reinstate my SMP if I revoke this notice before the end date given in Section C.
Mother’s surname
Mother’s first name(s)
Child’s expected date of birth
Actual date of child’s birth (if born)
SECTION B: Curtailing maternity leave (must be completed)
Date maternity leave started/is intended to start
Date maternity leave will come to an end
Total number of weeks of statutory maternity leave that will have been taken at the date that statutory maternity leave ends
SECTION C: Curtailing maternity pay (only complete if claiming ShPP)
Date SMP started/is intended to start
Date SMP will come to an end
Total number of weeks of SMP that will have been paid at the date that SMP ends
SECTION D: Signature (must be completed)
Signature of mother
Date signed

Form 2: Notification that Mother is intending to take SPL (for Mother’s Employer)

SECTION A: General (must be completed)
Please accept this as notification that I (the mother) am entitled to and intend to take SPL (and ShPP if section C is completed).
Mother’s Surname
Mother’s First name(s)
Partner’s surname
Partner’s first name(s)
Partner’s Address
Partner’s National Insurance number (State ‘none’ if no number is held)
Child’s expected date of birth
Actual date of child’s birth (if child not yet born I will provide this information as soon as reasonably practicable following birth and before I take any SPL)
SECTION B: Maternity entitlement details (all answers that apply must be completed)
Date mother started (or intends to start) statutory maternity leave
Date mother’s statutory maternity leave ended (or will end)
Total number of weeks of statutory maternity leave that will have been taken at the date that statutory maternity leave ends
Date mother started (or intends to start) SMP or MA
Date mother’s SMP or MA ended (or will end)
Total number of weeks SMP or MA has been paidor will have been paid at date of curtailment
Total number of weeks by which SMP or MA will be reduced (i.e. 39 weeks minus total number of weeks SMP or MA has been paid or will have been paid at date of curtailment)
SECTION C: Amount of SPL available (must be completed)
Total number of weeks of SPL created (52 weeks less total number of maternity weeks taken and any SPL from a previous notice and revocation)
Total number of weeks of SPL I (the mother) intend to take
Total number of weeks of SPL my partner intends to take
SECTION D: Indication of Mother’s leave intentions (must be completed but is not binding)
I (the mother) currently expect to take SPL as follows:
Note: It will usually be helpful to answer this in a “From… To…” format
SECTION E: Amount of ShPP available (only complete if claiming ShPP)
Total number of weeks of ShPP created (39 weeks less total number of SMP taken and any ShPP paid from a previous notice and revocation)
Total number of weeks of ShPP I (the mother) intend to take:
Total number of weeks of ShPP my partner intends to take:
I (the mother) currently expect to take ShPP as follows:
Note: It will usually be helpful to answer this in a “From… To…” format
SECTION F: Mother's declaration (must be completed)
The following points apply in all circumstances where a mother is entitled to maternity leave:

I am giving notice that I am entitled to and intend to take SPL
I have, or will have, been continuously employed for 26 weeks at the end of the 15th week before the week in which the child is due
I will remain employed with this employer until any period of SPL that I intend to take
I had (or will have) the main responsibility for the care of the child at the time of the child’s birth (along with my partner who has made the declaration below)
I am entitled to maternity leave, my maternity leave period is reduced and the remaining weeks are now available as SPL
I will inform my employer immediately if I am no longer caring for my child
I will give my employer a copy of my child’s birth certificate or a declaration of the date and place of the birth where no certificate is available if my employer asks for this within 14 days of the date of this notice
I will give my employer the name and address of my partner’s employer or a declaration that they do not have an employer if my employer asks for this within 14 days of the date of this notice
I (or my partner) have given a period of SPL notice
The information provided in this declaration is accurate and meets the notification requirements for SPL

The following points only apply if Section E has been completed:

I am giving notice that I am entitled to and intend to take ShPP
I have been (or will be) paid at least the Lower Earnings Limit in the 8 weeks leading up to the end of the 15th week before the expected week of childbirth
I am entitled to SMP in respect of the birth of our child, my maternity pay period is reduced and the period that remains is available as ShPP
I will be absent from work in each week in which I will be paid ShPP and I will be on SPL in those weeks (if entitled to SPL)
I intend to care for my child in the weeks I receive ShPP
I will remain employed with this employer until before the date of my first period of ShPP
I will immediately inform the person who will be paying ShPP if I revoke the curtailment of my SMP or MA
The information provided in this declaration is accurate

Signature of mother
Date mother signed
SECTION G: Partner’s declaration (must be completed)

I am the father of the child, or at the date of the birth I was/will be the mother’s spouse, the mother’s civil partner and/or the mother’s partner living with her and the child in an enduring relationship
I had (or will have) the main responsibility for the care of our child at the time of the birth (along with the child’s mother)
I have been (or will have been) employed or self-employed in England, Scotland or Wales in 26 weeks of the 66 weeks before the expected week of birth
I have (or will have) earned in total at least £390 in 13 weeks of the 66 weeks before the expected week of childbirth
I consent to the amount of SPL which the mother intends to take, as set out in Section D above.
I consent to the mother’s employer processing the information I have provided
I consent to the amount of ShPP which the mother intends to take, as set out in Section E above.
The information provided in this declaration is accurate

Signature of partner
Date partner signed

Form3: Notice confirming that Partner is taking SPL but mother is not (for Mother’s Employer)

SECTION A: General (must be completed)
Please accept this as notification that I (the mother) do not intend to take SPL (or ShPP where relevant) but that my partner will be.
Mother’s surname
Mother’s first name(s)
SECTION B: Confirmation

I am either not entitled to SPL (or ShPP where relevant), or I do not intend to take SPL (or claim ShPP where relevant)
I declare that my partner has given a notice to their employer to take SPL and/or ShPP.
I consent to my partner’s intended claim for SPL and/or ShPP.

SECTION C: Signature (must be completed)
Signature of mother
Date signed

Form4: Notification that Partner is intending to take SPL (for Partner’s Employer)