Solemn Declaration
Regarding Absence from Work

RevisedMay 2013

(Must be sent in on the first day of absence)

Name: ______

Civil registration no.: ______

Address: ______

I hereby solemnly declare that I am/was unfit to work

from_____day, ____/____20____

As a result of:(tick off one box)

Sickness

Pregnancy-related sickness

Registered as absent during pregnancy due to working environment conditions

Work-related injury

Child’s 1st or 2nd day of illness

The absence is expected to be of:

Shorter duration

Longer duration

I will be/was:

Confined to bed

Able to get up and move about

I have consulted a doctor:

Yes

No

Date______

Signature

To be filled in by the employer
Yes / No / Work resumed
Prompt notification by telephone
Prompt registration of sickness
Certificate of Absence from the 4th day
Certificateof Absence from the ___ day
Ability Statement

Agreed terms for notification and documentation of sickness, etc.

  1. Notification of absence due to sickness, etc., must be given to the employer at the beginning of standard working hours.The agreed way to give notification of sickness appears from the contract of employment.
  2. A written solemn declaration must be sent the same day as it is requested by the employer.
  3. In case of absence due to sickness lasting more than3 days, the employer reserves the right to require a certificate of absence, which must be sent to the employer immediately (the employer shall pay the expenses related to obtaining the certificate of absence).
  4. In special circumstances, the employer reserves the right to demand a certificate of absence from the 1stday of absence (the employer shall pay the expenses related to obtaining the certificate of absence).
  5. The employer hasthe right to request an ability statementfrom an employee who is registered as sick. The ability statement may replace or be supplementary to the solemn declaration and the certificate of absence. The ability statement may be used in any time during the sickness period and also during periods where the employee is no longer registered as sick but has previously been repeatedly registered as sick.
  6. The employee registered as sick is obligated to give notification that he/she is fit for work as soon as he/she is able to resume work.
  7. Absence of any kind which is not reported to the company promptly in the agreed way entails loss of entitlement to sickness benefits and will be interpreted as a breach of the contract of employment, which may lead to the termination of the employment.

The employer’s telephone number:______

Telephone number to which notification of sickness must be given: ______

Deliberately submitting false information of sickness in this solemn declaration may result in prosecution in accordance with Danish criminal law.

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