Total Work Days Or Shifts Absent (Unless Still Off Work): Days/Shifts

• This form should be completed when a member of staff returns to work after sick leave or, if still on sick leave, whenever a doctor’s certificate is supplied.
• Staff can self-certify absences of seven calendar days or less using this form. From day eight onwards staff must provide a medical certificate from their doctor and every certificate must cover each calendar day of the entire absence period.
• Forms and certificates should be forwarded via the person’s manager or supervisor to your local HR team for the faculty/ department/ division/ school/ institute as soon as possible, retaining a copy for your records.

Total work days or shifts absent (unless still off work): days/shifts

1. What was the type of problem causing the absence?

1. If you think your illness or injury may be related to an activity or incident at work please tick this box and give details here (information provided may be passed to the College’s Occupational Health service):

1. Do you think you will need any adjustments to assist you in undertaking your work yes no, and/or any assistance to evacuate a building in the event of an emergency (e.g. mobility, visual or hearing impairment) emergency? Yes no.

I confirm that the information I have given above is correct

HR use only: medical cert received CID/first day of absence noted on cert cert covers entire absence a/l taken during sickness absence

NB: This side of the form only is to be forwarded to Payroll (i.e. not Return to Work meeting notes)

Return to Work meeting

This checklist is intended as an aide memoire. Not all points will be applicable to short absences. It is good practice to keep a written record of any important issues discussed at a return to work meeting

Recent illness

 Does the person feel fully recovered?

 Does the person require any special assistance or arrangements to evacuate their workplace(s) in the event of an emergency? Refer to Personal Emergency Egress Plan (PEEP) Guidance and Template on the Equality Diversity & Inclusion web pages on drawing up a PEEP even if it is a time limited adjustment.

 Do they have any concerns over resuming normal duties?

• If so, are any temporary alterations to duties needed?

 Does the person think their illness may have been related to an activity or incident at work?

• If yes you should inform the Safety Department and your local HR representative immediately and consider referral for an Occupational Health assessment1,

 Is the person undergoing any treatment/taking medication that may affect them at work?

• If yes review risks & consider referral for Occupational Health advice

Future fitness & well-being

 Does the person have any continuing health problems that might affect attendance or fitness for duties in future?

• If yes, consider referral for an Occupational Health opinion1

 Will the person need time away from work to attend doctor’s appointments etc?

 Does the person have any problems in their work or personal life that might affect attendance or ability to cope with their work

• If yes, remind the person of support available via Confidential Care, the staff counselling & advice service or contact them by telephone on: 0800 085 4764

 Discuss any set patterns of absence (if applicable) and expectations on future attendance

Resuming work

 Update on any workplace developments whilst absent (e.g. changes in procedures, staff, important announcements)

 Discuss handover of work covered by others whilst absent, if appropriate

 Discuss operational impact of absence, including arrangements for dealing with backlogs of correspondence & work tasks

 Discuss any required adjustments e.g. build-up in hours of work and duties (if one has been recommended by Occupational Health/GP)

 Review work plans or performance targets 2

Documentation

 Sickness absence notification form completed

 Doctors certificate supplied (Required for absences of more than 7 calendar days)

 Employee details recorded on reverse of doctor’s certificate (if supplied)

 Sickness absence notification form and certificate sent to HR

 Local absence record or the Availability and Absence Management System (where this has been rolled out to departments)

 Note made in personal file of any significant issues discussed or agreements made

Notes

1. A referral for an Occupational Health fitness assessment should be considered if the member of staff considers their illness may have been caused by work or indicates that they have a continuing medical problem that may affect their fitness for duties, or cause absence again in future or if the manager has concern over fitness to resume work.
2. The Department’s HR Adviser can advise on management of non-health issues or agreements to vary duties etc. to accommodate problems

For further guidance see Sickness Absence Policy and Procedure -