Sickness Absence Form | County Care Berkshire

Sickness Absence Self-Certication Form

If you have been sick, please complete this form

This form will cover a maximum of 7 (seven) days period. Periods longer than 7 (seven) days must be supported by a doctor's Fit Note.

Employee First Name:

Employee Surname:

Email Address:

Telephone:

The first day of absence:

The last day of absence:

Total Number of Absent Days:

Reasons for absence:

Our site uses cookies. For more information, see our cookie policy. Accept cookies and close

Reject cookies Manage settings