Self Certification Form

Self Certification Form PDF – Overview

Self Certification Form
Self Certification Form is an official statement that you make about yourself, especially in connection with illness. You may self-certify your absence for the first seven days.

Self Certification Form

In these few simple steps you can fill your Self Certification Form

• First you have to fill the Information about yourself.
  Your Name
  Your Employee Number
  Business/Function
  Your Job Title
• Absence Details
  The reason for your absence from work
  Tick the best describes the reason for your absence from work
  Illness
  Accident which occurred whilst working for The Co-operative Group
  Accident which occurred during other employment
  Accident which occurred outside of work
  Other
• Full detailed reason of your Absence
• Did you consult a doctor or other medical practitioner?
• Are you fit to return to your normal duties?
• Was your absence pregnancy-related?
• Absence dates     From__/__/__to__/__/__
• Start time / Time sent home
• First day of illness (if not the same day)
• Number of working days absent
• About your Absence Notification
  Did you notify your manager on the first day of your absence?
  Time and date you notified your manager
  If your absence exceeded 7 consecutive days, have you provided a Fit Note?
• Authorisation
  Your Signature and Date

Download Self Certification Form PDF from assets.ctfassets.net using the direct download link given below.