Self Certification Form

Download Self Certification Form PDF using the direct download link.

Self Certification Form PDF

PDF NameSelf Certification Form
Published/Updated On
No. of Pages2
PDF Size0.15 MB
Source(s) /

Download PDF of Self Certification Form from using the direct download link given at the bottom of this article.

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
    Your Job Title
  • Absence Details
    The reason for your absence from work
    Tick the best describes the reason for your absence from work
    Accident which occurred whilst working for The Co-operative Group
    Accident which occurred during other employment
    Accident which occurred outside of work
  • 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 using the direct download link given below.

Self Certification Form PDF Download Link

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