Model documents

 
 

Sickness and sick pay

Downloadable model documents relating to sickness and sick pay.
Word

Contract clause on discretionary sick pay entitlement

  (124K)
Last Modified: 06/02/2012
Use this contract clause to explain that an employee may be entitled to discretionary sick pay.
 
 
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This contract clause states that an employee may be entitled to discretionary sick pay, giving conditions for this and circumstances under which it may need to be repaid.

 
 
 
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Word

Fit note record

  (130K)
Last Modified: 06/02/2012
Record of review meetings with employee following receipt of fit note.
 
 
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Use this form to record the outcome of review meetings with an employee following receipt of fit note from GP.

 
 
 
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Word

Fit note return to work timetable

  (131K)
Last Modified: 06/02/2012
Use this timetable to set out a phased return to work for an employee.
 
 
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Use this timetable when a GP has recommended a phased return to work for an employee.

 
 
 
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Word

Form declaring fitness for work

  (141K)
Last Modified: 06/02/2012
Use this form for employees to declare their fitness to return to work after sickness absence.
 
 
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This form is for employees to declare their fitness to return to work following sickness absence, including any advice or recommendations from their doctor.

 
 
 
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Word
 
 
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This form is for an employee to give their consent to a medical examination at the Company's expense, including their rights under the Access to Medical Reports Act 1988.

 
 
 
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Word

Form for an employee to give employer access to their medical record

  (134K)
Last Modified: 06/02/2012
Use this form for employees to give their consent for the employer access to a medical report.
 
 
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This form is for an employee to give their consent for the employer to have access to a medical report, and includes their rights under the Access to Medical Reports Act 1988.

 
 
 
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Word

Form for return to work interview following sickness

  (135K)
Last Modified: 06/02/2012
Use this form to record the interview of an employee on return to work following sickness absence.
 
 
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This form is to record the interview of an employee by their manager on their return to work following a period of sickness absence, and to record whether or not this absence is authorised.

 
 
 
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Word

Form for self-certifying sickness absence

  (138K)
Last Modified: 06/02/2012
Use this form for employees to self-certify sickness absence of less than seven days.
 
 
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This form is for employees to self-certify a period of sickness absence of less than seven days, giving details of the sickness and any effects it may have on their work.

 
 
 
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Word

Letter confirming a meeting during long-term absence

  (126K)
Last Modified: 06/02/2012
Send this letter to an employee to confirm a meeting with them during a period of long-term absence.
 
 
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This letter explains the reason for the meeting, the location and what will be discussed at the meeting.

 
 
 
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Word

Letter confirming the situation regarding long-term sickness absence

  (128K)
Last Modified: 06/02/2012
This letter can be sent to an employee following a meeting to discuss long-term absence.
 
 
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This letter can be sent to an employee following a meeting to discuss long-term absence. It covers the details discussed at the meeting and further actions that are planned.

 
 
 
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Word

Letter inviting an employee to attend a meeting on their return to work following a period of sickness absence

  (125K)
Last Modified: 06/02/2012
Use this letter to invite an employee to a meeting on their return after a period of sickness absence.
 
 
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This letter invites an employee to a meeting, on their return to work, to discuss their recent sickness absence and any medical report/recommendations.

 
 
 
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Word

Letter requesting an employee attend a medical examination

  (125K)
Last Modified: 06/02/2012
Use this letter to ask an employee on sickness absence to attend a medical examination.
 
 
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This letter asks an employee on sickness absence to attend a medical examination at the company's expense.

 
 
 
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Word

Letter requesting an employee on sickness absence to indicate an anticipated date of return to work

  (125K)
Last Modified: 06/02/2012
Use this letter to ask an employee on sickness absence for an anticipated date for return to work.
 
 
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This letter is to request an employee on sickness absence to indicate an anticipated return to work date, if such date has been given by their doctor, or whether the absence is likely to be prolonged.

 
 
 
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Word

Letter terminating employment due to long-term sickness absence

  (128K)
Last Modified: 08/02/2012
This letter is used to terminate employment in cases of continued absence from work due to ill health.
 
 
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Where an employee is continually absent due to ill health this letter confirms that their employment is terminated. It refers to meeting(s) held with the employee and that no alternative duties, adjustments or support can be adopted to faciltate a return. The employee is informed that they can appeal.

 
 
 
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Word

Letter to a medical practitioner requesting a medical report on an employee on long-term sick leave

  (128K)
Last Modified: 06/02/2012
Use this letter to request a medical report on an employee with long-term sickness absence.
 
 
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This letter is to ask a doctor to provide a medical report on an employee with long-term sickness absence, asking their opinion of the medical condition, its likely duration and how it will affect the employee.

 
 
 
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Word

Letter to a medical practitioner requesting a medical report on an employee who has persistent short-term sickness absence

  (128K)
Last Modified: 06/02/2012
Use this letter to request a medical report on an employee with persistent short-term sickness absence.
 
 
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This letter is to ask a doctor to provide a medical report on an employee with persistent short-term sickness absence, asking their opinion of the medical condition and how it will affect the employee.

 
 
 
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Word

Letter to an employee requesting permission to apply to a medical practitioner for a medical report

  (125K)
Last Modified: 06/02/2012
Use this letter to request permission from an employee to apply for a medical report.
 
 
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This letter requests permission from an employee to apply to a medical practitioner for a medical report regarding their state of health or medical condition.

 
 
 
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Word

Letter to send to employee following discussions relating to a fit note

  (126K)
Last Modified: 06/02/2012
Send this letter to an employee when their fit note states that they 'may be fit for work'.
 
 
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This letter sets out the agreement between employer and employee regarding a return to work.

 
 
 
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Word

Return to work interview following sickness absence form

  (128K)
Last Modified: 06/02/2012
This form is to be filled in following a return to work interview.
 
 
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The form covers periods of sickness absence in the previous 12 months, key points discussed at the return to work interview, action required and agreed timescales for improvement.

 
 
 
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