SSP - Employee Statement of Sickness

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This form can only be used for the 1st 7 calendar days of a sick absence (i.e. 10th - 16th). Kindly use the table below to correctly complete your self certification:

Covid-19 rules linked to self certs have now ended. All self certs have reverted to a maximum of seven calendar days.

If dates provided exceed this, we will only be able to process for the 1st seven days & you will need to supply medical certification from day 8+ - you will not be notified where you provide certification longer than allowed.

Employee Number - Numbers only NO LETTERS *

Name *

Date of Birth *

	DD/MM/YYYY

SSP - Employee Statement of Sickness

Employee Number - Numbers only NO LETTERS *

Name *

Date of Birth *

National Insurance Number

Contact Telephone Number *

SSP - Employee Statement of Sickness

Employee Number - Numbers only NO LETTERS *

Name *

Date of Birth *

National Insurance Number

Contact Telephone Number *

Brief details of sickness *