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SICKNESS SELF CERTIFICATION

Filled in by the worker, first seven days · Statutory Sick Pay (Medical Evidence) Regulations 1985; Employment Rights Act 2025 sections 10 and 11

Use this for an absence of seven calendar days or fewer. That count includes weekends and days you were not due to work. Nobody should be sending you to a GP for a note inside those seven days, and a doctor may charge you for one you did not need.

Your details

Name: _______________________________________________    National Insurance number: ____________________
Assignment or client site: ____________________________________________________________________
Your telephone number: _______________________________________________

The absence

First day you were unfit for work: ______________    Last day: ______________    Still off: Yes / No
Days you would have worked in that period: ____________________________________________
Date and time you first told us: ______________    Who you told: ____________________________

What was wrong

A general description is enough. You do not have to give a diagnosis, and you do not have to name a condition.

_____________________________________________________________________________________
_____________________________________________________________________________________

Was it caused by an accident at work, or by the work itself?   Yes / No

If yes, tell us separately as well. It may need to go in the accident book, and under RIDDOR it may be reportable. That is our job to sort out, not yours, but we cannot do it if we do not know.

Declaration

I confirm that the information above is true, and that I was unable to work on the days shown because of the sickness described.

Signed: ______________________________________    Date: ______________

What happens next, and what will not happen

• We work out your SSP and pay it with your normal wages, shown as its own line on the payslip so you can see it. It is taxable in the ordinary way.
• If we decide you do not qualify, we must give you form SSP1 explaining why, so you can claim Employment and Support Allowance instead. That form is your right and not a favour, and you should not have to ask twice for it.
• Off for more than seven calendar days? We may ask for a fit note. A fit note can be issued by a GP and also by a nurse, an occupational therapist, a pharmacist or a physiotherapist, so the appointment is usually easier to get than people expect.
• Being ill is not misconduct. We will not end an assignment because you were genuinely sick, and if a client asks us to, we will say no and we will tell you that they asked.
• A pattern is a conversation, not a punishment. If absences are frequent we will talk to you about it, and the first question will be whether something at work is causing it or making it worse.
• If your condition is long term and has a substantial effect on day to day activities, it may be a disability under the Equality Act 2010, and reasonable adjustments have to be considered. You never have to explain a diagnosis to ask for one.

Return it by email to hello@hiringuk.co.uk or hand it to whoever runs the site. Keep a copy. We keep ours for the period in the retention schedule and no longer.

HIRINGUK LTD, company number 17414012. Sickness self certification, version 1.0. Reviewed at least once a year and whenever the law changes. © HIRINGUK LTD. This document is issued under Statutory Sick Pay (Medical Evidence) Regulations 1985; Employment Rights Act 2025 sections 10 and 11.

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