Get Application Form Temporary Incapacity Leave Long Period Pdf

Filling out the Application Form for Temporary Incapacity Leave can be an important step in managing your leave. This guide provides a clear, structured approach to completing the form online, ensuring that you provide all required information accurately.

Follow the steps to complete the online application form successfully.

1. Press the ‘Get Form’ button to access the application form and launch it in your editor.
2. Fill out Part A, which includes your personal details such as your surname, first names, date of birth, ID number, PERSAL number, gender, shift worker status, and whether you are a casual employee. Additionally, provide your address during your absence and contact numbers.
3. Indicate the period of absence by specifying the start and end dates.
4. Attach the necessary medical evidence by ticking the appropriate boxes in the checklist, including the compulsory medical certificate.
5. Review the declaration section, confirming that all provided information is true and that you understand the implications of any inaccuracies.
6. Sign and date the declaration to complete Part A.
7. Proceed to Part B and fill out the consent form, authorizing your medical records to be shared with the employer and Health Risk Manager.
8. Complete the consent for medical examination, confirming your understanding and acceptance of potential evaluations required by the employer.
9. If you refuse consent, fill out the refusal section and provide your signature.
10. Parts C to F will be completed by authorized personnel. Ensure that your form is submitted with all the required documentation before the necessary deadlines.
11. Finally, save the changes, download a copy of the form for your records, and/or print it for submission.

Begin your application process by filling out the form online today.