Record of Absence - Self-Certification Form

State:
Multi-State
Control #:
US-457EM
Format:
Word; 
Rich Text
Instant download

About this form

The Record of Absence - Self-Certification Form is designed for employees to formally report periods of absence due to illness. This form is essential for employers to maintain accurate records of employee absences, identify trends, and provide necessary support. Unlike other leave forms, this particular form is specifically tailored for self-certification without the immediate need for a medical certificate for short absences.

Key parts of this document

  • Employee details section for personal information.
  • Specific illness categories to choose from, enabling accurate reporting.
  • Duration of absence specified, determining whether a medical certificate is necessary.
  • Manager and employee confirmation section ensuring proper documentation.
  • Confidentiality statement to protect employee privacy.
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When to use this document

You should use the Record of Absence - Self-Certification Form anytime you experience a sickness absence from work. If your absence lasts for fewer than seven days, this form can be completed upon your return. However, for absences exceeding seven days, the form must be filled out as soon as possible, allowing line managers to have a record of the absence for follow-up and support.

Intended users of this form

  • Employees reporting their own sickness absences.
  • Line managers needing to document and manage absence records.
  • Employers of all sizes looking to comply with attendance tracking requirements.

How to prepare this document

  • Enter personal details, including your full name and contact information.
  • Select the reason for your absence from the provided illness categories.
  • Indicate the start and end dates of your absence.
  • If applicable, acknowledge and sign for confirmation, either personally or through your line manager.
  • Submit the completed form to your manager or HR department as required.

Is notarization required?

In most cases, this form does not require notarization. However, some jurisdictions or signing circumstances might. US Legal Forms offers online notarization powered by Notarize, accessible 24/7 for a quick, remote process.

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Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

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If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

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We protect your documents and personal data by following strict security and privacy standards.

Mistakes to watch out for

  • Failing to complete all required sections of the form.
  • Not submitting the form in a timely manner, especially for long absences.
  • Using vague descriptions for the reason for absence.
  • Neglecting to obtain a medical certificate for absences longer than seven days.

Why use this form online

  • Convenience of downloading and completing the form from anywhere.
  • Editability allows for easy updates and corrections.
  • Reliable format ensures that all necessary information is collected efficiently.

Main things to remember

  • The Record of Absence - Self-Certification Form is essential for documenting employee sickness absence.
  • Use this form for absences under seven days without a medical certificate.
  • Timely completion and submission are critical to ensure compliance with workplace policies.

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FAQ

Many employers have their own self-certification forms. If your employer doesn't have its own form you can download this Self Certification Form (PDF). Please print it, fill it in and hand it in to your employer. You do not need to see a Doctor.

If you're off work sick for 7 days or less, your employer should not ask for medical evidence that you've been ill. Instead they can ask you to confirm that you've been ill. You can do this by filling in a form yourself when you return to work. This is called self-certification.

Many employers have their own self-certification forms. If your employer doesn't have its own form you can download this Self Certification Form (PDF). Please print it, fill it in and hand it in to your employer. You do not need to see a Doctor.

Sickness Certificates Your employer may require you to complete a self-certification form called an SC2 which is available from the HMRC website or you can click on the link below to download a form.

If you can't get form SSP1 or a written statement from your employer, contact HMRC's employees' enquiry line on 0300 200 3500. They'll ask your employer why they think you're not entitled to SSP.

If you are off work for less than seven days, you are responsible for your own self-certification on form SC1 (available from reception or any post office).

Sickness Certificates Your employer may require you to complete a self-certification form called an SC2 which is available from the HMRC website or you can click on the link below to download a form.

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Record of Absence - Self-Certification Form