Sick leave record template - UK employer checklist

Employee:
Manager:
First day of sickness:
Normal working days affected:
Reason category:
Notification received by:
Notification time:

SSP and evidence
- Confirm whether the employee has been sick for at least one full working day.
- Record average weekly earnings or 80% calculation where relevant.
- Record SSP decision and pay dates.
- Self-certification received for first 7 calendar days where needed.
- Fit note received if absence lasts more than 7 calendar days.
- Record fit note dates and any suggested adjustments.

Return to work
- Return date:
- RTW interview completed:
- Work-related factors discussed:
- Support or adjustments agreed:
- Follow-up date:
- Trigger point or Bradford Factor review needed:

Notes: