Self certification sick form wales 2026

1. Click ‘Get Form’ to open the self certification sick form in the editor.
2. In Part 1, enter your full name, position, address, directorate, department, and employee number. Ensure all details are accurate for proper identification.
3. Move to Part 2 and fill in the period of sickness or injury. Specify the first and last day of absence, including all days unfit for work. If known, provide your expected date of return.
4. Indicate whether you consider the absence work-related and if it relates to a disability as defined by the Equality Act 2010 by selecting 'Yes' or 'No'.
5. Provide a brief reason for your absence. This should not be a medical diagnosis but rather an indication of the nature of your sickness or injury.
6. In the declaration section, confirm that you have not engaged in activities inconsistent with your absence and that you are fit to return to duty. Sign and date this section.
7. Finally, ensure that Part 3 is completed by your manager who will confirm the accuracy of the information provided.

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