Self certification form wales 2026

1. Click ‘Get Form’ to open the self certification form in the editor.
2. Begin by filling out Part 1, entering your full name, job title, home address, department, location, and employee number. Ensure all fields are completed accurately.
3. Proceed to Part 2. Indicate the first day of sickness or injury and provide a brief reason for your absence. Remember, this is not a medical diagnosis.
4. Answer the questions regarding medical advice and whether the absence is work-related. Be honest in your responses about any incident forms or disability status.
5. Fill in the last day of sickness and the date you plan to return to work.
6. In the declaration section, confirm that you have not engaged in activities inconsistent with your absence and sign with the date.
7. If applicable, ensure that Part 3 is completed by your manager for verification.

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