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Sickness Leave Form Template

Simplify Your Sick Leave Application Process

Feeling unwell and need to take a sick day? This Sickness Leave Form Template helps employees like you efficiently request time off due to illness. With a clear structure, it allows for quick completion and submission to your supervisor, ensuring necessary approvals and seamless payroll processing. Easily communicate your absence, keep track of your sick leave days, and maintain compliance with company policies-all while enjoying a WCAG-aligned design for enhanced accessibility. Start using this interactive template and streamline your sick leave request process effortlessly.

Use this Template (FREE) Live Preview
Full name
Employee ID or number
Department or team
Manager or supervisor name
Work email
First day of absence
Last day of absence
Expected return to work date
Total working days absent
Did you notify your manager about this absence?
Yes
No
Brief reason for sickness (do not include details you prefer not to share)
Is this illness or injury work-related?
Yes
No
Do you have a medical certificate or doctor's note?
Yes
No
How will you provide the certificate if required?
Upload via HR system
Email to HR
Provide paper copy on return
Not applicable
Do you anticipate any workplace adjustments needed on return?
Yes
No
Unsure
Use sick leave balance for this absence?
Yes
No
If sick leave is insufficient, which other leave types may be applied?
Annual leave
Personal leave
Unpaid leave
Time off in lieu
Not applicable
Applicant full name
Date of submission
I confirm the information provided is accurate to the best of my knowledge.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
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Paper art illustration featuring a sickness leave form for FormCreatorAI article.

When to use this form

Use this form when you are unwell and need time away, whether it is a single sick day, a multi-day recovery, or a medical appointment. It also fits contagious symptoms that require isolation or caregiving for a sick child. Submitting it early helps your manager plan coverage and keeps HR records clean. If you are well enough to work remotely, request that option with the Work from home request form. If the absence is not health related, send a Time off request form instead. Running out of paid sick time? A teammate may donate hours through our PTO Donation form. When illness overlaps a planned break, coordinate dates with the Vacation request form.

Must Ask Sickness Leave Questions

  1. What dates and times will you be away from work?

    This pins down the schedule impact so your team can plan coverage and shift swaps. Include start and return dates, partial-day hours, and your time zone.

  2. What is your leave reason category (illness, injury, medical appointment, or caregiving)?

    Categories help HR track policy, benefits, and any compliance rules without exposing private details. Choose the best fit; if you also need to notify a school, use the Leave application form for school form.

  3. Are you able to work remotely during any of this period?

    If yes, list tasks you can handle and the hours you are available. This helps your manager maintain momentum while supporting your recovery.

  4. Will you provide a doctor's note, and by what date?

    Some policies require documentation to approve paid leave and update payroll. Give a target date so approvers know when to expect it.

  5. Who will cover urgent tasks while you are out?

    Naming a backup speeds approval and reduces delays for customers or partners. Share where files live and how to reach your backup for emergencies.

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