Employee Self-Certification of Short Medical Absence Form

Making employees who call in sick furnish a doctor’s note used to be standard operating procedure for just about any company. Now it’s problematic, especially in Ontario, BC, and other provinces where employment standards laws ban employers from requiring doctors’ notes to verify an employee’s need for sick leave and other short-term medical leave. So, how can employers and their HR directors verify that employees who call in sick are really sick without a doctor’s note?  One option to consider is self-certification of short medical absences. Strategy: Adopt an HR policy that requires employees who miss 3 or fewer days of work to complete a written form listing the reasons for the absence and certifying that those listed reasons are true either via email during the absence or in hardcopy on the day they return. Here’s a template Self-Certification form that you can adapt for your own circumstances.  

 Employee Self-Certification Form

Instructions: While verifying medical absences is a vital HR function, ABC Company also recognizes that asking employees to obtain a note from a doctor or other health care professional when they miss work due to illness may impose an undue administrative burden on all parties while also discouraging employees from staying home when they’re sick. It may also be impermissible under employment standards laws. The good news is that ABC Company trusts its employees to provide truthful information about the medical absences they take. It is that trust that enables us to comfortably rely on certification by employees themselves rather than their doctors to verify medical absences of a short duration. Accordingly, we ask that you please complete this Self-Certification Form on the first day that you return to work after a medical absence of three days or less.  

Please sign the Form after you complete it and provide a copy to your supervisor. The completed Form will be kept in your personnel file and retained for three years.