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COVID-19 SICK NOTE Posted on 27 Mar 2020

Dr Ian Czerniewski               Dr Kate Reynolds               Dr Sam Chesser         Dr Laura Harris


Dunchurch Surgery

Dunsmore heath

Dunchurch, Rugby

Warwickshire, CV22 6AP

01788 522448





Name ___________________ _____________________


I have been absent from work from    _ _ / _ _ /2020.


This is because I am following current Government and Public Health advice related to the Covid-19 pandemic.


c  I have symptoms of Covid-19


c  A household contact is symptomatic so I am required to self-isolate for 14 days


c  I am following government advice for high risk patients to self-isolate for 12 weeks as I suffer from:


___________________ _____________________


Signature of employee           ___________________


Date                                        _ _ / _ _ /2020


Due to the current pandemic and consequent pressure on General Practice, the surgery is prioritising the urgent medical needs of our patients and are unable to provide a medical certificate for this absence.


By law employers may use their discretion around the need for medical evidence if an employee is absent from work for more than seven days due to sickness. We would ask you to apply this discretion to help support NHS general practice to provide care for our population.


Should you decide on taking disciplinary action against an employee purely on the grounds of being unable to provide a sickness medical certification relating to Covid-19 we would make it clear in any disciplinary/grievance/tribunal report that under the circumstances we would deem your action to be inappropriate.

 Many thanks for your assistance during this challenging time


The Partners

Dunchurch Surgery

Covid sick note (1).docx