Sick Leave Form for the Netherlands

Sick Leave Form Template for Netherlands

This document serves as an official sick leave notification and documentation form compliant with Dutch labor laws and the Works Councils Act (WOR). It facilitates the proper recording and management of employee sick leave in accordance with Dutch regulations, including the Gatekeeper Improvement Act and GDPR/AVG requirements for handling medical information. The form captures essential information about the illness notification, expected duration, work handover arrangements, and contact agreements while maintaining employee privacy rights. It includes provisions for both short-term and long-term illness scenarios, ensuring proper documentation for both employer and employee protection.

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What is a Sick Leave Form?

The Sick Leave Form is a standardized document designed for use in the Netherlands to comply with Dutch labor laws and regulations regarding employee illness notification and management. This form is essential for properly documenting the start of sick leave, maintaining communication during absence, and ensuring compliance with the Dutch Civil Code and the Gatekeeper Improvement Act. It should be used whenever an employee reports sick and includes crucial information about the illness notification, expected duration, work handover arrangements, and contact agreements. The document helps organizations fulfill their legal obligations while protecting employee privacy rights under GDPR/AVG, particularly regarding the handling of medical information. It serves as a key document in the broader context of Dutch sick leave management, which includes unique features such as the two-year employer payment obligation during illness.

What sections should be included in a Sick Leave Form?

1. Employee Information: Basic details including name, employee ID, department, and contact information during sick leave

2. Illness Report: Date and time of illness notification, first day of absence, and expected duration if known

3. Work-Related Information: Current projects/responsibilities and handover arrangements

4. Contact Agreements: How and when the employee will maintain contact with their manager during sick leave

5. Privacy Statement: Statement about handling personal data in accordance with GDPR/AVG requirements

6. Declaration: Employee confirmation of truthful information and understanding of sick leave procedures

7. Signatures: Space for employee and manager signatures with date

What sections are optional to include in a Sick Leave Form?

1. Work-Related Illness: Additional section to be included if the illness might be work-related, requiring specific documentation for occupational health and safety purposes

2. Partial Work Capability: Section to be included if employee can perform some work duties while recovering

3. Medical Appointment Details: Section for planned medical appointments and treatments, if already known

4. Third Party Liability: Section to be included if the illness/injury was caused by a third party, relevant for insurance purposes

5. International Aspects: Additional section for employees who become ill while working abroad or living across borders

What schedules should be included in a Sick Leave Form?

1. Company Sick Leave Policy: Summary of relevant company policies and procedures regarding sick leave

2. Privacy Notice: Detailed information about how medical data will be processed and protected

3. Return to Work Protocol: Standard procedures for returning to work after illness

4. Contact Information Sheet: List of relevant contact persons (HR, occupational physician, insurance provider)

5. Rights and Obligations: Overview of employee and employer rights and obligations during sick leave

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

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What is a Sick Leave Form?

What sections should be included in a Sick Leave Form?

What sections are optional to include in a Sick Leave Form?

What schedules should be included in a Sick Leave Form?

Authors

Alex Denne

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