Sickness enquiry form

If you have been off sick and need advice, please read our sickness advice guide as it if highly likely you will find what you need. Our guide includes information on fit notes, meetings, occupational health and more.

If you have a formal sickness meeting and need advice or support from the RCN, please complete our online form. If you have been invited to an informal meeting or it is your first formal sickness meeting, we may not need to attend.

It is important you give us enough information below so we can advise you appropriately and/or pass your details to the relevant RCN department. Based on the information you provide, we may decide that your local RCN office is best placed to offer support - in which case, they'll contact you directly.

Contact details

Full name: RCN membership number: Address: Best contact number: Where an onward referral is required, we will provide these contact details to your local regional/country office. Do you give us your consent to pass on this information? Yes No Can we leave you a voicemail? Yes No Can we contact you on this matter by email? Yes No If we need to pass your enquiry to your local RCN office or a specialist RCN department, would you like any emails from them to be password protected? Yes No Email address you would like us to reply to Please confirm the email address you would like us to reply to Please list any times that you are unavailable for calls during the next week (9am-5pm):

Employment details

Place of work Employer When did you start working with your current employer? Ward or department Job category Job title Weekly contracted hours Do you have any meetings scheduled? Yes No If yes, please give date, time and location: Please give details: Are you already being supported by a rep? Yes No If yes, please include details below: Are you in the UK on a visa? Yes No If yes, please include details below (including how long you have been in the UK):

Sickness

Date when sickness first started: Please give details of your enquiry and include the dates and length of sickness under review: Please give the reason for each period of sickness and if any were caused by your employer or due to a disability:

By submitting this form, you are giving the RCN permission to contact you about your submission.

You can control the information you receive from the RCN by updating your preferences at MyRCN.

We don’t update your contact details unless you ask us to. The best way to check and update the details we hold for you is by visiting MyRCN.

Protecting your privacy is very important to us. Please view our privacy policy to find out more about the information we collect and how it is used.

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