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A Sick Pay Form is an official document Dutch employees submit to request and track their paid sick leave under the Ziektewet (Sickness Benefits Act). It records essential details about your illness, expected recovery time, and any medical appointments - helping both employers and employees manage sickness absence properly.

Once completed, this form triggers the Dutch mandatory sick pay process, where employers must continue paying at least 70% of wages for up to two years. It also helps track doctor's notes, workplace adjustments, and return-to-work plans, ensuring compliance with Dutch labor laws while protecting employee privacy rights regarding medical information.

Submit a Sick Pay Form immediately when illness prevents you from working in the Netherlands - ideally on your first sick day. Dutch law requires notifying your employer promptly about any sickness absence, and this form starts the official documentation process. Use it for both short-term illnesses like flu and longer-term health conditions.

The form becomes especially important when your illness extends beyond a week, as it helps track your eligibility for continued wage payments under Dutch sick leave laws. Fill it out for every new illness episode, even if you've used it before. This creates a clear record for both HR departments and medical professionals monitoring your recovery.

• Basic Return-to-Work Form: Standard version used for simple illness cases, focusing on basic absence details and expected return date
• Extended Medical Form: Detailed version for complex or chronic conditions, including space for medical provider information and treatment plans
• Partial Work Capacity Form: Specifically designed for employees who can work reduced hours during recovery
• Occupational Illness Form: Special version for work-related health issues, including additional fields for workplace factors
• Pregnancy-Related Illness Form: Tailored for pregnancy-specific conditions under Dutch maternity leave regulations

• Employees: Must complete and submit the Sick Pay Form when unable to work due to illness, providing accurate details about their condition and expected recovery
• HR Departments: Process and manage these forms, track sick leave patterns, and ensure compliance with Dutch labor laws
• Direct Managers: Review forms, arrange workplace coverage, and coordinate return-to-work planning
• Company Doctors: Assess medical information, validate sick leave claims, and advise on workplace adjustments
• UWV Officials: May review forms when evaluating long-term disability claims or investigating compliance with Dutch social security regulations

• Personal Details: Gather your employee number, department, and direct supervisor's contact information
• Illness Information: Note the first day of illness, symptoms (without medical details), and expected duration if known
• Contact Arrangements: Specify how and when you can be reached during sick leave
• Work Commitments: List any urgent tasks or meetings that need reassignment
• Medical Appointments: Include scheduled doctor visits or treatment dates
• Recovery Plan: Note any work modifications needed for gradual return
• Documentation: Attach any relevant medical certificates or doctor's notes

• Employee Information: Full name, employee ID, department, and position as registered with the employer
• Absence Details: First day of illness, expected duration, and any work-from-home possibilities
• Privacy Statement: GDPR-compliant clause about handling medical information
• Contact Protocol: Mandatory communication procedures during sick leave per Dutch law
• Recovery Declaration: Section for indicating return-to-work date and any workplace adjustments
• Employer Obligations: Statement outlining sick pay entitlements under Dutch labor law
• Signatures: Space for both employee and employer representative signatures with dates

A Sick Pay Form is often confused with a Return to Work Form, but they serve distinct purposes in Dutch employment law. While both relate to employee absence management, their timing and focus differ significantly.

• Purpose and Timing: Sick Pay Forms are submitted at the start of illness to initiate sick leave and wage continuation, while Return to Work Forms document the end of sick leave and outline workplace reintegration plans
• Legal Requirements: Sick Pay Forms trigger the employer's obligation to pay 70% of wages during illness, whereas Return to Work Forms focus on workplace adjustments and gradual return arrangements
• Content Focus: Sick Pay Forms detail illness onset and expected duration, while Return to Work Forms specify accommodations, modified duties, and working hour adjustments
• Stakeholder Involvement: Sick Pay Forms primarily involve the employee, HR, and company doctor, while Return to Work Forms also require input from occupational health specialists and direct supervisors