Genus Maternity/ Paternity/Adoption Leave Form

Gradual return sickness absence notification form (S.R.2 Form) V1.0 Issued May 2017
When to complete this form:
Part A: / At the start of a period of gradual return to work; typically following a long term, full time absence.
Thisworking pattern will be applied until a separate SR2 is submitted to notify a change.
Part B: / If the gradual return working pattern changes, this working pattern will be applied until another SR2 is submitted to notify of a change
Part C / If annual leave is used to offset against the sick pay
Part D / If a gradual return ends
School details

School name

Work location/address
Employee details

Last Name

First Name

Assignment number that this SR2 relates to

A separate SR2 form,with the same sections completed, should be submitted for each assignmentyou hold for this employee, even where:

A gradual return is not in place for all jobs

Where the employee is able to carry out duties in a full time capacity in their additional job(s) entering their normal contracted working hours/fte%.

/ Optional: For schools’ use only
/

The original ePayroll absence (starting from the first day of the long term absence) should be left open; it must not be closed as the sickness absence does not end until the employee has resumed their full normal working duties.

Part A – Initial gradual return working hours weekly summary
Date the initial gradual return started
Support staff: Total weekly hours worked / HH:MM
Teachers :Total weekly fte% worked / Fte%
Part B – Revision of gradual return working hours weekly summary
Date the gradual return changed
Support staff: Total weekly hours worked / HH:MM
Teachers :Total weekly fte% worked / Fte%
Start date of the revised working hours / From
Part C – Annual leave is being used to offset against the sick pay
Support staff: Holiday hours to be offset against sick pay / HH:MM
Teachers : Holiday hours in fte% to be offset against sick pay / Fte%
Part D – End of the gradual return to work
Date employee returned to work
Confirm whether or not there has been a change to the contractualhours/weeks on return to work that are submitted and approved via ePayroll / Yes / No
Date the full time absence resumed
SR2 Submission
Please complete all relevant form fields and email to:
/ This form is not accepted as a hard copy document /
School authorisation
Authorised by /