Questionnaire for Sick Pay

First name

Last name

Email

Phone

1. How long have you been employed by the company?

2. Do you have an employment contract?

Yes

No

I’m not sure

3. What are you entitled to receive when you are off sick?

I receive Statutory Sick Pay (SSP)

I receive my full normal contractual pay when I’m off sick.

I’m not sure

4. What are your average monthly earnings?

I earn less than £123 per week.

I earn more than £123 per week

5. What days were you off sick?

6. Did you provide the company with a sick note covering these days?

Yes

No

7. What issue have you had with your sick pay?

I am not sure whether I am being paid the right amount when off sick.

I have not been paid at all whilst off sick.

I have been paid for only a period of time when I was off sick, but there are days missing.

8. Additional information