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Fit Note Request (Ireland)

Fit Note Request (Ireland)

Request for Medical Certificate — Sick Leave Act 2022

[Employer Name]

[Letter Date]

[Employee Name]

[Employee Job Title]

Dear [Employee Name],

REQUEST FOR MEDICAL CERTIFICATE

We write to confirm that you have been absent from work since [Absence Start Date], a total of [Days Absent] working days.

In accordance with our sick leave policy and the Sick Leave Act 2022, you are required to provide a medical certificate from a registered medical practitioner covering your absence to date. Please submit your medical certificate to [HR Contact Name] by [Cert Deadline].

Your sick pay entitlement is governed by: [Sick Pay Policy]. Under the Sick Leave Act 2022, statutory sick pay of 70% of your normal daily wage (up to a maximum of €110 per day) is payable for the statutory number of days per year (increasing to 10 days by 2026), subject to receipt of a valid medical certificate.

We hope you recover quickly. If you have a known return to work date of [Return To Work Date], please confirm this to your line manager at the earliest opportunity.

[Additional Note]

Failure to provide a medical certificate by the deadline above may result in absence being treated as unauthorised, and any sick pay entitlement being withheld pending receipt of certification.

Yours sincerely,

[HR Contact Name]

[Employer Name]

HR Manager / Line Manager

________________

Signature

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What Is a Fit Note Request (Ireland)?

A Fit Note Request in Ireland records an employment request, entitlement, or HR particular and the information the parties need to action it, and is shaped by the Employment Equality Acts 1998-2015.

The legal framework governing the Fit Note Request (Ireland) in Ireland draws on several key statutes and regulatory bodies. Under the Employment Equality Acts 1998-2015, enforced by the Workplace Relations Commission (WRC), parties to this agreement retain rights under the Unfair Dismissals Acts 1977-2015 and the Organisation of Working Time Act 1997. Section 8 of the Unfair Dismissals Act 1977 grants the WRC adjudication officers jurisdiction to hear claims. The Data Protection Act 2018, implementing GDPR in Ireland, governs personal data processed under this agreement. Revenue Commissioners require PAYE/PRSI compliance for all employment arrangements. Parties executing a Fit Note Request (Ireland) in Ireland should confirm the document reflects current Irish law, including any amendments enacted since the original drafting date. The Employment Equality Acts 1998-2015 sets the foundational requirements, while secondary legislation and statutory instruments may impose additional obligations depending on the specific circumstances of the transaction.

When Do You Need a Fit Note Request (Ireland)?

A Fit Note Request is needed whenever parties in Ireland wish to formalize their arrangement regarding employment relationships, workplace rights, and HR administration. There are numerous situations in which this document becomes essential for protecting the interests of all involved parties. In the employment context, you will typically need a Fit Note Request when hiring new employees, when changing the terms of existing employment arrangements, when addressing workplace issues, or when managing the departure of staff members. Employers in Ireland have specific legal obligations regarding employment documentation and record-keeping. You should also consider using a Fit Note Request when there has been a change in circumstances that affects an existing arrangement, when you need to comply with new regulatory requirements, when you wish to update outdated documentation, or when professional advisors recommend formalizing certain aspects of your affairs. In Ireland, maintaining current and accurate legal documentation is considered established standards and can help prevent costly disputes. It is generally advisable to prepare a Fit Note Request before any issues arise, rather than trying to document terms after a dispute has already begun. Proactive documentation provides clarity and reduces the potential for misunderstandings. If you are unsure whether you need this document for your specific situation in Ireland, consulting with a qualified legal professional can provide guidance tailored to your circumstances. The timing of executing a Fit Note Request is also important. In Ireland, certain documents must be executed before specific actions are taken or within prescribed time periods to be effective. Delaying the preparation of necessary legal documents can result in complications, lost rights, or additional costs. Therefore, it is recommended to prepare this document as early as possible once the need has been identified.

What to Include in Your Fit Note Request (Ireland)

A well-drafted Fit Note Request for use in Ireland should contain several essential elements to confirm it is legally effective and provides adequate protection for all parties. Party Identification: The document should clearly identify all parties involved, including their full legal names, addresses, and relevant identification numbers. For individuals in Ireland, this may include identity card or passport numbers. For companies, registration numbers and registered addresses should be specified. Clear identification prevents disputes about who is bound by the agreement. Recitals and Background: The document should include background information explaining the context and purpose of the arrangement. This helps establish the parties' intentions and can be important in interpreting the terms of the document if any ambiguity arises later. The recitals section provides valuable context for the operative provisions that follow. Operative Terms: The core terms and conditions should be set out clearly and thoroughly. This includes the rights and obligations of each party, any conditions or prerequisites, the duration of the arrangement, and any limitations or restrictions. All key terms should be defined precisely to avoid ambiguity and potential disputes. Payment and Financial Terms: Where applicable, the document should specify any payments, fees, deposits, or other financial considerations. The amounts, currency (EUR), payment schedules, and methods of payment should be clearly stated. Any provisions for late payment, interest charges, or adjustments should also be included. Term and Termination: The document should specify its duration, including the start date, end date or conditions for expiry, and any provisions for renewal or extension. The circumstances under which either party may terminate the arrangement early should be clearly defined, along with any notice requirements and the consequences of termination. Dispute Resolution: The document should include provisions for resolving any disputes that may arise, such as negotiation, mediation, arbitration, or litigation. In Ireland, parties may choose to specify the jurisdiction of Irish courts and the applicable law. Including a clear dispute resolution mechanism can save significant time and expense if disagreements occur. Governing Law and Jurisdiction: The document should specify that it is governed by the laws of Ireland and that disputes shall be subject to the jurisdiction of Irish courts. This is particularly important in cross-border transactions or where parties are based in different jurisdictions. Signatures and Execution: The document must be properly signed by all parties or their authorised representatives. In Ireland, certain documents may need to be witnessed, notarised, or executed as deeds to be legally effective. The date of execution should be clearly recorded, and each party should retain an original signed copy for their records. The forms-legal.com Fit Note Request (Ireland) template covers the mandatory elements under Employment Equality Acts 1998-2015.

Cite this page

Reference this free template in an article, syllabus, or research note:

APA

Forms Legal. (2026). Fit Note Request (Ireland) (Ireland) [Legal document template]. Forms Legal. https://forms-legal.com/ireland/employment/hr-forms/fit-note-request-ireland

MLA

"Fit Note Request (Ireland) (Ireland)." Forms Legal, 2026, https://forms-legal.com/ireland/employment/hr-forms/fit-note-request-ireland.

BibTeX
@misc{formslegal-fit-note-request-ireland,
  author       = {{Forms Legal}},
  title        = {Fit Note Request (Ireland) (Ireland)},
  year         = {2026},
  howpublished = {\url{https://forms-legal.com/ireland/employment/hr-forms/fit-note-request-ireland}},
  note         = {Free legal document template. Based on Employment Equality Acts 1998-2015}
}

Frequently Asked Questions

Based on Employment Equality Acts 1998-2015 — Template last modified June 2026Verify the source →

This template is provided for informational purposes only and does not constitute legal advice. Laws vary by jurisdiction and change over time. Consult a qualified attorney for advice specific to your situation.Full disclaimer

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