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This sample letter is to be used by the employer to request a medical certificate where an employee intends to work within the six week period before the expected date of birth of the child (as provided by the National Employment Standards). The medical certificate needs to be provided within seven days of the request and should contain a statement as to whether the employee is fit for work, and if so, whether there are any risk factors with continuing in their present position.  

The risk factors include any illness or risks arising out of the employee‘s pregnancy, or hazards connected with the employee‘s position.

Members are encouraged to contact the Workplace Advice Line on 1300 55 66 77 for further assistance in determining whether the employee can be directed to commence unpaid parental leave.

Guidance notes and instructions are shown italicised.

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Date Update
15/11/2019 This form has undergone a periodic review. No significant changes have been made.
13/06/2019 This letter has undergone a periodic review. No significant changes have been made.



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