DAY ONE FAMILY LEAVE DECLARATION (HR-F027) Contact DAY ONE FAMILY LEAVE DECLARATION Day One Family Leave Declaration (Maternity, Paternity, Adoption, SPL & Neonatal) (HR-F027)SECTION 1: EMPLOYEE BASELINE & LEAVE CATEGORYTitle- Select -MrMrsMissMsMxOtherStaff Member NameStaff_IDOperating Local Authority- Select -HaringeyIslingtonBarnetWaltham ForestCamdenHackneyBrentHarrowRedbridgeNewhamCity of LondonWestminsterTower HamletsBarking and DagenhamHaveringKensington and ChelseaHammersmith and FulhamEalingHillingdonHounslowSouthwarkLambethLewishamGreenwichWandsworthRichmond upon ThamesMertonKingston upon ThamesSuttonBexleyBromleyCroydonOtherDate of DeclarationCategory of Family Leave Requested- Select -Maternity LeavePaternity / Partner LeaveAdoption LeaveShared Parental Leave (SPL)Neonatal Care Leave (Statutory Day-One Right)SECTION 2: KEY DATES, OPERATIONAL TIMELINE & STATUTORY DOCUMENTATIONExpected Week of Childbirth (EWC) / Date of PlacementIntended Start Date of LeavePaternity Block Structure: "Under 2024 regulations, you may take your 2 weeks of statutory paternity leave as a single block or two separate 1-week blocks at any time in the first 52 weeks.- Select -Single 2-Week BlockOne 1-Week BlockTwo 1-Week BlocksEstimated Return Date (If known)Antenatal / Pre-Adoption Appointments- Select -I require time off for statutory appointments and will provide evidence at least 7 days in advance.I do not require specific time off as appointments fall outside my contracted hours.Status of Evidentiary Documents- Select -MATB1 Certificate Attached (Maternity)SC3 Form Attached (Paternity)Matching Certificate Attached (Adoption)Notice of Entitlement Attached (SPL)Medical/Hospital Declaration Attached (Neonatal Leave)Documents not yet issued (Must be provided within 21 days of start date)Payroll Notification- Select -I acknowledge HR will calculate statutory pay based on the 'qualifying period'. If I do not qualify, Mutima Care will issue the correct forms to claim directly from the government.Mandatory Risk Assessment Flag (Maternity)By submitting this form, an automated alert has been sent to the Registered Manager to complete HR-F023Immediate Pre-Assessment Disclosures: Are there any immediate medical restrictions your manager needs to be aware of before the formal risk assessment takes place?- Select -NoneManual HandlingTravel/DrivingInfection RiskChemical RiskWorking HoursExtended Redundancy Protection (2024 Act)- Select -I acknowledge my statutory protection from redundancy processes from today until 18 months after the birth/placement date.Preferred Contact Method During Leave- Select -Personal EmailPhone CallTextDo Not Contact except for statutory updatesKeep In Touch (KIT) Days- Select -I acknowledge I can legally work up to 10 'KIT Days' (or 20 SPLIT days) during my leave by mutual agreement without losing statutory paySECTION 3: FORMAL DECLARATIONS & PROCESSINGOrganisational Updates: Do you wish to be kept informed of internal promotions, training opportunities, or social events while on leave?- Select -YesNoN/AEmployee Declaration- Select -I declare that the information provided is accurate. I understand that I must give at least 8 weeks' written notice if I wish to change my formal return-to-work date.HR / Registered Manager Acknowledgment- Select -Declaration received. Payroll has been alerted for qualifying calculations. Redundancy protection marker applied. For expectant mothers, the HR-F023 Risk Assessment has been scheduled.DateNext Review Date:SUBMIT FORM
