Maternity, Paternity and Adoption Procedure
Introduction Glossary of Terms Documents Maternity Maternity Leave Eligibility Occupational Maternity Pay Return to work after maternity leave Time Off for Antenatal Care Sickness and Maternity Leave Holidays Pension arrangements Options after the birth Protection against unfair dismissal Stillbirth Contact during Maternity Leave Transfer of Maternity Leave Adoption Paternity Ordinary Paternity Leave Eligibility Ordinary Statutory Paternity Pay Additional Paternity Leave Additional Statutory Paternity Pay Parental Leave
Useful Information and Contacts
Introduction
Human Resources have produced the University of Central Lancashire’s Maternity, Paternity, Adoption and Childcare information. It is a practical guide to your rights, services and facilities that are available, with particular reference to what is provided locally and what your entitlements are as an employee.
It is important to state that the information given aims to provide accurate, authoritative information on the subjects it covers. It is offered to readers on the understanding that it is not an authoritative statement of the law, and does not prejudice your statutory rights.
1 Glossary of Terms
AML Additional Maternity Leave
ASPP Additional Statutory Paternity Pay
EDC Expected Date of Childbirth
EWC Expected Week of Childbirth
HR Human Resources
LGPS Local Government Pension Scheme
MA1 Maternity Allowance Application Form
MATB1 Maternity Certificate
MPP Maternity Pay Period
OAP Occupational Adoption Pay
OML Ordinary Maternity Leave
OMP Occupational Maternity Pay
OPL Ordinary Paternity Leave
QW QW Qualifying Week
SAP Statutory Adoption Pay
ShPL Shared Parental Leave
ShPP Shared Parental Leave Pay
SMP Statutory Maternity Pay
SPP Statutory Paternity Pay
TPS Teachers Pension Scheme
USS Universities Superannuation Scheme
2 Forms
Maternity Application Form
Pregnancy Health & Safety Checklist
Notification of intention to transfer maternity/adoption leave form
Adoption leave/pay application form
SC3 – Ordinary Paternity Leave/Ordinary Paternity Pay application form
SC4 – Ordinary Paternity Leave/Ordinary Paternity Pay application - adoption
SC5 – Ordinary Paternity Leave/Ordinary Paternity Pay application – adoption from abroad
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Maternity Leave eligibility
You may be eligible for a range of different types of leave which are described in this guide. You are advised to contact your Human Resources Advisor at the earliest opportunity, in order to ensure that your rights and related matters are fully disclosed and understood. All discussions will be held in complete confidence, but you are asked to make your manager aware of your condition as soon as possible. This is important as he/she has a responsibility to safeguard your health and safety. It will also enable your manager and colleagues to plan ahead and arrange cover for your absence.
If you have not already contacted Human Resources by the end of the 15th week* before your expected week of childbirth then you need to contact your Human Resources Advisor as soon as reasonably possible. (*this is known as the qualifying week).
To be eligible for the University’s Maternity Benefits you must have completed at least 26 weeks continuous service by the end of the qualifying week.
If you have less than 26 weeks continuous service at the qualifying week you will not be entitled to the above, but you will be entitled to 52 weeks unpaid maternity leave (see below), and you may be entitled to state Maternity Allowance. Staff in Human Resources can help you with your claim.
Maternity leave entitlement
All pregnant employees are entitled to take up to 26 weeks' ordinary maternity leave and up to 26 weeks' additional maternity leave, making a total of 52 weeks.
3 The earliest you can start your maternity leave is 11 weeks before your baby is due (unless your child is born prematurely before that date, in which case it will start earlier). Maternity leave will start on whichever date is the earlier of:
the employee's chosen start date; the day after the employee gives birth; or the day after any day on which the employee is absent for a pregnancy-related reason in the four weeks before the expected week of childbirth.
If the employee gives birth before her maternity leave was due to start, she must notify the University in writing of the date of the birth as soon as reasonably practicable.
The law obliges all employees to take a minimum of two weeks of maternity leave immediately after the birth of the child.
Ordinary Maternity Leave
During the period of ordinary maternity leave, the employee's contract of employment continues in force and she is entitled to receive all her contractual benefits, except for salary. In particular, any benefits in kind will continue; contractual annual leave entitlement will continue to accrue; and, where applicable, occupational pension contributions will continue to be made.
Salary will be replaced by statutory maternity pay (SMP) if the employee is eligible to receive it.
Employees are encouraged to take any outstanding annual leave due to them before the commencement of ordinary maternity leave. Employees are reminded that holiday must be taken in the year that it is earned and therefore if the holiday year is due to end during maternity leave, the employee should take the full year's entitlement before starting her maternity leave.
Additional Maternity Leave
Additional maternity leave, if taken, begins on the day after ordinary maternity leave ends.
During the period of additional maternity leave, the employee's contract of employment continues in force and she is entitled to receive all her contractual benefits, except for salary. Any benefits in kind will continue and contractual annual leave entitlement will continue to accrue.
Salary will be replaced by statutory maternity pay for the first 13 weeks of additional maternity leave if the employee is eligible to receive it. The remaining 13 weeks of additional maternity leave are unpaid.
Where applicable, occupational pension contributions will continue to be made during the period when the employee is receiving SMP but not during any period of unpaid additional maternity leave.
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Occupational Maternity Pay (OMP)
If you have worked for the University for 26 consecutive weeks before your qualifying week, you will be entitled to: 4 1. Full pay for the first 13 weeks of your maternity leave. (This includes SMP) 2. 50% of your salary plus the lower rate of SMP for the next 13 weeks of your maternity leave. If half pay and SMP total more than full pay, payments will be scaled down to no more than full pay. 3. Then up to 13 weeks at lower rate SMP only. 4. Then up to 13 weeks unpaid maternity leave.
There are certain rules concerning your eligibility for SMP that must be drawn to your attention. If you: work after the birth for any employer who you were not working for in the 15th week before your expected week of childbirth; or you are in legal custody at any time in your maternity pay period you must tell the University immediately, as you would not then be eligible for SMP. Additionally, if you come back to work at any time when you are receiving SMP, your SMP will stop on the day before you return, (This does not include Keeping In Touch days – see below). If you disagree with any of the University's decisions on SMP, you can apply to your social security office for adjudication, but you can of course contact your HR Advisor who will try to resolve any problems first.
If you do not qualify for OMP, you may be entitled to Maternity Allowance, paid directly by the government. Staff in HR can help you with your claim.
Salary Progression
You will be entitled to receive the normal annual increment on your pay in accordance with your contract of employment to take effect from the normal incremental date.
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Return to Work
If you wish to return to work earlier than agreed, you must give the University at least 8 weeks notice in writing of your new return date.
If you do not continue in employment with the University for three months after your maternity leave for any reason, you may be asked to repay the 13 weeks contractual OMP at half-pay. If you reduce your working hours when you return to work, to avoid any repayment you will need to work longer than three months, pro rata to your reduction in hours, eg if you previously worked full time and return to work on a half time basis, you will need to work for the University for six months to avoid repayment.
If you decide not to return to work after maternity leave, you must give notice of resignation as soon as possible and in accordance with your notice period. If the notice period would expire after maternity leave has ended, the University may require you to return to work for the remainder of the notice period.
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Time off for Antenatal care
You are entitled to paid time off in order to keep appointments for antenatal care, made on the advice of a registered medical practitioner, registered midwife or registered health visitor. Antenatal care includes medical examinations. It may also include other appointments, for example, relaxation classes and parent-craft classes. You may be required to produce evidence of your appointments.
Top 5 Sickness and maternity leave
If you are absent due to a maternity related illness in the 4 weeks before your baby is due, your maternity leave and maternity pay will begin on the day after the first day of your absence.
If you are unable to return to work at the end of your maternity leave due to sickness or injury, the University’s normal arrangements for sickness absence will apply.
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Holidays
You will continue to accrue leave in the normal way during your period of maternity leave. You should note that if your maternity leave is likely to cross two leave years, you are advised to take the majority of the first year’s leave entitlement before the start of your maternity leave, as the normal arrangements for carrying over leave apply. You need to discuss any annual leave entitlements with your line manager. However, if your baby is born during a period of annual leave, maternity pay will commence on the day after your baby was born.
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Pension arrangements
Pension arrangements change from time to time, so you are strongly advised to contact your HR Advisor to discuss your individual situation.
During your maternity leave, pension contributions will be based on the pay you receive.
Once your maternity pay ceases, no further pension contributions will be payable until you return to work. This period of leave will not be included as pensionable service.
Members of the LGPS and USS may elect within 30 days of return from maternity leave to pay contributions to cover the period of no pay. Your contributions will be based on the pay you were receiving immediately before it stopped.
Periods of unpaid leave for members of the TPS are non-pensionable. Staff in the TPS may wish to contact the TPS directly to discuss what options are available to them.
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Options after the birth
You may return to work any time after 2 weeks from the birth of your baby, by giving 8 weeks written notice.
If you take your full entitlement to ordinary maternity leave (up to 26 weeks), you have the right to return to your job, with the same terms and conditions as if you had not been absent. However, if your employment with UCLan is on a fixed term contract, your manager will need to give consideration to the practicality of your return if your fixed term contract expires while you are on maternity leave. Consideration will be given to the reason why the contract is fixed term e.g. whether it is externally funded, to complete a time specific task, to cover for an absent colleague etc.
6 If you take additional maternity leave (up to a further 26 weeks), you have the right to return to your job with the same terms and conditions as if you had not been absent. However, if this is not reasonably practical, you may return to a similar job with terms and conditions which are at least equal to those of your previous job.
You may, by giving proper notification, be able to transfer maternity leave to your partner (see Shared Parental Leave for babies due on or after 5 April 2015,).
If you wish to change your working pattern when you return to work please discuss your plans with your manager as soon as possible. All requests for working part-time or term-time only will be considered carefully. Your manager will try to balance your needs with those of your colleagues and the need to provide a service.
If you wish to consider the possibility of a Career Break, or Job Share, again, please discuss with your manager as soon as possible.
If you decide not to return to work after maternity leave, you must give notice of resignation as soon as possible and in accordance with the terms of your contract of employment. If the notice period would expire after additional paternity leave has ended, the University may require you to return to work for the remainder of the notice period.
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Protection against unfair dismissal
No female member of staff will lose her job because of her pregnancy or for any other reason connected with it.
Arrangements will be made to protect you during your pregnancy if you are carrying out work which may put you and your baby at risk, if your condition makes it impossible to perform the duties of your job safely, or if it would be a contravention of the law to allow you to continue working.
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Stillbirth
In the event that you suffer a miscarriage, or deliver a stillborn baby, after the 25th week of pregnancy, you will be entitled to the full maternity pay and leave entitlements. If you suffer a miscarriage or still birth before the 25th week of pregnancy you will not be able to claim maternity pay or maternity leave.
Your Human Resources Officer is able to offer details for support groups outside of the University, and also provide details of the Staff Counselling Service within the University, if you require.
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Contact during Maternity Leave
Shortly before your maternity leave starts, your manager will discuss the arrangements for you to keep in touch during your leave, should you wish to do so. The University reserves the right in any event to maintain reasonable contact with you from time to time during your maternity leave. This may be to discuss your plans for return to work, to discuss any special arrangements to be made or training to be given to ease your return to work or simply to update you on developments at work during your absence.
Keeping-In-Touch Days
7 Except during the first two weeks after childbirth, you can agree to work for the University (or to attend training) for up to 10 days during either ordinary maternity leave or additional maternity leave without that work bringing your maternity leave to an end and without loss of a week's SMP or any OMP. These are known as "keeping-in-touch" days. Any work carried out on a day shall constitute a day's work for these purposes.
The University has no right to require you to carry out any work, and you have no right to undertake any work, during your maternity leave. Any work undertaken, will be paid at your normal rate of pay. Any keeping-in-touch days worked do not extend the period of maternity leave. Once the keeping-in-touch days have been used up, any further work would result in the loss of a week’s SMP, any OMP and may also bring maternity leave to an end.
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Transfer of Maternity Leave
If you wish to return to work without using your full 52-week entitlement to maternity leave, you may be eligible to transfer up to 50 weeks of your outstanding maternity leave to your spouse, civil partner, partner, or the father of your child. This entitlement is dependent on you having given the University the correct notice of your return to work date (see options after the birth above).
The person to whom you have transferred the outstanding leave would then take this time as Shared Parental Leave (ShPL) which would start as soon as you return to work.
The earliest that ShPL may commence is 2 weeks after the date on which the child is born and it must end no later than 12 months after the date of birth.
If you wish to transfer outstanding maternity leave please inform your HR Advisor. You will be required to complete a declaration confirming the employer details for the person to whom you wish to transfer your maternity leave and giving the University permission to disclose to that employer details of your maternity leave, confirming your relationship to the person to whom you are transferring the leave and confirming that the person to whom you are proposing to transfer your leave is the only person exercising the right to ShPL in respect of your child. You may also be required to submit a signed declaration form to the employer of that person confirming the maternity leave you have taken and your employment details.
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Adoption
Any member of staff who adopts a child as the primary carer will have entitlements to adoption leave and pay, which ‘mirror’ those applying to maternity leave and pay. In the case of adoption “date of birth” will be read as “date of placement”.
In addition, any member of staff who is defined as a ‘dual approved prospective adopter’ and has a child placed with them with a view to them adopting that child may be eligible for adoption leave and pay.
Adopting parents are entitled to paid time off work to attend pre-adoption meetings.
Application for adoption leave and pay should be made in writing as early as possible. Notwithstanding the fact that minimum notice may be given to adoptive parents of a child placement, informal discussion should take place with your HR Advisor at the earliest opportunity.
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8 Paternity
Time off for antenatal care
You are entitled to paid time off in order to accompany your partner on up to two appointments for antenatal care, made on the advice of a registered medical practitioner, registered midwife or registered health visitor. Antenatal care includes medical examinations. It may also include other appointments, for example, relaxation classes and parent- craft classes. You may be required to produce evidence of your appointments.
Statutory paternity leave - eligibility
Any UCLan employee whose wife, civil partner or partner gives birth to a child, or who is the biological father of the child, can take one week’s paternity leave regardless of his or her length of service. This leave must be taken in a single block of a week. The leave does not have to start on the day that the child is born but it cannot be taken before the child is born and it must be taken within eight weeks of the child’s birth.
If you have 26 weeks' continuous service with UCLan by the end of the 15th week before the expected week of childbirth you are entitled to choose between taking either one week’s leave as set out above or two weeks' occupational paternity leave (OPL).
OPL must be taken in a single block of one or two weeks and must be taken between the date on which the child is born and within eight weeks of the child’s expected date of birth. If the child is born early, OPL can start earlier than planned but must still be taken within eight weeks of the date on which the child was originally expected to be born.
OPL can start either from the date the child is born or from a chosen number of days or weeks after that date but if you wish to take OPL or any form of paternity leave you must comply with the notification requirements set out below.
To qualify for any form of paternity leave, you must also have, or expect to have, responsibility for the upbringing of the child and you must be making the request to take paternity leave in order to help care for the child or to support the child’s mother.
Notification of ordinary paternity leave
Where you wish to request Paternity Leave in respect of a birth child, you must give your line manager 15 weeks' written notice of the date on which your partner's baby is due, the length of ordinary paternity leave you wish to take and the date on which you wish the leave to commence.
If you subsequently wish to change the timing of Paternity Leave, you must give 28 days' written notice of the new dates.
To apply please contact your HR Advisor. You must complete and sign a self-certificate (form SC3) declaring that you are entitled to Paternity Leave and statutory paternity pay.
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Statutory paternity pay
Pay during Statutory Paternity leave will be at full pay for the first week, which will include Statutory Paternity Pay (SPP). If a second week of Statutory Paternity leave is taken, and the employee meets the eligibility criteria, it will be 9 paid at full pay. If the employee does not meet the eligibility criteria, it will be paid at a standard rate per week set by the Government, or at a rate equivalent to 90% of the employee's average weekly earnings if this figure is less than the Government’s set weekly rate. However, employees whose average weekly earnings are below the lower earnings limit for national insurance contributions will not be eligible for SPP.
Occupational paternity pay
Pay during Occupational paternity leave will be at full pay for both weeks, this will include Statutory Paternity Pay.
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Shared Parental Leave
Shared Parental Leave applies to eligible parents whose babies are born, or have children placed for adoption with them on or after 5th April 2015.
Further information is available on the Family Leave website and in the Shared Parental Leave Policy
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Rights during paternity leave
During the period of additional paternity leave, your contract of employment continues in force and you are entitled to receive all your contractual benefits, except for salary. In particular, any benefits in kind will continue and contractual annual leave entitlement will continue to accrue.
Salary may be replaced by Additional Statutory Paternity Pay (ASPP) for some of the APL period if you are eligible to receive it. Any remaining period of APL will be unpaid.
If applicable, occupational pension contributions will continue to be made during any period when you are receiving ASPP but not during any period of unpaid APL. Employee contributions will be based on actual pay. Pension arrangements change from time to time, so you are strongly advised to contact your HR Advisor to discuss your individual situation.
You are reminded that holiday must be taken in the year that it is earned and therefore if the holiday year is due to end during your APL, you should take your outstanding entitlement before starting your APL, as the normal arrangements for carry-over of annual leave apply.
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Contact during Shared Parental Leave (for partners)
Shortly before your leave starts, your manager will discuss the arrangements for him/her to keep in touch with you during your leave, should you wish to do so. The University reserves the right in any event to maintain reasonable contact with you from time to time during your leave. This may be to discuss your plans for return to work, to discuss any special arrangements to be made or training to be given to ease your return to work or simply to update you on developments at work during your absence.
Keeping-in-touch days during shared parental leave
10 You can agree to work for the University (or to attend training) for up to 10 days during shared parental leave without that work bringing the period of your ShPL to an end and without loss of a week's ShPP. These are known as "keeping-in-touch" days. Any work carried out on a day shall constitute a day's work for these purposes.
The University has no right to require you to carry out any work, and you have no right to undertake any work, during your additional paternity leave. Any work undertaken, will be paid at your normal rate of pay. Any keeping-in-touch days worked do not extend the period of additional paternity leave. Once the keeping-in-touch days have been used up, any further work would result in the loss of a week’s ShPP and may also bring the ShPP period to an end.
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Returning to work after additional paternity leave
You are expected to return as agreed at the end of your additional paternity leave, unless you notify the University otherwise. If you are unable to attend work at the end of APL due to sickness or injury, the University's normal arrangements for sickness absence will apply.
If you wish to return to work earlier than agreed, you must give the University at least eight weeks' notice in writing.
If you decide not to return to work after APL, you must give notice of resignation as soon as possible and in accordance with the terms of your contract of employment. If the notice period would expire after APL has ended, the University may require you to return to work for the remainder of the notice period.
Rights on and after return to work
On resuming work after OPL you are entitled to return to the same job as you occupied before commencing paternity leave on the same terms and conditions of employment as if you had not been absent.
If you take APL (up to the maximum of 26 weeks), you have the right to return to your job with the same terms and conditions as if you had not been absent. However, if this is not reasonably practicable, you may return to a similar job with terms and conditions which are at least equal to those of your previous job.
Parental Leave
All employees with one year’s continuous service with UCLan are entitled to take a maximum of 18 weeks unpaid leave for each child up to the age of 18. Employees who are adopting a child will also qualify for the leave under the same criteria.
Examples of the way parental leave may be used are:
■to spend more time with the child in early years;
■to accompany a child during a stay in hospital;
■to settle a child into new childcare arrangements;
■to enable a family to spend more time together
The University may ask for reasonable evidence to support a request for parental leave, for example, proof of the child’s age, and proof of employee’s responsibilities towards that child. 11 Leave can be taken in one week blocks to a maximum of 4 weeks per year, with the exception of leave taken for a disabled child, which can be in one day blocks or for longer periods. If an employee wishes to take parental leave they must apply in writing to their line manager (copied to Human Resources) at least 4 weeks prior to the first date of leave and specifying the dates the leave will start and end.
The exception to this is for UCLan employees whose wife, civil partner or partner gives birth to a child, or who is the biological father of the child, who wish to take leave straight after the baby is born or prospective adoptive parents who wish to take leave straight after the child is placed with them for adoption, in this case three months’ notice must be given to the University before the week in which the birth or adoption is expected.
Once arrangements have been agreed between the line manager and employee, the line manager should notify Human Resources and a letter will be issued to the employee within 2 weeks of the decision confirming start and end dates for the parental leave. Human Resources will also notify payroll so that appropriate salary adjustments can be made.
Parental Leave is a statutory right and an application for Parental Leave will not be unreasonably refused. However, leave may be postponed, where necessary, for the needs of the University. Leave can be postponed to an agreed date, or to a suitable future period but will not be postponed for more than six months. In the event of a postponement the University will give notice in writing of the postponement stating the reason for it and specifying suggested dates for the employee to take parental leave. If this means leave is postponed beyond the eighteen year limit, the right to take it still exists.
Useful Information and Contacts
University Contacts: Human Resources, Sizer Building: 01772 892324 Payroll, Sizer House: 01772 892210 Health Centre, Harris Building: 01772 892598 , Pre-School Centre, Hanover Building 01772 892597 Occupational Health Nurse 01772 892336
Pensions Teachers Pensions 0345 6066166 www.teacherspensions.co.uk Your Pension (LGPS) 0300 1236717 www.yourpensionservice.org.uk [email protected] USS (Universities Superannuation Scheme) 0845 068 1110 www.uss.co.uk
Lancashire County Council Welfare Advice Teams Preston & Fylde 01772 533656 Hyndburn, Rossendale & Ribble Valley 08450 530013 Pendle & Burnley 01282 470570 South Ribble & Chorley 01257 517272 Lancaster & Wyre 08450 530013 West Lancashire 01695 51928
Department for Work and Pensions (Job Centre Plus) -845 6088524 www.dwp.gov.uk Child Benefits Central Helpline 0870 155 5540 Working Families Tax Credit 0844 4966511 National Childbirth Trust [email protected]
12 Application for Maternity Leave
When you were given this form, you will have discussed the options available to you surrounding your Maternity Leave with your Human Resources Adviser. Please complete this form in your own time, but don’t hesitate to contact your HR Adviser if you need any more information.
Name: Job Title:
Department / Faculty: Extension:
Expected Due Date:
I intend to commence Maternity Leave on:
At this stage, I do/do not intend to return to work after maternity leave. (Please delete as appropriate).
I do / do not wish to be paid 13 weeks half pay during my maternity leave. I understand that I may be required to repay this if I do not return to work for 3 months (or longer if there is a reduction in hours).
I enclose form MAT B1 Maternity Certificate Yes / No
I enclose form MALeave (Members of Local Government Pension Scheme only) Yes /No
Signed: Date:
13 PREGNANCY HEALTH AND SAFETY CHECKLIST
Please complete this form as soon as you think that you are pregnant.
NAME…………………………………. Job Title…………………………………
Department……………………………. Location…………………………………
Tel No. / Ext…………………………… When is your baby due?………………...
1. Physical job demands
Does the work involve lifting or pushing heavy objects? Yes/No Does the work involve standing or squatting for long periods? Yes/No Does the work involve a lot of walking? Yes/No Does the job involve working at height or climbing steep steps? Yes/No Does the employee need to access areas with limited space? Yes/No Will any tasks become more hazardous as the employee changes shape and size? Yes/No
Does the work involve shift work? Yes/No If so, does it involve working at night? Yes/No
2. Mental job demands
Does the job involve meeting challenging deadlines Yes/No Does the role involve rapidly changing priorities and demands? Yes/No Does the role require a high degree of concentration? Yes/No
3. Working conditions - general
Does the work involve lone working or working in remote locations? Yes/No Does the role involve home working? Yes/No Are toilet facilities easily accessible to the pregnant worker? Yes/No Can the employee take toilet breaks when required? Yes/No Can the employee take rest breaks when needed? Yes/No Can the employee control the pace of their work? Yes/No Are there any risks of violence at work? Yes/No Does any part of the job involve dealing with the public? Yes/No If so, does it involve distressed or disturbed people? Yes/No Does the role involve: - Contact with young children or sick people? Yes/No
-Unpredictable working hours Yes/No
- Dealing with emergencies? Yes/No
Are there any obstacles in corridors or offices that could cause
14 problems for pregnant workers, e.g. in the event of fire? Yes/No
Is there any form of air pollution? Yes/No Is the temperature in the working environment reasonable? Yes/No Is the adequate room for the worker to get into and out of the workstation? Yes/No
Will there be enough room as the pregnancy develops? Yes/No Does the worker have an adjustable seat, with a backrest? Yes/No
4. Specific hazards
Does any part of the job involve the use of chemicals? Yes/No If so, are thee any risks to the employee whilst she is pregnant or a nursing mother? Yes/No
Is there any exposure to vibration? Yes/No Is there any exposure to noise? Yes/No Does the employee wear protective clothing? Yes/No If so, will this present a problem as pregnancy develops? Yes/No Has your Doctor/Midwife given you any advice regarding your pregnancy which affects your ability to work? Yes/No
This checklist is completed to the best of my knowledge.
Signed…………………………………. Date…………………………….
Once you have fully completed this form please pass it to your Line Manager
New and expectant mother risk assessments should be completed by line managers who are competent to take account of all relevant information and who are familiar with the area of work and associated risks posed to the employee. Safety, Health and Environment Advisers are available to assist with the risk assessment process if required.
15 Application for Adoption Leave
When you were given this form, you will have discussed the options available to you surrounding your Adoption Leave with your Human Resources Advisor. Please complete this form in your own time, but don’t hesitate to contact your HR Advisor if you need any more information. Name: Job Title: Department / Faculty: Extension:
I intend to commence Adoption Leave on:
At this stage, I do/do not intend to return to work after adoption leave. (Please delete as appropriate). I do / do not wish to be paid 13 weeks half pay during my adoption leave. I understand that I may be required to repay this if I do not return to work for 3 months (or longer if there is a reduction in hours).
I enclose the Matching Certificate Yes / No
I enclose form MA Leave (Members of Local Government Pension Scheme) Yes/No
Signed: Date:
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