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Statutory Declaration - Personal/Carers Leave

Version 1.1 Updated 6 Dec 2017
Correspondence Manage

Who can use this form

This form can be used by all employers throughout Australia, except the following excluded employers:

  • In the State of New South Wales
  • Non-constitutional corporation employers in Western Australia;
  • State public sector employers (ie employees of a Minister, the Governor or the Crown); and
  • Local Government employers — except Tasmania.


Employees who are sick or who need to care for family or household members have an entitlement to personal/carer’s leave under the National Employment Standards. However, they must give their employer notice of the taking of personal/carer’s leave.

This notice must be given as soon as practicable, which could be at a time after the period of leave has started. Employees must also advise the employer of the period, or expected period, of the leave.

Importantly, if the employer requires, the employee must provide reasonable evidence of the circumstances leading to them taking leave pursuant to section 107 of the Fair Work Act 2009. The circumstances are that the leave is or was taken:

  • because the employee is not fit for work because of a personal illness or personal injury affecting the employee, or
  • to provide care and support to a member of the employee’s immediate family, or a member of the employee’s household who requires care or support because of a personal illness or personal injury affecting the member, or an unexpected emergency affecting the member.


In appropriate circumstances, the Statutory Declaration — Personal/Carer’s Leave can be completed by employees if they need to provide a statutory declaration in support of the particular absence. 

If an employee is a state public sector or local government employee in the State of New South Wales they will need to complete the New South Wales Statutory Declaration — Personal/Carer’s Leave found on Workplace.


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