SCHEDULEXXXIII TSC/MED/2
TEACHERS SERVICE COMMISSION
SICK SHEET
To be completed by the head of institution in respect of a teacher
SECTION 1
To medical officer in charge of …………………………………………………………………….
Name ……………………………………………………………………………………………….
TSC No …………………….………………………………………………………………………
Is sent here with for treatment
…………………………………………………………….………………………………………..
Signature head of institution
Name …………………………………..…………………………. Date …………………………
…………………………………………………………………
Official Stamp
SECTION II
To the head of institution ………………………………………………………………………….
Thereby certify that ……………………………………………………….………….. Is suffering
From ………………………………………………….....… And is able/unable to perform his/her
duties. Admitted to hospital /treated as an outpatient/to attend ………………………………. for
Treatment (delete where not applicable)
Admission /outpatient No…………………………………………………………………………..
Signature …………………………………………………………………………………………..
Name ………………………………………………………………………………………………
Designation ………………………………………………………………………………………...
Official stamp ………………………………………………..……….. Date ……………………
SCHEDULEXXXIII TSC/MED/2
SECTION III
I hereby certify that …………………………………..…….……..has now sufficiently recovered
To resume his/her duties
Number of days off duty …………………………………………………………………………...
Signature ……………………………………………….….………… Date ………………………
………………………………………………………………………………………………………
Designation/officer in-charge
Official stamp of the health institution
INSTRUCTIONS
The sick sheet is to be used in all institutions by all teachers who may wish to get medical
attention .
For each illness , a fresh sheet will be issued and be filled by the head of institution when
completed .
The sick sheet will be signed twice each week by a medical officer in charge and by the head of
institutions except when a teacher is admitted to hospital.
RECORD OF ATTENDANCE AND VISITS
Date Remarks Signature of medical officer
To be signed at least a week by officer in medical charge .
