Absence Reporting Form
This form is used by staff members to report details of absence and should be completed after calling the relevant manager to inform of absence
Your Name *
Your answer
Have you called a manager to report your absence? (please note, texts & emails or someone calling on your behalf are not permitted unless under extreme circumstances) *
Which manager / team leader did you speak to and at what time? *
Your answer
First Day of Absence (the shift you have called in absent for) *
MM
/
DD
/
YYYY
Reason for absence (please include symptoms and avoid using vague terms such as 'unwell' or 'sick'). *
Your answer
What time did you first become aware that you would be absent for work i.e. if you are vomiting, what time did you first vomit? *
Your answer
Have you contacted a GP (if absence is related to sickness)? *
What was advised by the GP (if medical advice has been sought)? - if not applicable please type N/A below *
Your answer
When is your next rota'd shift? *
MM
/
DD
/
YYYY
When do you expect to return to work? *
Your answer
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