Reporting Fit for Duty Form
This form is used by staff members to provide details of absence which will be required for your return to work
Your Name *
Your answer
When you reported yourself as fit for duty, who did you speak to? *
Your answer
What date did you call in reporting that you were fit for duty? *
MM
/
DD
/
YYYY
What time did you call in reporting that you were fit for duty? *
Time
:
First day of absence (when did you first call in absent?) *
MM
/
DD
/
YYYY
What was the reason for absence? (avoid vague comments such as unwell or sick) *
Your answer
Did you call a GP regarding the reason for your absence? (if sickness related) *
If you did contact a GP, what did they advise? *
Your answer
Do you have evidence of contacting GP i.e. appointment card, prescription etc *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy