Sickness Reporting Form
Completed forms should be passed to the School Business Manager and will be held confidentially in the Absence File.
Full name of Employee ……………………………………………………………………………………………………………………………… Job Title …………………………………………………………………………………………………………………………………………………… Absence reported at …………………………………………… (time) on ………………………………………………………. (date) Reason for absence …………………………………………………………………………………………........................................... …………………………………………………………………………………………………………………………………………………………………. First day of absence ………………………………… Date of anticipated return (if known) …………………………………… Is a Medical Certificate going to be provided? YES/NO Was the absence a result of an injury at work or work related accident/illness? YES/NO For expectant mothers is the absence pregnancy related? YES/NO
Signature ………………………………………………………………………………………………………. Name …………………………………………………………………………………………….... Date ……………………………………………
Sickness Reporting Form
Completed forms should be passed to the School Business Manager and will be held confidentially in the Absence File.
Full name of Employee ……………………………………………………………………………………………………………………………… Job Title …………………………………………………………………………………………………………………………………………………… Absence reported at …………………………………………… (time) on ………………………………………………………. (date) Reason for absence …………………………………………………………………………………………........................................... …………………………………………………………………………………………………………………………………………………………………. First day of absence ………………………………… Date of anticipated return (if known) …………………………………… Is a Medical Certificate going to be provided? YES/NO Was the absence a result of an injury at work or work related accident/illness? YES/NO For expectant mothers is the absence pregnancy related? YES/NO
Signature ………………………………………………………………………………………………………. Name …………………………………………………………………………………………….... Date ……………………………………………