Absence

Name

Place of work

Date of not reporting for your duties

Reason for not reporting for your duties

If you are sick, what are your symptoms?

The date you expect to return to work, or if not known, your best estimate

I confirm that the above information is correct

I confirm that the above information is correct

Name of person completing this form

Date completed

Supervisor

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IMPORTANT: please note you must telephone our office on 01527882050 by no later than 12 NOON if you not able to report for your duties. Do NOT text, WhatsApp or email.

Thank you for your assistance.