Employee Illness Record Sheet

You are required to fill out the following details after every bout of illness which requires you not being able to fulfil your stipulated hours. If you have obtained a doctors record of sick note during your illness please give it to Lesley Smith/Ronald Kirk. All forms and queries regarding sickness must be given to Lesley Smith/Ronald Kirk.

Staff Name (required)

I was absent from work on the following dates. Where illness is not stipulated by GP, briefly describe your symptoms.

Day 1

Date (required)

Reason for Absence (required)

Day 2

Date

Reason for Absence

Day 3

Date

Reason for Absence

Day 4

Date

Reason for Absence

Day 5

Date

Reason for Absence

Signature

Please write your signature in the box below