Host Organisation Absence Report Other Action Taken Comments

Host Organisation
Absence Report
Please send the completed form to [email protected] by the 6th of the month
Host Trust
or
Please select Trust
Link to Annual Leave Policy
09 March 2016
Link to Sickness Leave and Attendance Management Policy
Return to Work Interviews must be completed
for each occurrence of absence and the
completed form needs to be submitted to the
email address above.
OR
We're here to help.
Should you wish to discuss
Absence Procedures or need
advice, please contact
the Absence Team on
0161 604 5847
GP Surgery
If your location is not listed above, please click here:
Please select Month & Year
Select
month
Select
Month
AND
Add me - Location to be added to Absence Form
SelectSelect
Year Year
Completed by
GMC no
Specialty
Grade
Surname
First Name
Absence
Type
Sickness
Reason
Absence
Start Date
Absence
End Date
(DD/MM/YY)
(DD/MM/YY)
Duration Return to work OccHealth
in Days form completed Referral
(Calculated as
Calendar days)
and sent?
needed?
Attendance
Management
required?
Other Action Taken
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Comments