Information
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Location
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- Brookmans Park
- Potters Bar
- Hadley Wood
- New Barnet
- Oakleigh Park
- New Southgate
- Alexandra Palace
- Hornsey
- Harringay
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Conducted on
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Managers Name
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Employees Name
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Payroll number
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Job Title
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Date of discussion
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Date sickness commenced
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Date sickness ended
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Date of return to work
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Total days of sickness / absence
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Reason for sickness / absence
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Was correct procedure followed when sickness/absence was reported?
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Has a resumption medical taken place?
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Self certified form completed and received (for upto 7 days)? (If NO, please request that the employee do so immediately)
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Has the period of sickness been confirmed?
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Has a fit note (i.e. for sickness / absence after 7 days) been received)
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Have the implications of the sickness / absence on the business been explained to the employee? if YES please add response to comments
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Has the Managing for Attendance Procedure (MFA) been explained to the employee?
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Has medical advice been sought?
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Has medication been prescribed?
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Has the employee completed a 'Notification of Medication Form' to declare the use of the medications being
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Is there anything that Govia Thameslink Railway GTR or the individual can do to avoid further sickness/absence?
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If relevant, has an accident form been completed?
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Is the sickness / absence related to the individual undertaking / participating in an extreme or dangerous sport?
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Was the employee due to be on Annual Leave whilst off sick?
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Other services required (eg welfare, counselling etc) - please provide details of action that has been taken (or will be taken) and by whom OR how rehabilitation back to work has been agreed
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Employee to sign that information is correct
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Manager (or Team Leader)
