Title Page
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Conducted on
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Prepared by
- Danny
- Lisa
- Marie
- Sam
- Sikander
- Louise
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Agent (format e.g. Jane Doe)
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Dates of absence (from)
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Date of absence (to)
Checklist
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Confirm the reported reason and the type of absence was correct.
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Did you seek medical attention from a GP/Doctor/Nurse?
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Were you prescribed any medication we need to be aware of?
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Is the agent fit to return to work? (Full hours)
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Does the agent need a phased return to work?
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Is there anything the TT2 Ltd. can do to support you?
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If over 7 days has a doctors note been supplied? If not can that be obtained?
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Does this absence affect the agents attendance record? i.e number of sick days in the last year? 8 days in any rolling 12 month period. 3 or more days in 3 months. 3 or more separate absences in 6 months. Patterns of absence (i.e recurring recognizable patterns).
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Did the agent follow the absence reporting process?
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Did the sickness relate to a disability?
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Do you feel the sickness/ absence related to a accident at work. (report to Safety and Assurance Manager)
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Signpost the agent to the sickness and absence policy on the intranet.
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Have agreed actions/timescales been completed?
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Has the staff member been made aware of any changes since their absence.
Sign Off
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Agent
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Team Leader
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Has the form been sent to HR to log on file?