Title Page

  • Conducted on

  • Prepared by

  • Agent (format e.g. Jane Doe)

  • Dates of absence (from)

  • Date of absence (to)

Checklist

  • Confirm the reported reason and the type of absence was correct.

  • Did you seek medical attention from a GP/Doctor/Nurse?

  • Were you prescribed any medication we need to be aware of?

  • Is the agent fit to return to work? (Full hours)

  • Does the agent need a phased return to work?

  • Is there anything the TT2 Ltd. can do to support you?

  • If over 7 days has a doctors note been supplied? If not can that be obtained?

  • 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).

  • Did the agent follow the absence reporting process?

  • Did the sickness relate to a disability?

  • Do you feel the sickness/ absence related to a accident at work. (report to Safety and Assurance Manager)

  • Signpost the agent to the sickness and absence policy on the intranet.

  • Have agreed actions/timescales been completed?

  • Has the staff member been made aware of any changes since their absence.

Sign Off

  • Agent

  • Team Leader

  • Has the form been sent to HR to log on file?

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.