Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Team number.
- W0401
- W0402
- W0403
- W0404
- W0405
- W0406
- W0407
- W0408
- W0409
- W0410
- W0411
- W0412
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Date of first absence
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Date of returning to work
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Enter percentage of overall absence
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Reason for absence
- Gastrointestinal problems
- Cold/ flu/ influenza
- ear/nose/throat
- dental
- epilepsy
- eye problems
- non work inj/burns/fractures/Rta
- non work muskoskeletal
- non work rel back/disc problems
- occupational asthma
- occupational dermatitas
- pregnancy related
- schedule sickness code
- skin problems
- stres,anxiety,dep non work
- stress,anxiety work rel
- swine flu
- unknown cause
- vertigo,dizziness,insomnia
- wk inj,burns,fractures,rta
- work rel muskoskeletal probs
- work rel back,disc probs
- period pains
- headaches/migraines
- heart,bp,circulatory
- infectious diseases
- kidney,bladder problems
- diabetes
- diseases of nervous system
- Alcohol/ drug addictop
- allergy
- asthma(excl work related
- blood disorders
- breast problems
- cancer ,tumors
- chest/respiratory problems
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Supporting information (as applicable) eg doctors note
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Did the person visit doctor whilst absent?
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Is the person on medication as a result of absence?
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Details of discussion at return to work meeting (welcome)
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Employee feedback
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Support / action ( if applicable )
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Occupational health referral ?
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Is the person aware of absence policy/absence policy issued?
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Will this absence trigger an absence hearing?
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Will this absence period be paid?
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Engineers signature
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Managers signature
