In the event that an employee is unfit to attend work, they must telephone their line manager by 09:00 hrs. On their first day of absence, outlining the reason and indicating if possible when they would be expect to return to work.
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Information
ParkingEye Ltd
Personal Details
Employee's Name:
Department:
Manager's Name:
Conducted on:
Location:
Absence Details
First date of absence
Final date of absence
Total number of days absent:
Please detail the reason for absence choosing from the list of absences:
Allergies, Hay Fever
Anaemia
Anxiety, Depression, Nervous Illness
Asthma
Back, Neck and Spinal disorders
Blood Pressure disorders
Cancer, Chemotherapy
Chest conditions
Cough, Cold,Tonsillitis etc.
Dental disorders
Diabetes
Disability- related conditions
Ear conditions including Vertigo
Epilepsy
Exhaustion, Fatigue
Eye conditions
Face and Mouth disorders
Gynaecological disorders
Head Injury, Concussion
Headache, Migraine
Heart conditions
Hernia
Hospital Visit
Infectious Diseases eg. Measles
Influenza/Swine Flu
Joint pain eg. Arthritis
Kidney and Bladder disorders
Lower limb injury
Operation
Post-operative recovery
Pregnancy-related conditions
Skin conditions
Stomach disorders
Stress-related illness
Upper limb injury
Wounds or Burns
Did you receive medical treatment during your absence?
If yes, please state where and when below
Location:
Please enter time and date:
Is your absence as a result of an occupation injury
Employee's Signature
Please sign to confirm all details above:
ParkingEye Ltd
Self Certification Absence Report
In the event that an employee is unfit to attend work, they must telephone their line manager by 09:00 hrs. On their first day of absence, outlining the reason and indicating if possible when they would be expect to return to work.
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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.
