Absence Form

Please fill out this form for all sickness absence of five calendar days or fewer and any other absence.

For periods of sickness lasting more than five calendar days, please provide a ‘Statement of Fitness for work’ (Fit Note) which has been signed by a doctor or your GP.

This form must be completed on the day you return to work.

Line managers to initial and send to HR.

  • If so, please provide brief details and date of accident, inform the designated person and ensure the accident record book has been updated to include details of this accident.
  • Please list any adjustments that need to be made by us to enable you to return.
  • DD slash MM slash YYYY