Absence Form

Please complete all required fields!

Name(*)

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Email(*)

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Department(*)

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First Date of Absence(*)

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Last Date of Absence(*)

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Date of Return to Work(*)

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Total Time Absent(*)

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Reason for Absence(*)

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Reason for Absence(*)

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If the absence has already taken place, did you obtain prior authorisation to be absent? (*)

Yes

N/A

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Please state who gave you authorisation and on what date(*)

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Data protection

These details will be held in confidence by the company and may be used for the following purposes in compliance with data protection legislation:

ensuring the health, safety and welfare at work of myself and other workers
the avoidance of discrimination on the grounds of disability
maintaining SSP and SMP records
supplying information on accidents where industrial injury benefits may be payable
ensuring the company is able to monitor and deal fairly with attendance and absence issues

Further information on how the company processes personal data and your rights under data protection legislation are set out in the Employee Privacy Notice.

Absence Form - Self-Certification