ABSENCE REPORT

Absence Form

Must be filled out by a Lead officer or member of Supervision and Management Team. Please submit for any absence, call off, or late arrival, even if the absence is approved and the employee is in good standing.
EMPLOYEE NAME *

First NameMiddle NameLast NameSuffix
REPORTING SUPERVISOR*

First NameMiddle NameLast Name
DATE OF REPORT*

MonthDayYear
DateHourMinutesAM/PM Option
DATE OF INCIDENT*

DayMonthYear
Date
WORK SITE*
ADDRESS AND/OR CLIENT DETAILS *
Nature of absence - (Mark all that apply) (UA = Unauthorized)*

Late Arrival, Employee did callLate Arrival, Employee did not call aheadNo call, No ShowClocked out early without approvalEmployee was off site without approvalEmployee did not wait for relief.Call off - within 24 hoursCall off - within 2 hoursCall off - did not provide reasonOther
Scheduled Work Date

MonthDayYear
Date
SCHEDULED SHIFT START

:HourMinutes
ACTUAL START (For billing)

:HourMinutes
SCHEDULED SHIFT END

:HourMinutes
ACTUAL END (For billing)

:HourMinutes
Was the employee contact by supervisors*

YES, by phoneYes, by textEmployee did not answerEmployee did AnswerEmployee was not contacted
Who did the employee notify? (Mark all that apply)

SupervisorManagerClientOffice StaffCoworkerEmployee did not notify anyoneOther
List person contact (REF above)
Is the client aware?*

YESNOUNK
Did you notify billing and payroll?*

YesNoOther
Did the employee's coworkers notify a manager or supervisor of the absence?

YesNoNA - Solo ShiftOther
Details of incident: (Supervisors notes)
Summary of Incident
Should be Empty:

Absence Form