Unplanned Absence
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Absence Days
this year
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Rolling 12-Month Tally
days lost
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Working Pattern
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Are you sure you want to cancel this absence record? This cannot be undone.
Employee:
This questionnaire must be completed following an employee's return from unplanned medical absence. Certain sections will only be displayed based on selected responses.
Persistent short-term (5 in 12 months) / Same medical reason trigger (3 in 3 months)
Please type "I agree" below to acknowledge that the information provided is a true reflection of the Return-to-Work discussion. *
Employee: