Form wording:
Name of
employee:
[ ]
Job title:
[ ]
Employee's start
date:
[ ]
Department:
[ ]
Name of
employee's manager:
[ ]
Period covered:
[This form
allows for absences to be recorded for a period of up to a year.]
| |
Jan |
Feb |
Mar |
Apr |
May |
Jun |
Jul |
Aug |
Sep |
Oct |
Nov |
Dec |
| 1st |
|
|
|
|
|
|
|
|
|
|
|
|
| 2nd |
|
|
|
|
|
|
|
|
|
|
|
|
| 3rd |
|
|
|
|
|
|
|
|
|
|
|
|
| 4th |
|
|
|
|
|
|
|
|
|
|
|
|
| 5th |
|
|
|
|
|
|
|
|
|
|
|
|
| 6th |
|
|
|
|
|
|
|
|
|
|
|
|
| 7th |
|
|
|
|
|
|
|
|
|
|
|
|
| 8th |
|
|
|
|
|
|
|
|
|
|
|
|
| 9th |
|
|
|
|
|
|
|
|
|
|
|
|
| 10th |
|
|
|
|
|
|
|
|
|
|
|
|
| 11th |
|
|
|
|
|
|
|
|
|
|
|
|
| 12th |
|
|
|
|
|
|
|
|
|
|
|
|
| 13th |
|
|
|
|
|
|
|
|
|
|
|
|
| 14th |
|
|
|
|
|
|
|
|
|
|
|
|
| 15th |
|
|
|
|
|
|
|
|
|
|
|
|
| 16th |
|
|
|
|
|
|
|
|
|
|
|
|
| 17th |
|
|
|
|
|
|
|
|
|
|
|
|
| 18th |
|
|
|
|
|
|
|
|
|
|
|
|
| 19th |
|
|
|
|
|
|
|
|
|
|
|
|
| 20th |
|
|
|
|
|
|
|
|
|
|
|
|
| 21st |
|
|
|
|
|
|
|
|
|
|
|
|
| 22nd |
|
|
|
|
|
|
|
|
|
|
|
|
| 23rd |
|
|
|
|
|
|
|
|
|
|
|
|
| 24th |
|
|
|
|
|
|
|
|
|
|
|
|
| 25th |
|
|
|
|
|
|
|
|
|
|
|
|
| 26th |
|
|
|
|
|
|
|
|
|
|
|
|
| 27th |
|
|
|
|
|
|
|
|
|
|
|
|
| 28th |
|
|
|
|
|
|
|
|
|
|
|
|
| 29th |
|
|
|
|
|
|
|
|
|
|
|
|
| 30th |
|
|
|
|
|
|
|
|
|
|
|
|
| 31st |
|
|
|
|
|
|
|
|
|
|
|
|
Manager's comments:
[ ]
Action taken:
[Details of
action taken in respect of the employee, eg sickness absence review or
warning.]
It is the
Company's policy that any employee whose absences (other than those to which
he/she is entitled by law) have exceeded a reasonable level will be subject to
the Company's incapability/disciplinary procedure.
Codes
Statutory
leave
AH Annual holiday
ML Maternity leave
PL Paternity leave
AL Adoption leave
PR Parental leave
TD Time off for dependants
ANT Time off for antenatal care
PD Time off for public duties
JS Time off for jury service
ER Time off for appointed employee
representatives to carry out consultation
TUD Time off for trade union
representatives to carry out duties or undergo relevant training
TUA Time off for employees to take part
in trade union activities
HS Time off for health and safety
representatives to carry out their functions
PS Time off for pension scheme trustees
to fulfil their functions
DIS Time off to act as another employee's
companion at a disciplinary hearing
GR Time off to act as another employee's
companion at a grievance hearing
SL Time off for study leave (employees
aged 16 to 18 only)
RD Time off for employees under notice
of redundancy to seek new work or arrange training
MS Medical suspension
Sickness
absence
SAF Sickness absence on full pay
SAH Sickness absence on half pay
SSP Absence on statutory sick pay only
SWD Absence on waiting day
SZP Sickness absence on zero pay
(certificated)
SUN Uncertificated sickness absence
Other
SUS Paid suspension for investigatory
purposes
GAR Paid garden leave
CLP Discretionary compassionate leave (paid)
CLU Discretionary compassionate leave (unpaid)
SAB Absence on sabbatical/career break
STU Discretionary study leave
APP Absence for medical, dental, etc
appointments
STR Strike or industrial action (unpaid)
RES Leave for reserve forces training
When to use this document
Use this form to create a comprehensive record
of an employee's absences for all reasons, both statutory and contractual.