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  • Employee Absenteeism Form

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    Nadou14
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    Mark each characteristic you have noted about the employee with a "x" and include the date. DATES ABSENTEEISM _________________ _____ Repeated unauthorized leave ___________________________ _____ Excessive sick leave ___________________ _____ Frequent long lunches / breaks _________________________________.

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    Mark each characteristic you have noted about the employee with a "x" and include the date. DATES ABSENTEEISM _________________ _____ Repeated unauthorized leave ___________________________ _____ Excessive sick leave ___________________ _____ Frequent long lunches / breaks _________________________________.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    2K views2 pages

    Employee Absenteeism Form

    Uploaded by

    Nadou14
    Mark each characteristic you have noted about the employee with a "x" and include the date. DATES ABSENTEEISM _________________ _____ Repeated unauthorized leave ___________________________ _____ Excessive sick leave ___________________ _____ Frequent long lunches / breaks _________________________________.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    EMPLOYEE ABSENTEEISM REPORT

    EMPLOYEE NAME: ________________________________________


    DEPARTMENT: ____________________________________________
    MANAGER RESPONSIBLE: _______________________________

    Instructions: Mark each characteristic you have noted about the employee with
    a X and include the date.
    DATES ABSENTEEISM

    _________________ _____ Repeated unauthorized leave


    _________________ _____ Excessive sick leave
    _________________ _____ Frequent absences on the same day (friday)
    _________________ _____ Repeated absences
    _________________ _____ Excessive tardiness
    _________________ _____ Frequent long lunches/breaks
    _________________ _____ Leaving work early
    _________________ _____ Frequent unscheduled short term absences
    Details:_________________________________________________
    _________________________________________________________
    DATES WORK-POST ABSENTEEISM

    _________________ _____ Continued absences from post


    _________________ _____ Frequent trips to restroom
    _________________ _____ Long coffee breaks
    _________________ _____ Excessive talking
    _________________ _____ Physical illness on the job
    Details:_________________________________________________
    _________________________________________________________
    DATES ACCIDENT RATE

    _________________ _____ Accidents on the job


    Details:_________________________________________________
    _________________________________________________________

    DATES PROBLEM IN CONCENTRATION

    _________________ _____ Work requires greater effort


    _________________ _____ Jobs take more time
    _________________ _____ Trouble taking direction
    _________________ _____ Trouble learning new routines/procedures
    _________________ _____ Difficulty recalling instructions/details
    _________________ _____ Other significant memory problems
    Details:___________________________________________________
    _________________________________________________________
    DATES IRREGULAR WORK PATTERNS

    _________________ _____ Alternate periods of high/low productivity


    _________________ _____ Productivity impaired after lunch
    Details:___________________________________________________
    _________________________________________________________
    DATES REPORTING TO WORK

    _________________ _____ Coming to work in an inappropriate condition


    _________________ _____ Returning to work in an inappropriate condition
    Details:___________________________________________________
    _________________________________________________________
    ADDITIONAK RELEVANT COMMENT:

    _________________________________________________________
    _________________________________________________________
    _________________________________________________________
    _________________________________________________________
    _________________________________________________________
    _________________________________________________________

    Signature: ______________________________ Date: ____________

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