Sickness Absence Report Form

This form is for the use of Students' Union Managers to report employee sickness absence to enable the Personnel Office to maintain accurate sickness absence data for auditing purposes.

Employee Name    Department/Section

Date of sickness      

If part of day, time from to

Return/Anticipated date of return to work

Type of absence Please choose Sickness Compassionate Hospital Appointment Doctors Appointment Dental Appointment

If required please enter more specific details in the box below

Absence reported to    Time Notified

The University of Essex Students' Union is registered as a Data Controller under the 1998 Data Protection Act and the personal data supplied on this form will be held in accordance with the requirements of the Act.  The data will be held solely for the purposes of calculating occupational sick pay entitlement and for occupational health monitoring

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