Dear Staff Member,

If you are unable to attend work please report the absence to your line manager as soon as possible in line with the normal reporting procedures AND complete the form below.
If you have any questions, call the HR helpline on 01784 88 4330.

Please complete the absence reporting form below and click 'Done'. If you are pregnant, at increased risk or shielding/at very high risk, read the information below.
 
Pregnant Women
Advice for pregnant women link: Coronavirus infection and pregnancy

Increased Risk
You are at increased risk if a) you are aged 70 or older (regardless of medical conditions); b) under 70 with an underlying health condition (i.e. anyone instructed to get a flu jab as an adult each year on medical grounds). Please tick the appropriate box below. Guidance on social distancing for everyone in the UK - GOV.UK

Shielding/Very High Risk
Shielding - You are at very high risk if you fall into this category and are advised to be at home for 12 weeks. People in this group will be contacted by NHS England for further advice. Tick the appropriate box (H or I) below if you fall into this category. Guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from COVID-19 - GOV.UK

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* 1. Employee Name

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* 2. Job Title

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* 3. Division and Ward/Dept.

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* 4. Line Manager’s Name

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* 5. Absence Start Date

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* 6. End Date (if known)

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* 7. Return to Work Date

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* 8. Contact Details (phone & email)

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* 9. Employee Number (if known)

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* 10. Reason for Absence

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* 11. Pregnant Absence (see information above)

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* 12. Increased Risk Absence (see information above)

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* 13. Shielding/I am at very high risk (see information above)

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* 14. If you are at home due to caring responsibilities please tick the appropriate box below

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