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Absence Form
Your Name
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Absence Type
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Sickness - Return to work
Special Leave
Unpaid Leave
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Sickness Details
Reason
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Musculo-skeletal: Back & neck
Other Musculo: legs, arms
Eyes, ears, nose, dental
Chest, respiratory
Heart, blood pressure
Infectious: cold, flu
Headache, migraine
Stress, anxiety
Genito-urinary, menstrural problems
Stomach, vomiting, diarrhoea
Other
I confirm I am fit to return to work and this is a true and accurate statement
I understand I must speak my line manager to confirm my return as soon as I return to school
I understand that failure to speak to a senior leader on my return could lead to disciplinary action
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Leave Details
Reason
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Doc/Hos App
Funeral/Bereavement
Childcare
Maternity related
Religious Leave
Other
More Information (Required)
I have spoken to my line manager regarding this request before filling out this form
Cover Status
No cover needed
I need cover for
Duties Needing Cover
Before school duty
Morning break duty
Lunch duty
Afternoon play duty
After school club
Trip
Swimming
Meeting
Class cover
General event
1-1 with child
Other:
Notes:
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Dates & Times
First Day
Last Day
Duration
Full Day
Half Day
Time Out
Time Return
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Review & Confirm
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Request Submitted
Thank you. Your absence request has been successfully recorded.
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