Absence Report

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Employee Name		Date
Department / Division		Shift
First Date Absent		Expected Return Date
Reason For Absence
IIIness		Use of Personal Day
Vacation		Jury Duty
Family Death		Marriage
Accident on Job		Suspension
Family Leave Act		Leave without Pay
Explanation If necessary
Was Absence
Expected in Advance?		□ Yes □ No
Reported on First Date Absent?		□ Yes □ No
Considered by Supervisor as Excused?		□ Yes □ No
Employee's Signature		Date
Supervisor's Signature		Date
President's Signature		Date