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Employee Absenteeism Form

This employee absenteeism report tracks various metrics of an employee's attendance and work performance over time. Managers are instructed to mark dates where they have observed characteristics like repeated unauthorized absences, excessive sick leave, frequent absences on Fridays, excessive tardiness, long breaks, leaving work early, unscheduled short-term absences, continued absences from their work post, frequent trips to the restroom, accidents on the job, problems with concentration, irregular work patterns, and reporting to work in an inappropriate condition. Space is also provided for additional relevant comments.

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3K views2 pages

Employee Absenteeism Form

This employee absenteeism report tracks various metrics of an employee's attendance and work performance over time. Managers are instructed to mark dates where they have observed characteristics like repeated unauthorized absences, excessive sick leave, frequent absences on Fridays, excessive tardiness, long breaks, leaving work early, unscheduled short-term absences, continued absences from their work post, frequent trips to the restroom, accidents on the job, problems with concentration, irregular work patterns, and reporting to work in an inappropriate condition. Space is also provided for additional relevant comments.

Uploaded by

Nadou14
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

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: ____________

EMPLOYEE ABSENTEEISM REPORT EMPLOYEE NAME: ________________________________________ DEPARTMENT: _______________
_________________ _____ Work requires greater effort _________________ _____ Jobs take more time _________________ _____

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