Download and print PDF version HERE or complete and submit online below: Absence Report Employee Name Date of Occurence Absent or Tardy ? Absence Tardy Prior Notice Given? Yes No By Whom: First Date Absent Expected Return Date Reason for Absences Accident off the job Accident on the job Employee Illness Family Illness Death in the Family Floating Holiday Inclement Weather Jury Duty Lack of Work Leave of Absence Medical Appointment Military Leave Personal Day Suspension Transportation Unknown Vacation Day OtherOther Absence is Considered Excused Unexcused PAYROLL ACTION TAKEN radio no label Deduct Pay Make-up Time OtherOther PERSONNEL ACTION Disciplinary Action Taken Yes No OtherOther Comments Report Completed by Completion Date Submit