Department of Chemical & Materials Engineering
ABSENCE REPORT
Name: ______________________________________________
Type of Absence Dates Absent (hours if applicable)
General Illness ____________________________________
(Attach doctor’s certificate)
Casual Illness ____________________________________
Vacation ____________________________________
Unpaid days ____________________________________
Other (specify) ____________________________________
____________________________________
____________________________________
______________________________
Employee Signature
______________________________
Date
D:\Docstoc\Working\pdf\748ef014-0cb7-4bd1-a92e-376720cb3359.doc