GMU by xiaoyounan

VIEWS: 3 PAGES: 4

									                                             ABSENCE MONITORING FORM
Indicate absence by putting the number of contracted hours missed each day due to sickness absence.
Use drop down menu in final column to indicate reason for absence. Medical Appointments should be indicated at end of form
                   COMMENTS
                                   SERVICE                                  GMU
                       P/T - F/T
                          or                     MONTH                                                                          Jan 2010
                                                                                                                                                                                                   TOTAL
                       MEDICAL                                                                                                                                                                   WORKING
          NAME       APPOINTMENT         1   2   3   4     5   6   7     8   9   10   11    12   13   14   15   16   17   18     19   20   21   22   23   24   25    26   27   28   29   30   31 DAYS LOST                       Sickness Absence Code

                    PT - MON/WED/THURS               7.5       7.5 7.5                7.5        7.5 7.5                  7.5         7.5 7.5                  7.5        7.5 7.5                   12.2     12 Stomach, liver, kidney and digestion

                    FT                               7.5 7.5 7.5 7.5     7            7.5 7.5 7.5 7.5       7             7.5 7.5 7.5 7.5        7             7.5 7.5 7.5 7.5       7              20.0     9 Other musculo- skeletal problems

                    FT                               7.5 7.5 7.5 7.5     7            7.5 7.5 7.5 7.5       7             7.5 7.5 7.5 7.5        7             7.5 7.5 7.5 7.5       7              20.0     10 Other

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For HR use only                                                                                                                                                                                     52.2


Long Term figure         40.0 >=20


Short Term figure        12.2 <20


Total                52.2
Signature:



Date:
2nd Signature:



Date:
                                            ABSENCE MONITORING FORM
Indicate absence by putting the number of contracted hours missed each day due to sickness absence.
Use drop down menu in final column to indicate reason for absence. Medical Appointments should be indicated at end of form
                   COMMENTS        SERVICE                                  GMU
                       P/T - F/T
                          or                    MONTH                                                                         Feb 2010
                       MEDICAL
          NAME       APPOINTMENT       1    2   3   4     5   6   7   8     9   10   11   12   13   14   15    16   17   18    19   20   21   22    23   24   25   26   27   28   gmu feb                       Sickness Absence Code

                    PT - MON/WED/THUR 7.5       7.5 7.5               7.5       7.5 7.5                  7.5        7.5 7.5                   7.5        7.5 7.5                   12.2     12 Stomach, liver, kidney and digestion

                    FT                7.5 7.5 7.5 7.5     7                                                                                                                         5.0     9 Other musculo- skeletal problems

                    FT                7.5 7.5 7.5 7.5     7           7.5 7.5 7.5 7.5      7             7.5 7.5 7.5 7.5        7             7.5 7.5 7.5 7.5       7              20.0     10 Other

                    FT                                                      3                                                                                                       0.4     12 Stomach, liver, kidney and digestion     `

                    FT                                                                                              7.5 7.5                                                         2.0     9 Other musculo- skeletal problems

                    FT                                                                                                                              7.5 7.5 7.5     7               4.0     10 Other

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For HR use only                                                                                                                                                                    43.6


Long Term figure         32.2 >10


Short Term figure        11.4 <=10


Total                43.6
Signature:



Date:
2nd Signature:



Date:
                                           ABSENCE MONITORING FORM
Indicate absence by putting the number of contracted hours missed each day due to sickness absence.
Use drop down menu in final column to indicate reason for absence. Medical Appointments should be indicated at end of form
                   COMMENTS
                                   SERVICE                                  GMU
                       P/T - F/T
                          or                   MONTH                                                                         Mar 2010
                                                                                                                                                                                                 TOTAL
                       MEDICAL                                                                                                                                                                 WORKING
          NAME       APPOINTMENT     1     2   3   4     5   6   7   8     9   10   11   12   13   14   15    16   17   18    19   20   21   22    23   24   25   26   27   28   29    30   31 DAYS LOST                       Sickness Absence Code

                    FT               7.5       7.5 7.5               7.5       7.5 7.5                  7.5        7.5 7.5                   7.5        7.5 7.5                  7.5        7.5   14.2     12 Stomach, liver, kidney and digestion

                    FT               7.5 7.5 7.5 7.5     7           7.5 7.5 7.5 7.5      7             7.5 7.5 FINISHED                                                                          12.0     10 Other

                    FT               7.5 7.5 7.5 7.5     7           7.5 7.5 7.5 7.5      7             7.5 7.5 7.5 7.5        7             7.5 7.5 7.5 7.5       7             7.5 7.5 7.5      23.0     10 Other

                    FT                                                                                                                             7.5 7.5 7.5     7             7.5 7.5          6.0      2 Chest and Respiratory

                    FT                                                                                                                             7.5 7.5 7.5     7                              4.0      12 Stomach, liver, kidney and digestion

                    FT                                                                                                                       5.3 7.5 7.5 7.5                                      3.8      9 Other musculo- skeletal problems

                    FT                                                                                                                                                                      7.5   1.0      12 Stomach, liver, kidney and digestion

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For HR use only                                                                                                                                                                                   64.0


Long Term figure         23.0 >=20


Short Term figure        41.0 <20


Total                64.0
Signature:



Date:
2nd Signature:



Date:
                                  GMU                                                             GMU                                                             GMU
                                Jan 2010                                                        Feb 2010                                                        Mar 2010
                                             TOTAL                                                           TOTAL                                                           TOTAL
                 Sickness Absence Code     WORKING                               Sickness Absence Code     WORKING                               Sickness Absence Code     WORKING
                                           DAYS LOST                                                       DAYS LOST                                                       DAYS LOST

12 Stomach, liver, kidney and digestion        12.2             12 Stomach, liver, kidney and digestion        12.2             12 Stomach, liver, kidney and digestion        14.2
9 Other musculo- skeletal problems             20.0             9 Other musculo- skeletal problems                 5.0          10 Other                                       12.0
10 Other                                       20.0             10 Other                                       20.0             10 Other                                       23.0
0.0                                                0.0          12 Stomach, liver, kidney and digestion            0.4          2 Chest and Respiratory                            6.0
0.0                                                0.0          9 Other musculo- skeletal problems                 2.0          12 Stomach, liver, kidney and digestion            4.0
0.0                                                0.0          10 Other                                           4.0          9 Other musculo- skeletal problems                 3.8
0.0                                                0.0          0.0                                                0.0          12 Stomach, liver, kidney and digestion            1.0
0.0                                                0.0          0.0                                                0.0          0.0                                                0.0
0.0                                                0.0          0.0                                                0.0          0.0                                                0.0
0.0                                                0.0          0.0                                                0.0          0.0                                                0.0
0.0                                                0.0          0.0                                                0.0          0.0                                                0.0
0.0                                                0.0          0.0                                                0.0          0.0                                                0.0
0.0                                                0.0          0.0                                                0.0          0.0                                                0.0
0.0                                                0.0          0.0                                                0.0          0.0                                                0.0
0.0                                                0.0          0.0                                                0.0          0.0                                                0.0
0.0                                                0.0          0.0                                                0.0          0.0                                                0.0
0.0                                                0.0          0.0                                                0.0          0.0                                                0.0
0.0                                                0.0          0.0                                                0.0          0.0                                                0.0
                                               52.2                                                            43.6                                                            64.0


Sum of TOTAL WORKING DAYS LOST                                  Sum of TOTAL WORKING DAYS LOST                                  Sum of TOTAL WORKING DAYS LOST
Sickness Absence Code                      Total                Sickness Absence Code                      Total                Sickness Absence Code                      Total
10 Other                                                 20.0   10 Other                                                 24.0   10 Other                                                 35.1
12 Stomach, liver, kidney and digestion                  12.2   12 Stomach, liver, kidney and digestion                  12.6   12 Stomach, liver, kidney and digestion                  19.2
9 Other musculo- skeletal problems                       20.0   9 Other musculo- skeletal problems                        7.0   2 Chest and Respiratory                                   6.0
Grand Total                                              52.2   Grand Total                                              43.6   9 Other musculo- skeletal problems                        3.8
                                                                                                                                Grand Total                                              64.0

								
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