Employee Sick Leave Communication Log
Please use this form to notify and document employee sick leave for HR and management records.
Employee Full Name
*
First Name
Last Name
Employee ID Number
*
Department
*
Please Select
Human Resources
Finance
Operations
Sales
Marketing
IT
Other
Position/Job Title
*
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date and Time of Notification
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Sick Leave Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Expected Return Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Sick Leave
*
Please Select
Flu/Cold
Injury
Medical Appointment/Procedure
COVID-19 or Infectious Disease
Other Illness
Other
Method of Notification
*
Phone Call
Email
Text Message
In Person
Other
Has your direct supervisor/manager been notified?
*
Yes
No
Upload Supporting Document (e.g., medical certificate, doctor's note) if available
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Current Status of Sick Leave Request
*
Please Select
Pending
Approved
Denied
Additional Comments or Notes
Submit Sick Leave Log
Should be Empty: