Mine Worker Absence Report Form
Report an employee’s absence from mine work. Please complete all required fields to ensure accurate record keeping.
Employee Full Name
*
First Name
Last Name
Employee ID
*
Department / Work Area
*
Please Select
Underground Operations
Surface Operations
Maintenance
Processing
Administration
Other
Date of Absence
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Shift
*
Please Select
Morning
Afternoon
Night
Full Day
Reason for Absence
*
Please Select
Illness
Injury
Family Emergency
Scheduled Leave
Weather/Environmental
Other
Expected Return Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reporting Person’s Full Name
*
First Name
Last Name
Reporting Person’s Contact Email
*
example@example.com
Additional Comments
Submit Absence Report
Should be Empty: