Sick Leave Reporting Form

Name

First Name

Last Name

Email

Category Sick / Covid19

Manager

Number of Days Taken

If Covid19, please quarantine, work remotely from home, and follow CDC guidelines for return to in-person office schedule. If needed, indicate any Sick Days due to covid symptoms

Date of Sick Leave

MM

DD

YYYY

Reason for Sick Leave

Did you inform your manager?

Yes

No

Did you visit the doctor?

Yes

No

Additional information

If covid19, please indicate day 1 as per CDC guidelines and anticipated return to in-person office schedule

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