Absence Absence Record To be completed following any absence - any absence is when you are unable to complete your scheduled shift/run and or rota. You are not permitted to return to work or a scheduled rota until your form has been completed and submitted.Name(Required) Email(Required)You will receive a copy of your completed form. Area/ Team you work in:Select the area or team you work in - if you work in more than one team, then select the area you complete your most hours in.BallygowanBallynahinchBelfastCastlewellanComberCrossgarDownpatrickDrumanessDundonaldKillyleaghNewcastleSaintfieldSeafordeSouth BelfastLydian OfficeWhat date have you been off from:(Required) DD slash MM slash YYYY What date are you able to return to work:(Required) DD slash MM slash YYYY If you have been off work for an extended period of absence 10 days or more and or under medical advice you may require a follow up with your manager or HR before returning.Reason for absence:(Required)Do you confirm you are fit to return to work at normal duties?(Required)If you select no your absence declaration cannot be accepted and you will need to speak to HR. Yes No If you have 3 or more absences within a 3 month period you will require either a "Wellness Check in" or a "HR Check in" dependant on your absences. If your absences persist following the check-in period your suitability and availability for your care role will have to be reviewed and further action taken.