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Sick Leave Form

The document is a sick leave form for an employee to request time off due to illness. It collects information such as the employee's name, department, job title, and signature. The form is then sent to the medical unit to provide diagnosis details and approve the length of sick leave. The medical unit fills in areas for patient diagnosis, comments on medical status, and signs off on the approved sick leave period.

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Albert NAM
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7K views1 page

Sick Leave Form

The document is a sick leave form for an employee to request time off due to illness. It collects information such as the employee's name, department, job title, and signature. The form is then sent to the medical unit to provide diagnosis details and approve the length of sick leave. The medical unit fills in areas for patient diagnosis, comments on medical status, and signs off on the approved sick leave period.

Uploaded by

Albert NAM
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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SICK LEAVE FORM

Date : ____________________________________________________________

Name : ____________________________________________________________

Employee No : ____________________________________________________________

Department : ____________________________________________________________

Job Title : ____________________________________________________________

Employee Signature: ____________________________________________________________

FOR OFFICE USE

Please inform us about his/her medical status and the sick leave. Thanks

Admin Manager,

Signature

Comments: ______________________________________________________________________________________________

_____________________________________________________________________________________________________________

FOR MEDICAL UNIT USE

Patient Diagnosis: _______________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Sick Leave: ______________________________________________________________________

_________________________________________________________________________________

Stamp of Hospital / Clinic Doctor

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