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Sick Leave Form Template

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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 t…

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Albert NAM
  • Sick Leave Form

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

SICK LEAVE FORM Date : ____________________________________________________________ Name : __________________________

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