Illness Report

Employee Illness Report

Please complete the form below.

Employee Name(Required)
MM slash DD slash YYYY
Was this employee working at the time they brought this to your attention?
In detail, what exactly is wrong with them
If this employee has either vomiting or diarrhea, they may not return to work for 24 to 72 hours according to the Saginaw Department of Public Health.
Please upload any doctor's notes or paperwork below if available.
Drop files here or
Accepted file types: jpg, jpeg, pdf, docx, Max. file size: 2 MB.
    Please enter full name to indicate that you have read and understand the above
    MM slash DD slash YYYY
    MM slash DD slash YYYY
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