EmployeeIllness Report Employee Illness Report Please complete the form below. Employee Name(Required) First Last Date(Required) MM slash DD slash YYYY Department Was this employee working at the time they brought this to your attention? Yes No Time of Call - Please indicate AM or PM Symptoms Vomiting Diarrhea Specific SymptomsIn detail, what exactly is wrong with themIf 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.Upload File(s) Drop files here or Select files Accepted file types: jpg, jpeg, pdf, docx, Max. file size: 8 MB. Employee Signature Please enter full name to indicate that you have read and understand the aboveDate MM slash DD slash YYYY Supervisor Signature Date MM slash DD slash YYYY CAPTCHA
