Absence Report Name First Name Last Name Number Department Shift First Date Absent MM DD YYYY Expected Return Date MM DD YYYY Reason for Absence Illness Vacation Personal Time Family Death Accident on Job Family Leave Act Holiday Jury Duty Suspension Leave Without Pay Unknown Other Explanation, if necessary Was Absence: Expected in Advance Yes No Reported on First Date Absent Yes No Considered by Supervisor as Excused Unexcused Date MM DD YYYY Prepared by Thank you!