Western Omelette Employee Call Off Work Record

Please do not remove employee from scheduled shift.

Employee Name(Required)

First Last

Scheduled Shift(Required)

Scheduled Start Time(Required)

Reason For Calling Off(Required)

What was the reason for calling off?(Required)

Did the employee indicate this could be Covid-19 related?(Required)

Has the employee been tested for Covid-19

What was the Covid-19 test result?(Required)

Select one(Required)

How many days are being excused with this record(Required)

Do you have any reason to believe the reason provided is not valid?(Required)

Additional Information(Required)

Please add any additional information you feel important as to why this employee called off for a scheduled shift.

Managers Name(Required)

Person completing this form

First Last

Name

This field is for validation purposes and should be left unchanged.