Absence Form
Uses: Earned paid sick time may be used for the following purposes: (1) medical care or mental or physical illness, injury, or health condition; or (2) a public health emergency; and (3) absence due to domestic violence, sexual violence, abuse, or stalking. Employees may use earned paid sick time for themselves or for family members. See Arizona Revised Statutes § 23-373 for more information. *Note: If you worked with more than 1 client on a given day OR if you provided multiple services to the same client (e.g. respite, habilitation) on a given day, a separate absence form must be filled out.
Staff's Full Name
*
First Name
Last Name
Client's Full Name
First Name
Last Name
Date of Absence
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-
Month
-
Day
Year
Date Picker Icon
Time In
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Time Out
*
Service Provided
*
Respite
Habilitation
Speech
You are able to use accrued sick time for one of the 3 reasons listed at the top of the page. Will you be using your accrued sick time (if applicable) or will this be a non-paid day off? *Note: If you do not have enough hours in your paid time off bank, this will be a unpaid day off*
*
Sick Time
Un-Paid Time Off
Documentation (e.g. doctor's note) is required for 3 consecutive days of absence if you were absent due to illness. Will you be providing documentation?
*
Yes
No
Submit
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