I capture data from people who have travelled abroad too, as the BRC 7.3.1 takes into account in contact with as well as suffering from
I also subscribe to NOIDS, who send out a weekly notification of notifiable diseases.
Employee's Name: Date:_________________
Job Title / Department: _______________________________________________________
Please complete sections 1and 3 if you have been absent due to illness
Period of Incapacity: state the first day of which you felt incapable of work regardless of whether it would have been a rest day, public holiday or other day you would not normally work.
If you attended work on the first day of illness, please indicate leaving time am/pm
Number of days off work:
Please complete section 2 if you have travelled outside of the EU
Country Travelled to: State the country that you have travelled to:
If you have travelled to a Red Country please inform Technical Manager / Production Manager
Red countries include: Africa, India, Asia, Central & South America
TM / PM comments:
Nature of Incapacity: state the name of your illness if you know it, or describe the incapacitating symptoms:
If you had any sickness or diarrhea please indicate the day and time of the last incidence:
(you must not handle food until at least 48 hours after the last incidence)
Describe any treatment or medicine you took to help you recover (including whether or not you visited your G.P., hospital, or consulted any other medical / paramedical person).
I certify that I, the above named employee, have been absent from work for the period stated, due to the incapacity indicated. To the best of my knowledge and belief, these facts are correct. I understand that further enquiries may be made at the discretion of the management, only after consultation with myself.
Employees Signature:____ Date: _____________
Supervisors Assessment: Return to work immediately: YES / NO
Supervisors Signature:____ Date:______________