Employee Absence Form Your Name* First Last Branch*BrandonCalgaryCentral WarehouseChathamCorporateEdmontonGrande PrairieLangleyLethbridgeLloydminsterMississaugaOakbluffRed DeerReginaSarniaSaskatoonSudburyThunder BayWinnipegEmployee Name* First Last Title*Counter SalesAM SalesTrailer SalesParts HandlerShipper/ReceiverMechanic/TechDriverAdminManagerOtherOther (Please detail) First Day of Absence* MM slash DD slash YYYY Return to Work Date (if known) MM slash DD slash YYYY Days of AbsenceLeave of Absence Reason*Isolation Due to SymptomsChildcareIsolation Due to TravelVacationBereavementIsolation Due to ExposureOther Illness (please include details below)Other Absence (please detail in Other Information)Other Illness (Details)Other InformationDoes the Employee Qualify for COVID Testing?* Yes No Approval Requested to Work From Home* Yes No Other Information
