Google+
Home
Dryland Certificates (NEW)
SHOW MY VAC STATUS
DATES - HIP
DATES - TERMS
DATES - CLOSED
NEW STARTERS - FAQs
Background
Terms and Conditions
MY SWIM ACCOUNT
Venues
ARMADALE - Lauriston Girl's
MALVERN EAST - Swim Studio
TOORAK - St Catherines
TOORAK - Geelong Grammar
Learn To Swim
TWC - GGS = Enquire or Book FREE Assessment
MELBOURNE = Enquire or Book FREE Assessment
ST CATHERINE'S = Enquire or Book FREE Assessment
HOLIDAY INTENSIVE PROGRAMS
>
MELBOURNE = Book/Enquire Holiday Program
Frequently Asked Questions
News
Adults
Learn To Swim
Stroke Correction / Development
Want to find out more ?
Contact
Links
MY SWIM ACCOUNT - Help Desk
Please Give Us Your Feedback
Staff
Employment
Getting Qualified
Staff Availability - MELBOURNE
Shop
Staff: -
Sickness Certification Form
1. This form is to be completed on your return to work following any period of Sickness or Absence from work.
*
Indicates required field
I am submitting this form for the following reason:
*
Sickness
Absence
NAME:
*
First
Last
Email
*
Phone Number
*
Sickness or Absence BEGINS on DATE:
*
Sickness or Absence BEGINS on DAY:
*
Sickness or Absence BEGINS from TIME AM/PM:
*
Sickness or Absence FINISHED on DATE:
*
Sickness or Absence FINISHED on DAY:
*
Expected date of return to work from Sickness or Absence:
*
Please provide details of the Sickness or Absence
*
Did you consult a Doctor
*
YES
NO
If YES, please give details of the DOCTOR NAME, ADDRESS, DATE OF VISIT, TREATMENT & ANY CURRENT TREATMENT
*
If NO, Please state the reason why you did not see a Doctor
*
H2O OFFICE USE ONLY:
*
- Approved / Not Approved
- Program Manager Advised
- Recorded on Personnel file
Submit to H2O Office