DAY ONE ABSENCE & SSP REPORTING FORM (HR-F026) Notify DAY ONE ABSENCE & STATUTORY SICK PAY REPORTING FORM Day One Absence Triage & SSP Reporting Form (HR-F026)SECTION 1: ASSESSMENT BASELINE & TRIGGERTitle- Select -MrMrsMissMsMxOtherStaff Member NameStaff_IDOperating Local Authority- Select -HaringeyIslingtonBarnetWaltham ForestCamdenHackneyBrentHarrowRedbridgeNewhamCity of LondonWestminsterTower HamletsBarking and DagenhamHaveringKensington and ChelseaHammersmith and FulhamEalingHillingdonHounslowSouthwarkLambethLewishamGreenwichWandsworthRichmond upon ThamesMertonKingston upon ThamesSuttonBexleyBromleyCroydonOtherDate Absence ReportedPolicy Compliance & AWOL Triage- Select -CompliantNon-Compliant (Late Notice)AWOL / No-Show (Lone Worker Risk)SECTION 2: CLINICAL TRIAGE, IPC, LEGAL CLASSIFICATION & SAFETY (Safe QS6-7)Lone Worker Escalation Protocol- Select -Triggered IMMEDIATE Lone Worker Escalation Protocol: verify employee GPS/app status, contact Next of Kin, and escalate to Registered Manager to rule out an accident during commute or at a service user's propertyPrimary Reason for AbsenceGastrointestinal (Diarrhoea and/or Vomiting - D&V)Respiratory / Contagious Viral (Including COVID-19, Influenza)Musculoskeletal (e.g., Back pain, injury)Mental Health / StressStatutory Time Off for Dependants (Unpaid Emergency)Certified Sickness during pre-booked Annual Leave (Stringer Principle)Other Medical (Specify below)Specific Categorisation of Illness / Emergency- Select -D&V (Highly Contagious)Respiratory (Highly Contagious)Musculoskeletal (Acute)Minor AilmentPsychologicalDependant EmergencyIPC Statutory Exclusion Lock: If D&V or a highly contagious respiratory illness is reported, I have informed the employee they are legally excluded from clinical deployment until they have been symptom-free for a minimum of 48 hours, or as per current UKHSA guidelines.- Select -YesNoN/ARostering system hard-locks- Select -The rostering system hard-locked the employee out of deployment for 48 hoursEquality Act / Maternity Carve-Out: Did the employee state this absence is directly related to a previously declared disability, neurodivergence, or pregnancy?- Select -YesNoN/AStandard Bradford Factor- Select -Absence flagged to bypass standard Bradford Factor punitive triggered to prevent discriminatory disciplinary actionHealth & Safety / HSE Trigger: Did the employee state this absence is due to a workplace injury, assault, or work-related stress?YesNoN/AHR-F045 Formal Investigation- Select -Immediately triggered HR-F045 Formal Investigation or HSE Stress Risk AssessmentTotal Number of Calls Uncovered TodayHigh Acuity / Complex Care Flags: Are there any time-critical medication calls, double-handed hoisting visits, or delegated healthcare tasks (e.g., PEG, Insulin) on this rota?- Select -YesNoN/AMitigation Strategy Executed (Select all applied)- Select -Reassigned calls to available Standby/On-Call staff.Split the rota among existing field staff (Verified no Working Time Directive 11-hour rest breaches).Office staff/Management stepped out to cover clinical calls.Next of Kin / Families notified of adjusted call times due to emergency cover.SECTION 3: STATUTORY SICK PAY (SSP) & PAYROLL TRACKING (Well-led QS5)Delegated Task Verification- Select -I confirm that any calls involving specific Delegated Healthcare Tasks have ONLY been reassigned to cover staff holding a valid HR-F041 competency sign-off for that specific Service User.Coordinator Declaration- Select -I confirm that 100% of the visits assigned to this employee for the next 24 hours have been successfully reassigned to appropriately trained and compliant cover staff. No Service User has been left at risk.First Full Day of Incapacity for Work (PIW)Expected Return Date (If known)Certification Status Requirements (Advised to Employee)- Select -Days 1 to 7Day 8+Stringer PrinciplePayroll Notification- Select -I confirm this form triggers an automated notification to Payroll to log the 3 statutory 'Waiting Days' (where SSP is not payable) and verify the Lower Earnings Limit (LEL) criteria.SECTION 4: NEXT STEPS & WELFARE PROTOCOLKeep in Touch (KIT) Agreement: "When is the employee next expected to contact the office to update on their operational status?Return to Work (RTW) Interview Mandate- Select -I acknowledge that a formal RTW Interview must be scheduled and completed on the employee's first day back to assess fitness, update the Bradford Factor score (excluding Equality Act absences), and conduct a handover of missed clinical communications.Time of Employee's First Scheduled Shift TodayDate TriageCertification Status Requirements (Advised to Employee)- Select -Days 1 to 7Day 8+Stringer PrincipleNext Review Date:SUBMIT FORM
