Has the Colleague met the corporate trigger points in the last rolling 12 month period? (Please indicate Stage and Long or Short Term Sickness) Stage 1 STS - 3 occasions or 10 cumulative days absence – LTS - 4 weeks absence If yes, Stage 2 STS - 2 occasions or 7 cumulative days – consider a LTS - 3 months absence Yes referral to No Stage 3 STS - 2 occasions or 7 cumulative days – Health LTS - 5 months absence - 2 occasions or 7 cumulative Stage 4 STS – LTS - 7 months absence Has there been a pattern of absence causing concern eg every Friday/Monday or certain times of the year? Has the Colleague been made aware of future actions in accordance with the Mersey Care NHS Foundation Trust’s Supporting Attendance Yes No policy if they are absent again in the near future? Is a referral to Occupational Health required? Yes No If yes, please complete the relevant referral Form and send it to Occupational Health Has a Wellbeing Assessment been offered? Yes No Details of support offered to Colleague (actions agreed, including timescales). No additional support required at present I understand that this information will be used for the purposes of recording and monitoring sickness absence and may be shared with Occupational Health; Human Resources and my Line Managers Signed Colleague Date Signed Manager Date
Has the Colleague met the corporate trigger points in the last rolling 12 month period? (Please indicate Stage and Long or Short Term Sickness) Stage 1 – STS - 3 occasions or 10 cumulative days absence LTS - 4 weeks absence Stage 2 – STS - 2 occasions or 7 cumulative days LTS - 3 months absence Stage 3 – STS - 2 occasions or 7 cumulative days LTS - 5 months absence Stage 4 – STS - 2 occasions or 7 cumulative LTS - 7 months absence Has there been a pattern of absence causing concern eg every Friday/Monday or certain times of the year? Yes If yes, consider a referral to Health No Has the Colleague been made aware of future actions in accordance with the Mersey Care NHS Foundation Trust’s Supporting Attendance policy if they are absent again in the near future? Yes No Is a referral to Occupational Health required? If yes, please complete the relevant referral Form and send it to Occupational Health Yes No Has a Wellbeing Assessment been offered? Yes No Details of support offered to Colleague (actions agreed, including timescales). No additional support required at present I understand that this information will be used for the purposes of recording and monitoring sickness absence and may be shared with Occupational Health; Human Resources and my Line Managers Signed Colleague Date Signed Manager Date
hr07-2017-10-18-toolkit-for-colleagues.docx