Report A Problem

What is the nature of the problem?
First name of caller *
Surname of caller *
Employee ID
Contact telephone number *
Caller's company *
- Caller's work location/department *
- Caller's manager *
  Include both first and last name or specify in notes why full name was not given
Absence start date
Is the employee reporting a return to work? * No Yes
Expected return to work date
Confirmed return to work date
Reason for absence *
Additional details about the absence
Why did you complete this RAP form? *
Reason for RAP
Name of call handler *
  Message given *
  Message given *
* Required fields