Report an Employee Absence
Please fill out this form to report employee absences due to illness. The results of this form will be sent to Employee Health.
hasErrors()) { $_SESSION['errors']['employee-absence'] = $validator->getAllErrors(); } else { // send email $email_config = array( 'sender_email' => 'ljones@citizensmemorial.com', 'recipient_email' => 'lauren.fraser@citizensmemorial.com', 'subject' => 'Employee Absence due to Illness report', 'filter_values' => 'employee-absence' ); $sent_message = Form::sendMail($email_config); // clear the form Form::clear('employee-absence'); } } /* ================================================== The Form ================================================== */ $form = new Form('employee-absence', 'horizontal', 'novalidate, data-fv-no-icon=true', 'bs5'); // $form->setMode('development'); $form->addInput('text', 'number', '', 'Employee Number (of absent employee)', ''); $form->addInput('text', 'phone', '', 'Phone', ''); $form->addInput('text', 'dept', '', 'Department', ''); $form->addCheckbox('ltc', 'Ash Grove HCF', 'aghcf', 'data-toggle=false'); $form->addCheckbox('ltc', 'Butterfield Residential Care Center', 'brcc', 'data-toggle=false'); $form->addCheckbox('ltc', 'Citizens Memorial HCC', 'cmhcf', 'data-toggle=false'); $form->addCheckbox('ltc', 'Colonial Springs HCC', 'cshcc', 'data-toggle=false'); $form->addCheckbox('ltc', 'Community Springs HCF', 'cshcf', 'data-toggle=false'); $form->addCheckbox('ltc', 'Lake Stockton HCF', 'lshcf', 'data-toggle=false'); $form->addCheckbox('ltc', 'Parkview HCF', 'pvhcf', 'data-toggle=false'); $form->addCheckbox('ltc', 'Not an LTC employee', 'na', 'data-toggle=false'); $form->printCheckboxGroup('ltc', 'Long Term Care Facility:', true, ''); $form->addInput('text', 'dates', '', 'Date(s) of Absence', ''); $form->addCheckbox('symptoms', 'Nausea', 'nauseau', 'data-toggle=false'); $form->addCheckbox('symptoms', 'Fever', 'fever', 'data-toggle=false'); $form->addCheckbox('symptoms', 'Cough', 'cough', 'data-toggle=false'); $form->addCheckbox('symptoms', 'Rash', 'rash', 'data-toggle=false'); $form->addCheckbox('symptoms', 'Sore Throat', 'sore-throat', 'data-toggle=false'); $form->addCheckbox('symptoms', 'Nasal Con', 'nasal-congestion', 'data-toggle=false'); $form->addCheckbox('symptoms', 'Runny Nose', 'runny-nose', 'data-toggle=false'); $form->addCheckbox('symptoms', 'Vomiting', 'vomiting', 'data-toggle=false'); $form->addCheckbox('symptoms', 'Diarrhea', 'diarrhea', 'data-toggle=false'); $form->printCheckboxGroup('symptoms', 'Symptoms', true, ''); $form->addCheckbox('diagnosed', 'Flu', 'flu', 'data-toggle=false'); $form->addCheckbox('diagnosed', 'COVID', 'covid', 'data-toggle=false'); $form->printCheckboxGroup('diagnosed', 'Diagnosed with:', true, ''); $form->addInput('text', 'reported-by', '', 'Reported By', ''); $form->addRadio('covid-vac', 'Yes', 'yes', 'data-toggle=false'); $form->addRadio('covid-vac', 'No', 'no', 'data-toggle=false'); $form->printRadioGroup('covid-vac', 'Did the absent employee recently receive a COVID vaccination?', true, ''); $form->addInput('date', 'vac-date', '', 'Vaccination Date', ''); $form->addTextarea('comments', '', 'Comments', ''); $form->addPlugin('formvalidation', '#employee-absence', 'default', array('language' => 'en_US')); ?>
Please fill out this form to report employee absences due to illness. The results of this form will be sent to Employee Health.