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Report of Influenza Like Illness

The completion of this absence information will allow the University to identify and allocate resources to proactively manage issues that may arise as a result of widespread illness

Please complete the following information to report any ILI related absences.

The Office of Human Resources will contact you upon notification of the absence.

Influenza Like Illness (ILI)

(documented fever >=100.4 F), or a good history of fever (e.g. chills and shakes) AND cough and / or sore throat.)
* reporting not required if the conditions above are not present.
First Work Date Out: (mm/dd/yyyy)
Has the person returned to work: Yes    Date Returned: (mm/dd/yyyy)
                                                           No
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