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ATTENDANCE/PERFORMANCE RECORD

Physician Network Services

Absence Codes Reason No. Reason No. Name      


Team Member ID #      
A Unexcused Absence 1 Sick (Self) 7 Transportation
T Tardy 2 Family Illness 8 Military Dept.      
P Scheduled Absence 3 Injury on Job 9 Family/Medical Hire Date      
Leave Position      
L Left Early 4 Lack of Work 10 Severe Weather
H Holiday 5 Jury Duty 11 Unknown
6 Bereavement 12 Other
YEAR 2021

JANUARY FEBRUARY MARCH

Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat
1 2 1 2 3 4 6 5 1 2 3 4 5 6 7
                                                                                         
3 4 5 6 7 8 9 7 8 9 10 11 12 13 8 9 10 11 12 13 14
                                                                                                                             
10 11 12 13 14 15 16 14 15 16 17 18 19 20 15 16 17 18 19 20 21
                                                                                                                             
17 18 19 20 21 22 23 21 22 23 24 25 26 27 22 23 24 25 26 27 28
                                                                                                                             
24 25 26 27 28 29 30 28 29 30 31
                                                                 
31
     

APRIL MAY JUNE

Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat
1 2 3 4 1 2 1 2 3 4 5 6
                                                                       
5 6 7 8 9 10 11 3 4 5 6 7 8 9 7 8 9 10 11 12 13
                                                                                                                             
12 13 14 15 16 17 18 10 11 12 13 14 15 16 14 15 16 17 18 19 20
                                                                                                                             
19 20 21 22 23 24 25 17 18 19 20 21 22 23 21 22 23 24 25 26 27
                                                                                                                             
26 27 28 29 30 24 25 26 27 28 29 30 28 29 30
                                                                                         
31
     

JULY AUGUST SEPTEMBER

Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat
1 2 3 4 1 1 2 3 4 5
                                                           
5 6 7 8 9 10 11 2 3 4 5 6 7 8 6 7 8 9 10 11 12
                                                                                                                             
12 13 14 15 16 17 18 9 10 11 12 13 14 15 13 14 15 16 17 18 19
                                                                                                                             
19 20 21 22 23 24 25 16 17 18 19 20 21 22 20 21 22 23 24 25 26
                                                                                                                             
26 27 28 29 30 31 23 24 25 26 27 28 29 27 28 29 30
                                                                                                     
30 31
           

OCTOBER NOVEMBER DECEMBER

Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat
1 2 3 1 2 3 4 5 7 6 1 2 3 4 5
                                                                                         
4 5 6 7 8 9 10 8 9 10 11 12 13 14 6 7 8 9 10 11 12
                                                                                                                             
11 12 13 14 15 16 17 15 16 17 18 19 20 21 13 14 15 16 17 18 19
                                                                                                                             
18 19 20 21 22 23 24 22 23 24 25 26 27 28 20 21 22 23 24 25 26
                                                                                                                             
25 26 27 28 29 30 31 29 30 27 28 29 30 31
                                                                                   
NAME       TEAM MEMBER ID#      

SUMMARY OF COMMUNICATION: Indicate date and all pertinent recognition and performance communication. (Use additional sheets as necessary.)
Please do not include any information regarding medical conditions or illnesses.

DATE DESCRIPTION

           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           

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