The bearer of this form is a staff of DIFF Medical Centre.
Your name was submitted as one the persons to contact in the event of an emergency.
Please signify your consent for this role by filling the underlisted:
4 =No late for work or absence record during the appraisal period.
3 = Less than 3 times of late for work or absence record during the appraisal period.
2 = 3 times of late for work or absence record during the appraisal period.
1 = More than 3 times of late for work or absence record during the appraisal period.