Pandemic Absence Report : H1N1 Virus

Pepperdine University's pandemic response plan seeks to pro-actively safeguard against the potential health risks presented by an infectious disease outbreak. In order to best protect University community members, it is important for the University to collect information related to sick absences of staff and faculty.

[This information will be kept confidential and shared on a need-to-know basis only.]

I am reporting an absence for...
An employee that reports to me
A Coworker
Absentee Information
First Name*
Last Name*
School / Dpt.*

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