Leave Request Form

  • Date captured on form submission
  • Partial Shift Details

Employee Leave Days

  • Note: If you have inadequate sick time accumulated, then you will be paid from accured vacation time

Family Medical Leave - P&P 2.04.1

  • Note: Employees are required to give a 3 hour notice when calling off.  You need to follow the appropriate call off procedure as well as notifying ext. 3281.  Employees on unpaid FMLA leave must arrange to pay their contribution or co-pay for medical insurance.
  • By signing this page you are acknowledging that you are aware of your responsibilities for the employees' contribution of the benefits while you are off work.

Medical Leave - P&P 2.04.3

  • Note: If the employee does not qualify for FMLA leave, then the employee will accumulate one attendance occurrence for each absence that is unpaid (if not accompanied by a medical excuse).  The employee will then be placed on medical leave for employee medical conditions only.  Refer to P&P 2.08 Attendance Policy.  The employee must submit a medical release with no restrictions.
  • By signing this page you are acknowledging that you are aware of your responsibilities for the employees' contribution of the benefits while you are off work.

Workers Compensation - P&P 2.04.6

  • Note: Fill out Employee Accident Form within 24 hours of the injury.  (recommended to be completed immediately)  AFTER SUBMISSION, EMPLOYEE ACCIDENT FORM WILL BE SENT TO YOU FOR COMPLETION.

  • By signing this page you are acknowledging that you are aware of your responsibilities for the employees' contribution of the benefits while you are off work.