EIU Health and Counseling Services
VACATION/SICK LEAVE REPORT FORM

This form is for ALL employees.

All requests for accrued leave, break days, personal days leave must be approved at least 2 business days IN ADVANCE by your supervisor and then submitted to the Director of Health and Counseling Services. If you do not take vacation as planned, notify Administrative Office.

Exempt and Hourly Employees: Accrued Leave AND Sick Leave may be used in ¼ hour (or 15 minute) increments.

Hourly Employees should also use this form to report comp time earned and used. In order to earn comp time it must be approved by your supervisor in advance.

This form may be used for more than one time off request, but only for same month (exempt) or pay period (hourly).

Employee Name
Email
Date of Report Submission Date of Report Submission / MM / DD YYYY
Type of Leave

Type of Leave Personal Sick Leave Family Sick Leave Accrued Leave/Vacation (A&P, Civil Service, 12 Mo Unit B-ASP) Break Days (10 Mo Unit B ASP) Bereavement Leave (3 days for A&P, Civil Service, 5 days for ASP UNit B, wiithin 5 consecutive workdays beginning on the date of death or occurrence) Comp Time (Unit B ASP and Civil Service Hourly)
Date(s) of Absence
Amount of Hours Used/Length of Absence
Comment/Description/Rationale for Request/Absence

EIU Health and Counseling Services VACATION/SICK LEAVE REPORT FORM

EIU Health and Counseling Services VACATION/SICK LEAVE REPORT FORM

EIU Health and Counseling Services
VACATION/SICK LEAVE REPORT FORM

EIU Health and Counseling Services
VACATION/SICK LEAVE REPORT FORM