SRS Absence Report

Sports & Recreation Services

Surname:
First Name:
E-mail:
I will be absent:	From:	To:
	Date (MM/DD/YYYY)	Date (MM/DD/YYYY)
	Time	Time
	Total number of days off: Days

After absence of 5 days, the staff member must provide the supervisor with a written statement to the effect that the staff member is under the care of a Health Care Professional and the estimated date of return to work.

Reason:	Vacation owed
	Overtime owed
	Illness/Injury
	Health Care
	Leave of Absence	Specify
	Other	Specify

Supervisor:	Requests are not approved until you have received an "approval email" from your supervisor.