Employee Name: _____________________________ Date:____________
Leave requested ____hrs. of annual leave.
Current leave usage: _____________ Current standard: _______________
|
|
Yes |
No |
|
|
Is unit staffing adequate? Will staffing be adequate? |
|
|
|
|
Is the sick leave usage history within guidelines? (calculation below) |
|
|
|
|
Is the there some extraordinary circumstance to justify approval?* |
|
|
|
|
* if yes, explain here: |
|||
|
|
|||
|
|
|||
|
|
|||
|
|
|||
|
Calculation |
B Leave balance ________________ "Zero use balance" ______________ (from table)Years of Service ______________ Formula (zero use balance- leave balance)/ years of service = historical average Enter the historical average leave hours per year _____________ |
||
Recommendation: p approve to exceed limit p do not exceed limit
Submitted by: __________________________ Date: _____________