EMPLOYEE NAME | DEPARTMENT |
PAY PERIOD START DATE | END DATE |
Please indicate any time off taken during the pay period with the appropriate code below. | |
DAY | DATE | CODE | HOURS TAKEN | EXPLANATION IF NEEDED |
SAT | ||||
SUN | ||||
MON | ||||
TUE | ||||
WED | ||||
THU | ||||
FRI | ||||
SAT | ||||
SUN | ||||
MON | ||||
TUES | ||||
WED | ||||
THU | ||||
FRI | ||||
EXPLANATION CODES | ||||
V - Vacation | LWOP - Leave Without Pay (full days) | B – Bereavement** |
S - Sick* | H - Holiday | J - Jury Duty** |
M - Military Leave** | FML - Family Medical Leave** | P - Personal Day |
*A physician's note is required for absences in excess of 3 consecutive days
** Additional documentation must be submitted with the timesheet to Human Resources
[ ] CHECK HERE IF NO LEAVE WAS USED DURING THIS PAY PERIOD
EMPLOYEE SIGNATURE: | DATE: |
MANAGER SIGNATURE: | DATE: |
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