Excused Absence or Tardy
This form is to be used for any excused absence or excused tardy. Do NOT use this form for Disciplinary actions, terminations, or voluntary resignation
Date
*
-
Month
-
Day
Year
Date
Date of Incident
*
-
Month
-
Day
Year
Date
Time of Incident
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Employee Name
*
First Name
Last Name
Department
*
Production
Converting
Sales
Shipping
Management
Administrative
Traffic
Type
*
Absent
Tardy
*
Paid
Unpaid
Comments
*
Manager Signature
*
Employee Signature Obtained
*
Yes
No
Submit
Print Form
Should be Empty: