Reporting Scheduled & Unscheduled Time off

Reporting Scheduled & Unscheduled Time off
Staff Member*
Have you taken any SICK days in the past 15 days?*

YesNo
If YES, please select dates:
Who did you notify?
Notification Method
Did you have any TARDY days in the past 15 days?*

YesNo
If Yes, please specify dates and how long:
Did you take any other time off during this period?*
If YES, please select dates
(Other, Reason)
Did you make up this time off?*

YesNoN/A
If Yes, please report dates and hours worked:
Should be Empty: