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6
Questions
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1
Your Name
*
This field is required.
First Name
Last Name
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2
Pay Period Start Date
*
This field is required.
-
Date
Month
Day
Year
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3
Pay Period End Date
*
This field is required.
-
Date
Month
Day
Year
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4
Did you take any time off during the pay period?
*
This field is required.
Any PTO (Vacation/Sick) or Holidays taken during this period?
YES
NO
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5
Select Days Off
Only select the day where you were off, if you want pay, Full or half day, and record reason. If Holiday just select Did not Work and put reason as Holiday.
Did Not Work
Reason
Pay Y/N
Full or Half
Sun 04/07/2024
Row 0, Column 0
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 0, Column 1
Y
N
Y
N
Row 0, Column 2
Full
Half
Full
Half
Row 0, Column 3
Mon 04/08/2024
Row 1, Column 0
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 1, Column 1
Y
N
Y
N
Row 1, Column 2
Full
Half
Full
Half
Row 1, Column 3
Tues 04/09/2024
Row 2, Column 0
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 2, Column 1
Y
N
Y
N
Row 2, Column 2
Full
Half
Full
Half
Row 2, Column 3
Wed 04/10/2024
Row 3, Column 0
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 3, Column 1
Y
N
Y
N
Row 3, Column 2
Full
Half
Full
Half
Row 3, Column 3
Thur 04/11/2024
Row 4, Column 0
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 4, Column 1
Y
N
Y
N
Row 4, Column 2
Full
Half
Full
Half
Row 4, Column 3
Fri 04/12/2024
Row 5, Column 0
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 5, Column 1
Y
N
Y
N
Row 5, Column 2
Full
Half
Full
Half
Row 5, Column 3
Sat 04/13/2024
Row 6, Column 0
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 6, Column 1
Y
N
Y
N
Row 6, Column 2
Full
Half
Full
Half
Row 6, Column 3
Sun 04/14/2024
Row 7, Column 0
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 7, Column 1
Y
N
Y
N
Row 7, Column 2
Full
Half
Full
Half
Row 7, Column 3
Mon 04/15/2024
Row 8, Column 0
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 8, Column 1
Y
N
Y
N
Row 8, Column 2
Full
Half
Full
Half
Row 8, Column 3
Tues 04/16/2024
Row 9, Column 0
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 9, Column 1
Y
N
Y
N
Row 9, Column 2
Full
Half
Full
Half
Row 9, Column 3
Wed 04/17/2024
Row 10, Column 0
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 10, Column 1
Y
N
Y
N
Row 10, Column 2
Full
Half
Full
Half
Row 10, Column 3
Thur 04/18/2024
Row 11, Column 0
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 11, Column 1
Y
N
Y
N
Row 11, Column 2
Full
Half
Full
Half
Row 11, Column 3
Fri 04/19/2024
Row 12, Column 0
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 12, Column 1
Y
N
Y
N
Row 12, Column 2
Full
Half
Full
Half
Row 12, Column 3
Sat 04/20/2024
Row 13, Column 0
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 13, Column 1
Y
N
Y
N
Row 13, Column 2
Full
Half
Full
Half
Row 13, Column 3
Sun 04/07/2024
Mon 04/08/2024
Tues 04/09/2024
Wed 04/10/2024
Thur 04/11/2024
Fri 04/12/2024
Sat 04/13/2024
Sun 04/14/2024
Mon 04/15/2024
Tues 04/16/2024
Wed 04/17/2024
Thur 04/18/2024
Fri 04/19/2024
Sat 04/20/2024
Did Not Work
Row 0, Column 0
Reason
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 0, Column 1
Pay Y/N
Y
N
Y
N
Row 0, Column 2
Full or Half
Full
Half
Full
Half
Row 0, Column 3
Did Not Work
Row 1, Column 0
Reason
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 1, Column 1
Pay Y/N
Y
N
Y
N
Row 1, Column 2
Full or Half
Full
Half
Full
Half
Row 1, Column 3
Did Not Work
Row 2, Column 0
Reason
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 2, Column 1
Pay Y/N
Y
N
Y
N
Row 2, Column 2
Full or Half
Full
Half
Full
Half
Row 2, Column 3
Did Not Work
Row 3, Column 0
Reason
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 3, Column 1
Pay Y/N
Y
N
Y
N
Row 3, Column 2
Full or Half
Full
Half
Full
Half
Row 3, Column 3
Did Not Work
Row 4, Column 0
Reason
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 4, Column 1
Pay Y/N
Y
N
Y
N
Row 4, Column 2
Full or Half
Full
Half
Full
Half
Row 4, Column 3
Did Not Work
Row 5, Column 0
Reason
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 5, Column 1
Pay Y/N
Y
N
Y
N
Row 5, Column 2
Full or Half
Full
Half
Full
Half
Row 5, Column 3
Did Not Work
Row 6, Column 0
Reason
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 6, Column 1
Pay Y/N
Y
N
Y
N
Row 6, Column 2
Full or Half
Full
Half
Full
Half
Row 6, Column 3
Did Not Work
Row 7, Column 0
Reason
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 7, Column 1
Pay Y/N
Y
N
Y
N
Row 7, Column 2
Full or Half
Full
Half
Full
Half
Row 7, Column 3
Did Not Work
Row 8, Column 0
Reason
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 8, Column 1
Pay Y/N
Y
N
Y
N
Row 8, Column 2
Full or Half
Full
Half
Full
Half
Row 8, Column 3
Did Not Work
Row 9, Column 0
Reason
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 9, Column 1
Pay Y/N
Y
N
Y
N
Row 9, Column 2
Full or Half
Full
Half
Full
Half
Row 9, Column 3
Did Not Work
Row 10, Column 0
Reason
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 10, Column 1
Pay Y/N
Y
N
Y
N
Row 10, Column 2
Full or Half
Full
Half
Full
Half
Row 10, Column 3
Did Not Work
Row 11, Column 0
Reason
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 11, Column 1
Pay Y/N
Y
N
Y
N
Row 11, Column 2
Full or Half
Full
Half
Full
Half
Row 11, Column 3
Did Not Work
Row 12, Column 0
Reason
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 12, Column 1
Pay Y/N
Y
N
Y
N
Row 12, Column 2
Full or Half
Full
Half
Full
Half
Row 12, Column 3
Did Not Work
Row 13, Column 0
Reason
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Holiday
Sick
Vacation
Training
Covid-19
Funeral
Other (comment)
Row 13, Column 1
Pay Y/N
Y
N
Y
N
Row 13, Column 2
Full or Half
Full
Half
Full
Half
Row 13, Column 3
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6
Comments/Notes
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Created with Sketch.
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7
Send a copy to this Email Address
A copy of your submitted form will be emailed to this address. If you do not fill out, you will not receive a copy.
example@example.com
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8
Date Submitted
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Submitted Date
Year
Month
Day
1
2
3
4
5
6
7
8
9
10
11
12
4
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
10
20
30
40
50
30
00
10
20
30
40
50
Minutes
AM
PM
AM
AM
PM
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9
Visitor Location
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