Time Off Reporting Form


Use this form to report your days off from the previous month. Please fill it out by the 5th day of each month.

* indicates a required field.


This form will be mailed to your supervisor for confirmation before being submitted to the IAR administrator.

* Please select your supervisor:

 

The next item is intended to provide a reminder for the upcoming month or so – it should NOT be used to request new time off.

Please enter currently planned days off:


* Enter Month/Year for the data you are reporting:

 

Days Off:

* Enter total number of vacation days for the month (can be zero):

Actual vacation dates (if any):

 

* Enter total number of sick days for the month (can be zero):

Actual sick dates (if any):
* Enter total number of jury days for the month (can be zero):

Actual jury dates (if any):
* Enter total number of other days (for example: bereavement) for the month (can be zero):

Describe:

Other dates (if any):