Earned Sick Time Use Reporting – Monthly Employees – Human Resources

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Employee's Name(Required)

First Last

Employee's Email(Required)

Department Chair/Supervisor's Name(Required)

First Last

Department Chair/Supervisor's Email(Required)

For what reason are you reporting sick time?(Required)

Use for an unforeseeable ESTA-defined reason

Use for a foreseeable ESTA-defined reason

I am rescinding previously reported sick time use

Are you reporting a whole work day, part of a workday, or more than one workday?(Required)

Whole work days will be counted as 8 hours

A whole work day

Less than a whole work day

More than one work day

Enter the date reported(Required)

Enter the dates that you are reporting(Required)

Enter the date previously reported(Required)

Enter the number of hours previously reported(Required)

Enter 8 if you had reported a whole day

Please enter a number less than or equal to 8.

Enter the date when you will use/used some of your sick time.(Required)

Enter the number of hours used.(Required)

Please enter a number less than or equal to 8.

Supporting document(s), if any

Drop files here or

Max. file size: 5 MB.

Additional information, if any