PTO / TIME-OFF REQUEST FORM [Company name] Submit at least [__] business days before the first day off (see the time-off policy). EMPLOYEE -------- Employee name: _____________________________________________________ Job title / department: ____________________________________________ Manager / approver: ________________________________________________ Date submitted: ____________________________________________________ TIME OFF REQUESTED ------------------ Type (circle one): Vacation Sick Personal Unpaid Other: ________ First day off: _____________________________________________________ Last day off: ______________________________________________________ Half day? No Yes, morning off Yes, afternoon off Date: ________ Total workdays requested: __________________________________________ Date back at work: _________________________________________________ COVERAGE -------- Who covers my work while I'm out: __________________________________ Handover notes / where to find things: _____________________________ ____________________________________________________________________ EMPLOYEE SIGNATURE ------------------ Signature: _________________________________________________________ Date: ______________________________________________________________ MANAGER USE ONLY ---------------- Decision (circle one): Approved Approved with changes Denied Changes or reason for denial: ______________________________________ ____________________________________________________________________ PTO balance before this request (days): ____________________________ Balance after this request (days): _________________________________ Approved by: _______________________________________________________ Signature: _________________________________________________________ Decision date: _____________________________________________________ Entered in time-off log (initials / date): _________________________ Keep the signed form with the employee's time-off records. Do not write medical details on this form.