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PTO / Time-Off Request Form

Company: ______________________________

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.