REPORT OF ABSENCE GEORGIA STATE UNIVERSITY EXEMPT FACULTY & STAFF
Complete this form to report all absences from work except regularly scheduled holidays.
NAME DEPARTMENT Emp ID TITLE EFT EXTENSION
Physician's statement required for sick leave claimed for a period in excess of 5 consecutive workdays For a planned Leave of Absence in excess of two weeks, submit a HR Personnel Action Form (HRPF#2) Consult the Classified Employee Handbook or Faculty Handbook for Leave Information or call 651-2380
TYPE OF ABSENCE
Annual Leave
(Vacation and Personal Leave)
PERIOD ABSENT - Inclusive Dates and Total Hours Absent
(If total hours absent do NOT equal 8 hours each day, please indicate partial hours absent per day)
_________________________ _________________________ _________________________
_____________________________ _____________________________ _____________________________
Sick Leave
_________________________ _________________________ _________________________
_____________________________ _____________________________ _____________________________
Employees may utilize accrued sick leave for the following reasons: Illness or injury of the employee. Medical, dental and vision treatment or consultation. Quarantine due to a contagious illness in the employee’s household. Illness, injury or death in the employee’s immediate family requiring the employee’s presence. The immediate family is defined as: employee’s spouse, parents, children, brothers, sisters, stepchildren, grandparents, grandchildren, foster parents or legal guardian and in-laws in the same categories.
(Georgia State University: Classified Employee Handbook)
Military Leave
(ATTACH ORDERS)
__________________________ __________________________
______________________________ ______________________________
Court Duty
(ATTACH SUMMONS OR SUBPOENA)
EMPLOYEE SIGNATURE ___________________________________________ DATE ________________ APPROVING OFFICIAL ____________________________________________ DATE _______________ IMPORTANT NOTE: It is the responsibility of the approving official to insure that the leave reported on this form is in accordance with the leave policy as stated in the Georgia State University Classified Employee Handbook. Please forward the completed form directly to the Office of Payroll and Employee Records, Suite 330, One Park Place South.
HRF#11 Rev. 1/99