Leave Report Form - District School Board of the Collier County

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OFFICE USE ONLY
LEAVE REPORT FORM
By: _______________
Date: _____________
EMPLOYEE NAME:
EID#: ______________________________ JOB#:_________________________________________
JOB TITLE: ____________________________________
REPORTING CENTER#: ______________
SCHOOL/DEPT:_________________________________
Leave Type:
UPD-Unpaid Leave
PRS-Personal
VAC-Vacation
SCK-Sick Leave
TPD-Temporary Duty
SBK-Sick Bank
WORK
PR
Date of Leave
Reason #
FROM Time
AM
TO Time
AM
HOURS
Leave
DE
Sub Name
Substitute's EID
Use
MM dd yy
*See Back
hh
mm
PM
hh
mm
PM
ABSENT
Type
Use
Job ID
HOURS
(Optional)
PM
990_TPD
PM
TPD
990_TPD
PM
PM
TPD
PM
990_TPD
PM
TPD
990_TPD
PM
PM
TPD
990_TPD
PM
PM
TPD
990_TPD
PM
PM
TPD
PM
990_TPD
PM
TPD
PM
990_TPD
PM
TPD
990_TPD
PM
PM
TPD
990_TPD
PM
PM
TPD
TOTAL WORK HOURS ABSENT:
I certify that the above statements are true to the best of my knowledge.
If this is a Temporary Duty Assignment Request, fill in the following: Purpose and Location:
____________________________________________________________________
____________________________________________________________________
EMPLOYEE SIGNATURE: _________________________________ Date: ______
Estimated Total Cost of Trip: _______________________________________________________________
DEPT DIR/PRIN SIGNATURE: _______________________________ Date: ______
(Designee/Superintendent)
Budget Source: Location [ ]
Grant [ ]
Other (Specify): _______________________________________
Out of State Travel approved by Board on:
___________________________________________________
APPROVED: _______
DISAPPROVED: _______
(Attach Board Agenda)
USER INSTRUCTIONS:
All leave will be reported on this form. Multiple forms may be used in one reporting period. A line on this form must be filled in for each DAY of leave. The dates reported on a single form may be in
more than one reporting period. If you are unsure about the TYPE of leave, locate the proper REASON CODE on the next page. Do not fill in the lines beyond the Leave Type.
34107 - 02/04/10
Reset Form
Print Form
OFFICE USE ONLY
LEAVE REPORT FORM
By: _______________
Date: _____________
EMPLOYEE NAME:
EID#: ______________________________ JOB#:_________________________________________
JOB TITLE: ____________________________________
REPORTING CENTER#: ______________
SCHOOL/DEPT:_________________________________
Leave Type:
UPD-Unpaid Leave
PRS-Personal
VAC-Vacation
SCK-Sick Leave
TPD-Temporary Duty
SBK-Sick Bank
WORK
PR
Date of Leave
Reason #
FROM Time
AM
TO Time
AM
HOURS
Leave
DE
Sub Name
Substitute's EID
Use
MM dd yy
*See Back
hh
mm
PM
hh
mm
PM
ABSENT
Type
Use
Job ID
HOURS
(Optional)
PM
990_TPD
PM
TPD
990_TPD
PM
PM
TPD
PM
990_TPD
PM
TPD
990_TPD
PM
PM
TPD
990_TPD
PM
PM
TPD
990_TPD
PM
PM
TPD
PM
990_TPD
PM
TPD
PM
990_TPD
PM
TPD
990_TPD
PM
PM
TPD
990_TPD
PM
PM
TPD
TOTAL WORK HOURS ABSENT:
I certify that the above statements are true to the best of my knowledge.
If this is a Temporary Duty Assignment Request, fill in the following: Purpose and Location:
____________________________________________________________________
____________________________________________________________________
EMPLOYEE SIGNATURE: _________________________________ Date: ______
Estimated Total Cost of Trip: _______________________________________________________________
DEPT DIR/PRIN SIGNATURE: _______________________________ Date: ______
(Designee/Superintendent)
Budget Source: Location [ ]
Grant [ ]
Other (Specify): _______________________________________
Out of State Travel approved by Board on:
___________________________________________________
APPROVED: _______
DISAPPROVED: _______
(Attach Board Agenda)
USER INSTRUCTIONS:
All leave will be reported on this form. Multiple forms may be used in one reporting period. A line on this form must be filled in for each DAY of leave. The dates reported on a single form may be in
more than one reporting period. If you are unsure about the TYPE of leave, locate the proper REASON CODE on the next page. Do not fill in the lines beyond the Leave Type.
34107 - 02/04/10
REASON CODES
SICK LEAVE (Type SCK)
TEMPORARY DUTY (Type TPD)
110 Personal Illness
680 Out-Of-County Travel - No Substitute
(Conferences)
111 Family Illness/Death
681 Out-Of-County Travel - With Substitute
(Workshops)
112 Accident/Not Work Related
(Athletic Events)
(Academic Events)
113 Maternity Leave (attach doctor's statement)
690 In-County Travel - No Substitute
(Field Trips)
* 114 Worker's Compensation Offset (attach doctor's statement)
691 In-County Travel - With Substitute
116 Family Medical Leave (Requires FMLA Form)
660 Jury Duty (attach copy of subpoena or notice)
PERSONAL LEAVE (Type PRS)
220 Personal With Pay
662 Other Witness
663 Military (attach copy of orders)
664 Professional (attach letter of explanation. Appropriate only for
SICK BANK (Type SBK)
pre & post planning leaves)
330 Sick Leave Bank
665 Suspension with Pay
115 Sick Pool Membership (Payroll Department use only)
* 666 Illness in the Line of Duty (attach doctor's statement)
667 Administrative Assignment
VACATION LEAVE (Type VAC)
668 Association Leave
440 Vacation
669 Sabbatical (attach letter of request with supporting information)
* 444 Worker's Compensation Offset (attach doctor's statement)
753 Paid for by School Improvement
754 Paid for by Locational Budget
UNPAID LEAVE (Type UPD)
755
Paid for by Grants/MISC. (School must complete journal entry)
550 Personal without Pay (attach letter of explanation)
990
National Board Candidacy
551 No Leave Available (Sick, Personal, Vacation)
552 Suspension without Pay
* 553 Worker's Compensation (attach doctor's statement)
554 Parental/Family (attach doctor's statement)
555 Accident/not Work Related
556 Family Medical Leave (Requires FMLA form)
557 Absent without Approved Leave
* Must have prior approval from Worker's Compensation Office.
34107 - 02/04/10

Download Leave Report Form - District School Board of the Collier County

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