COVID-19 Self Quarantine Employee Leave Form

COVID-19
Self Quarantine Employee Leave Form
Request leave for...
First NameLast Name
Employee status
Phone (employee)
Area CodePhone Number
Email (employee)
example@example.com
Date the leave starts
MonthDayYear
Date
Employee department
Position/Title of the employee
Number of hours the employee is scheduled to work per week.
Supervisor's Name
First NameLast Name
Supervisor's phone number
Area CodePhone Number
Any special circumstances HR may need to know.
Supervisor's please contact Kim Hall 801-804-4504 or Tara Silver 801-804-4589 as soon as the employee's condition changes. (ie. becomes sick or their situation changes)
Should be Empty: