Anonymous

Johansen Paid Sick and Safe Leave (PSSL) Form

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Title Page

Conducted on
Prepared by
Location

Paid Sick and Safe Leave is available for employees to care for their health and the health of their family members. Please use the following form to request paid sick leave or immediately notify your supervisor when you want to use paid sick leave for the day(s) you have missed.
Date Requesting Off
Employee Signature
Supervisor Signature

Anonymous

Johansen Paid Sick and Safe Leave (PSSL) Form

Use this Template

Print as PDF

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.