Title Page

  • Document No.

  • Conducted on

  • Prepared by

  • Annual leave

  • Sick Leave

  • Leave without pay

  • Special leave with pay

  • Rostered day off

  • Please enter leave start date

  • Please enter leave finish date

  • Please enter any special notes here

  • Applicant signature

  • Office use :

    Admin : please check leave time is available and sign.

    Supervisor : Please check jobs are not booked for this time and sign

  • Admin sign off

  • Supervisor sign off

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.