Jose Sanz

USI Worker Leave Form

To be completed by installers and office staff prior to taking time off

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Print as PDF

Use this Template

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Title Page

Full name
Dates of Leave
Total Number Of Working Days
Return to Work Date
Type of Leave
- Annual Leave
- Unpaid Leave
- Left Early Unpaid
- Left Early Paid
- Compassionate Leave
- Half Day RDO
- Half Day RDO & Half Day Annual Leave
- Sick & Carers Leave (Medical Certificate must be provided to HR)
Hours Left Early (if applicable)
Employee Signature
Approved by Peter Harris

Jose Sanz

USI Worker Leave Form

To be completed by installers and office staff prior to taking time off

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.