MONTHLY STAFF LEAVE REPORT
NAME: ______________________________________
MONTH ENDING: ______________
YEAR: _________________
Please check off which Department you work for:
Dean’s Office
Mechanical & Materials Engineering
Chemical & Biochemical Engineering
Boundary Layer Wind Tunnel
Civil & Environmental Engineering
University Machine Services
Electrical & Computer Engineering
Biomedical Engineering
WindEEE Research Institute
Fraunhofer Project Center
REASONS FOR LEAVE:
Dates:
# of Days:
VACATION Days: ____________________________________________________
__________
PMA/UWOSA Days: ___________________________________________________
__________
SICK Days: __________________________________________________________
__________
OTHER Leave:
_____________________________________________________
Specify (Compassionate leave, Bereavement leave, Jury Duty)
__________
(Please specify whether a full or half day. If a half day please note whether the morning or afternoon)
_____________________
Staff Member
____________
Date
_____________________
Supervisor
__________
Date
*This form must be signed by staff member and supervisor every month even if NIL report*
SUPERVISOR TO FORWARD THIS FORM TO HUMAN RESOURCES (Engineering)
Questions should be directed to Laura Fleming (Ext: 81154), lflemi@uwo.ca
HR Eng
Rev.04.16