Crisis Lines Time Off Form

Please complete this form whenever you would like to or are unable to work your scheduled shift(s) on the crisis lines with less than 2 weeks notice, including missing partial shifts. This will notify Staffing and Supervisors about absences, tardies and early departures happening in less than 2 weeks and count as Unexpected Time Off unless alternate coverage is found. For information about Lines for Life’s Absence policy, please see: https://linesforlife.sharepoint.com/:w:/g/Human%20Resources/EYQcACrgPrtJl9n8ie997QcBV-MlJyGT2u3G2sP_wHap7g. The expectation is that this form will be filled out as far in advance as possible and that it will be completed prior to the start of your scheduled shift (or prior to leaving a shift if leaving during a scheduled shift). Supervisors or Schedulers may call you if additional information about the time off is needed.

What is your first and last name?*
Time off duration*
- Partial Shift - Late Arrival
- Partial Shift - Extended Mid-Shift Break
- Partial Shift - Early Departure
- 1 Full Shift
- Multiple Full Shifts
- Multiple Partial Shifts
Time Off Start Date*
MM slash DD slash YYYY
What time will you be available to start working your shift? (Pacific Time)*

: Hours

Minutes

AM/PM
What is the start and end time of the extended mid-shift break? (Please list in the Pacific Time Zone)*
What time do you need to or wish to leave your shift? (Please list in the Pacific Time Zone)*

: Hours

Minutes

AM/PM
Time Off End Date*
MM slash DD slash YYYY
What time(s) do you need off from your shifts? (Please list in the Pacific Time Zone)*
If you have found a team member who has agreed to cover your shifts or trade shifts without either of you going into overtime, please list the coworker's name, and if trading, the shift you'll be taking below.
Are you unable to work due to technical issues?
- Yes
- No
Please provide a brief synopsis of the tech issue.
Please troubleshoot with your supervisor. If the problem still persists, please email [email protected] about the issue.
Are you requesting to have this absence excused from the standard attendance policy due to family and medical leave reasons, a natural disaster, or other extenuating circumstances? If you select yes, when you submit this form you will be redirected to complete a confidential form that will only be reviewed by the HR team.
If you would like to receive confirmation of this form, please enter your email address below.
Notes
Please note that these notes are shared with all Crisis Lines Floor Leadership and Staffing, so please do not put any confidential notes here. If you select "yes" to having this absence excused from the standard attendance policy then you will be led to a 2nd form that is only sent to the HR team.