Crisis Lines Time Off

Crisis Lines Time Off Form

Crisis Lines Staff, please complete this form whenever you are requesting time off or are unable to work all or a portion of your regularly scheduled shift. The Staffing Team reviews requests within 48 hours to see if the time off can be approved based on coverage, and this also notifies Supervisors of absences or shift modifications in a timely manner.

First & Last Name of Person Requesting Time Off or Taking Unscheduled Time Off*
Is this for shift(s) less than 48 hours away?*
- Yes
- No
Time off duration*
- Partial Shift
- 1 Full Shift
- Multiple Days
Start Date*
Date Format: MM slash DD slash YYYY
Start Time (Pacific Time)*

: HH

MM
End Date
Date Format: MM slash DD slash YYYY
End Time (Pacific Time)*

: HH

MM
If you found a coworker to switch shifts for you, please list their name and the shift to which you are switching.
Notes
Is the reason for this time off for family and medical reasons that may be protected by Sick Leave, Family & Medical Leave Acts, ADA or due to technology failures or a personal crisis that you'd like to request have excused by HR?
If you check yes, you will be directed to complete a second form that will be reviewed by HR to determine whether or not this absence is approved. Otherwise Lines for Life's Attendance & Tardiness policy will be followed.