Year Enter the year . Date End Date Hours Worked Enter the begin date of the work week. Enter the end date of the work week. Enter for each day the number of hours worked. Enter leave usage on days in which leave was used.
Date Enter the date the form was completed by the employee.
Signature of Employee Employee signs here. Date Enter the date the form was reviewed by the supervisor. Head Supervisor or department head signs here after reviewing and approving the information on the form. These codes are to used when recording leave usage. Record Retention Keep original for departmental records.