PTO REQUEST FORM

Region:*

DATE SUBMITTED

MonthDayYear

Employee Name*

First NameLast Name

REQUESTED DATES OFF*

TOTAL # of DAYS REQUESTED*

Total # of PTO Days Available to Employee*

MANAGER NAME*

Scheduled?

Unscheduled?

Declined?

Unpaid?

Human Resources System Entry Date

Approved by Supervisor/Date

ACKNOWLEDGEMENT *

NOTE: Approval of PTO will be based on the needs of the business. Request for PTO with less than one (1) week advance notice will be approved at the Manager’s discretion. Employees can use unearned PTO, up to the allowable maximum negative balance of five days per the Quench PTO policy, so long as the employee’s current PTO plan would allow them to earn such amount before the end of the calendar year. PTO may be taken in increments as low as four (4) hours.

PTO FORM