EMPLOYEE ATTENDANCE Office of Education MONTHLY REPORT PLEASE PRINT Name Month Year Identification # Division: Department: Absence Explanation/Comments Supervisor Approval Date Code(s) Substitute Name ABSENCE CODES 1 Code Reason 2 982 Administrative Assignment* 3 970 Bereavement* 4 971 FMLA* 5 984 Floater/Birthday holiday* 6 901 Illness/Medical 7 910 Illness/Medical (AB1522 max 24 hrs) 8 980 Jury Duty 9 981 Military Service* 10 931 Personal Compelling 11 921 Personal Necessity 12 985 Unpaid* 13 941 Vacation* 14 983 Workers’ Compensation* 15 *REQUIRES PRE-APPROVAL Absence Definition on Reverse 16 17 Absence Reporting 18 Employees must report all absences in advance to their supervisor. 19 Employees must comply with individual 20 departmental rules relative to advance reporting of absences. 21 22 23 PLEASE CONTACT THE PAYROLL DEPARTMENT TO APPLY FOR THE 24 FOLLOWING LEAVES: Medical (over 10 days) 25 FMLA/CFRA Catastrophic Leave 26 27 Maternity/Paternity Leave FMLA/PDL/CFRA 28 Sabbatical 29 30 Unpaid Leave of Absence 31 Workers’ Compensation FMLA/CFRA THIS REPORT SERVES AS THE OFFICIAL RECORD OF EMPLOYEE ABSENCE(S): Absences should be indicated with the appropriate code and amount of time in 15 minute increments. Sign and submit monthly to your immediate supervisor on the last working day of each Reports must be completed even if there are no absences. Employee’s Signature Date Supervisor’s Signature Date Original to be forwarded to the Payroll Department by the SIXTH (6th) of the following month HR-45 (Revised 4-2018)
Office of Education EMPLOYEE ATTENDANCE MONTHLY REPORT PLEASE PRINT Name Month Year Identification # Division: Department: Date Absence Code(s) Explanation/Comments Substitute Name Supervisor Approval ABSENCE CODES 1 Code Reason 2 982 Administrative Assignment* 3 970 Bereavement* 4 971 FMLA* 5 984 Floater/Birthday holiday* 6 901 Illness/Medical 7 910 Illness/Medical (AB1522 max 24 hrs) 8 980 Jury Duty 9 981 Military Service* 10 931 Personal Compelling 11 921 Personal Necessity 12 985 Unpaid* 13 941 Vacation* 14 983 Workers’ Compensation* 15 *REQUIRES PRE-APPROVAL 16 Absence Definition on Reverse 17 Absence Reporting Employees must report all absences in advance to their supervisor. Employees must comply with individual departmental rules relative to advance reporting of absences. 18 19 20 21 22 23 PLEASE CONTACT THE PAYROLL DEPARTMENT TO APPLY FOR THE FOLLOWING LEAVES: Medical (over 10 days) FMLA/CFRA Catastrophic Leave Maternity/Paternity Leave FMLA/PDL/CFRA Sabbatical Unpaid Leave of Absence Workers’ Compensation FMLA/CFRA 24 25 26 27 28 29 30 31 THIS REPORT SERVES AS THE OFFICIAL RECORD OF EMPLOYEE ABSENCE(S): Absences should be indicated with the appropriate code and amount of time in 15 minute increments. Sign and submit monthly to your immediate supervisor on the last working day of each Reports must be completed even if there are no absences. Employee’s Signature Date Supervisor’s Signature Date Original to be forwarded to the Payroll Department by the SIXTH (6th) of the following month HR-45 (Revised 4-2018)