Request to Receive Donated PTO

If you wish to receive PTO Donation, please complete the form below. Please note you will need to submit a new request each pay period.


  • Care team members in need of receiving additional PTO through the donation process, must complete a PTO Donation Request Form within 2 weeks of exhausting PTO.
  • Please note only qualifying care team members who have exhausted their PTO bank and are on an approved continuous leave [associated with Family and Medical Leave (FML), Americans with Disabilities Act (ADA), Short Term Disability (STD), and Personal Leave] will be eligible to receive donated PTO.
  • The following types of leave do not qualify as eligible time away under this policy: intermittent leave, leave or time missed from work associated with a work-related injury, or leave associated with bonding, military, or disaster response.
  • Care Team Members who have requested to save a week of PTO are not eligible to receive PTO Donation.
  • Please see the MaineHealth PTO Donation Policy https://mainehealth.ellucid.com/documents/view/16259?product=polic for more information.



For questions, please contact the Support Center via the ASK HR icon located on all MaineHealth Desktops or phone at 207-661-4000.


We encourage you to select the box at the bottom of this form to receive an emailed copy for your records.

Please write N/A if non applicable

If you do not know your Employee ID number, please contact the HR Support Center at 207-661-4000.

Local Health Care System*

Please note the MaineHealth PTO Donation policy does not apply to Maine Health Care at Home. Care Team Members who are part of this entity are not eligible to receive or donate PTO.

The week ending date should be a Saturday. Week endings may not be more than two payroll cycles in advance.

The week ending date should be a Saturday. Week endings may not be more than two payroll cycles in advance.

By checking the box below I certify that I meet the eligibility requirements outlined above and on an approved leave of absence.

 

Powered by Smartsheet Modern Logo On Light
Privacy Notice|Report Abuse