UTS Official Time Off Request Form 2023

UTS Official Time Off Request Form 2023

Please feel free to utilize this form as needed.

Time off Guidelines

For Full-Time and Part-Time Therapists, your Time Off Requests are for approval by Marina and Misty.
For PRN Therapists, you must file your Time Off so that we may plan and prepare accordingly for your patient's coverage.
For admins, you must file your time off two weeks prior to your intended time off. All requests are subject for approval by Misty.

For the admin team, kindly provide the name of the employee to whom you have delegated your task in the "Remarks" section.

Date Added*

Name*

Please state your full name

Time Off Start Date*

If you have a multiple date range, kindly fill out a new form. Thank you!

Time Off End Date*

If you have a multiple date range, kindly fill out a new form. Thank you!

Type of Leave*

For PRN: N/A

For W2 employees Only: I am filing for Unpaid Time Off.

For W2 employees Only: I am filing for Flexible Day Off. (Taking a Weekday off and will compensate on the weekend. Must meet target caseload requirement. Otherwise, Paid Time Off will be utilized according to current balance in Gusto.)

For W2 employees Only: I am filing for Paid Time Off. Please also make sure to file it on Gusto.

I am from the admin team.

Do we need to reassign your patients?*

Yes - All

Yes - Partial

Unknown

Patient List*

Visit Dates and Name of the Patients that needs reassignments.

Remarks

Send me a copy of my responses

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