Fillable Bereavement-leave-application-form-hr-108-d- HR108d Compassionate Leave form

Fill Online, Printable, Fillable, Blank Bereavement-leave-application-form-hr-108-d- HR108d Compassionate Leave form Form

Use Fill to complete blank online IRELAND - HEALTH SERVICE EXECUTIVE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Bereavement-leave-application-form-hr-108-d- HR108d Compassionate Leave form

On average this form takes 8 minutes to complete

The Bereavement-leave-application-form-hr-108-d- HR108d Compassionate Leave form form is 1 page long and contains:

  • 0 signatures
  • 0 check-boxes
  • 32 other fields

Country of origin: IRELAND
File type: PDF

Ireland forms for Health Service Executive

BROWSE IRELAND - HEALTH SERVICE EXECUTIVE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Bereavement Leave
Application Form – HR 108 (d)
This form is to be used by employees to apply for Bereavement Leave. Where applicable,
p
lease complete Online, print off, sign , scan and forward to your local processing unit.
HR 108 (d)_V3 NOV 2019 Page 1 of 2 Revised 06/11/2019
Grade:
Personnel No:
I hereby notify my Manager that I am applying to take Bereavement Leave in accordance with the
provisions of HSE HR Circular 029/2019
Father Mother Brother Sister
Father in law Mother in law Child Spouse
Date From : Date to :
To be completed by the Line Manager
I have checked the relevant supporting documentation required for the leave requested and confirm that
the leave complies with the provisions outlined in HSE HR Circular 029/2019
Application Approved: Yes No
Signature:
Date:
Name:
Grade:
Contact Phone No:
E-mail address:
Date :
No. of days leave applied for?
Signature:
Date of Death:
Relationship of deceased to employee:
PPS No: Location:
First Name: Surname:
To be completed by the employee
Date From:
No. of days leave approved:
Date To:
If leave is not approved, state reason:
HR 108 (d)_V3 NOV 2019 Page 2 of 2 Revised 06/11/2019
1. Bereavement Leave may be granted to an employee in the event of the death of a relative
up to a limit of:
(A) Twenty working days (twenty eight calendar days) in the case of a spouse (including a
cohabiting partner), child (including adopted children and children being cared for on the
basis of 'in loco parentis') or any person in a relationship of domestic dependency, including
same sex partners;
(B) Five working days (seven calendar days) in the case of other immediate relatives as
follows: father, mother, brother, sister, father in law, mother in law.
2. In exceptional circumstances (e.g where the employee concerned has lived in the same
house as the deceased or has to take charge of the funeral arrangements) an employee may
be granted up to three working days' special leave on the death of a more distant relative.
3. In a case where an employee has to travel abroad to make funeral arrangements in respect
of a relative specified in 1 (A) or (B), special leave with pay in excess of the limits prescribed
above may be granted at the discretion of the employer.
4. The granting of Bereavement Leave and the amount granted will depend on whether or not
the employee was scheduled/rostered to work for the period in question. Bereavement leave
is granted only at the time of the bereavement to facilitate the employee with time off from
work and is not granted retrospectively where it occurs during days / shifts when an
employee is not normally scheduled/rostered to work.
Further information on bereavement leave is outlined in HSE HR Circular 029/2019. https://
www.hse.ie/eng/staff/resources/hr-circulars/hr-circular-029-2019-re-bereavement-leave-
revised-arrgements.pdf
Explanatory Note on Bereavement Leave
Appendix 1
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Bereavement-leave-application-form-hr-108-d- HR108d Compassionate Leave form

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 3 April 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document