CENTRAL OREGON COMMUNITY COLLEGE
FAMILY MEDICAL LEAVE/OREGON FAMILY MEDICAL LEAVE (FMLA/OFLA)
EMPLOYEE MONTHLY TIME SHEET
(PRINT OR TYPE ONLY)
Instructions: Please show the number of hours for each day you have taken off during your FMLA/OFLA leave
(holidays are included as FMLA/OFLA leave). Do not include days you are not expected to work. Return a copy
of this form each month (by the fifth working day of the next month) with your signature, your supervisor’s
signature and date signed, to the Human Resources Office (Location: NEW 103, Office Hours: 8:00 A.M.-4:30
P.M., M-F, Phone: 541-383-7216, Fax: 541-317-3066). (You will need to submit a completed timesheet for each
month you are on FMLA/OFLA leave.)
NAME:
COCC 820# ID:
PHONE NUMBER:
Office #:----------------
Home #:----------------
DEPARTMENT:
Month & Year:
Sunday
Monday
Tuesday
Thursday
Friday
Saturday
Total Hours Used This Month for FMLA/OFLA:
Employee’s Signature: Date:
Supervisor’s Signature: Date:
REV: 08-2013
Saved As: t:\wp\fmla\fmla formscurrent\employee timesheet
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