December 2017 RRJ
Monthly Faculty Sick Time
Please indicate the days off when you were sick by placing an “X” next to the date during the month of .
Return the completed form within one week of using sick hours. Save this form as a Word document for your
records and attach the form in an email to payroll@callutheran.edu.
DAY DAY DAY DAY DAY DAY DAY
Comments:
Employee Name:
Note: This form is set up like a calendar, with space for 31 days.
Sick time may be used for the illness of an employee or an eligible family member; preventive care, diagnosis,
care of treatment of an existing health condition for an employee or an employee’s family member; or for
specified purposes if an employee is a victim of domestic violence, sexual assault or stalking. Click on Sick
Leave Policy to view the sick leave policy in its entirety.
*Employees who are absent from work for five or more consecutive days or is hospitalized for any amount of
time should contact Human Resources to provide a physician’s Return to Work Certification. Employees may
also be entitled to a job protected leave of absence with the use of sick hours concurrently. For an unforeseen or
scheduled need of more than five consecutive days off, employees must contact Human Resources as soon as
practically possible to understand their rights and protocol of such a leave.
