COVID 19- Leave Advancement
Request ONLY
Name: UofSCID:
Department: Dept. No.:
This form is to be completed by employees requesting an advance up to 15 days of additional sick
leave related to COVID-19 if the event extends beyond available sick leave. Documentation from a
health care practitioner is not required. It is the responsibility of the employee or leave administrator to
enter the proper COVID-19 code in iTAMS. Upon return to work, all sick leave earned by the employee
will be applied to the sick leave deficit until the deficit is eliminated. Please email the completed form to
BENEFITS@mailbox.sc.edu.
Beginning Date: Ending Date: Total Hours Requested:
Brief Explanation of Leave Requested:
Attach additional sheet if necessary. Check here if additional sheet attached.
Signature of Employee (Sign original in blue ink) Date
If employee is not available for signature, please attach a copy of the request from the employee to this form.
TO BE COMPLETED BY DEPARTMENT: Approved Denied (Please retain copy for your file.)
Comments or Reason for Denial:
Signature of Department Head (Sign original in blue ink) Date
If Department Head is not available for signature, please attach a copy of their statement of approval to this form.
TO BE COMPLETED BY HUMAN RESOURCES: Approved Denied
Comments or Reason for Denial:
Authorized Human Resources Signature (Sign original in blue ink) Date
COVID-19 3/16/2020
click to sign
signature
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click to sign
signature
click to edit
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click to sign
signature
click to edit
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