Substitute Public Holiday Form
When an Employee is required to work on a Statutory Public Holiday and notified
of this requirement, they must complete this form, as per HR Policy 502, that will
outline the substitute day off of work. The Supervisor will consult with the Employee to
identify a suitable substitute holiday date which is agreeable to both the University and the Employee.
Section 1. (To be completed by Employee):
Date form filled out:
Employee Name:
Position Title:
Immediate Supervisor:
Union / Employee Group (where applicable):
Employment Status (Select one):
Public Holiday to be worked (Select one):
Substitute date(s)**:
Employee Signature:
Section 2. (Completed by Supervisor or Designate):
Supervisor’s Signature:
Date form provided to Employee:
* Civic Holiday AND the Day before New Year’s Day are not public holidays for Part-time
** Should an agreement to take the substitute day over more than one day, please indicate all dates
and number of hours on each date identified.
*** All PT employees and any TFT employees who are time reporting (working variable hours) will
receive statutory holiday pay based on the ESA calculation. Any substitute day off provided for these
individuals would be unpaid. In this situation, should an employee wish to forgo the unpaid day please
indicate this on the form.
A copy of this form shall be given to the employee and a copy retained by supervisor.
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