HomeMy WebLinkAboutOCDSB 138-A-ELEM LTO - Elementary LTO Leave RequestsLEAVE REQUEST – FORM 138-A-ELEM LTO
ELEMENTARY LTO ABSENCES
Completed by ELEM LTO: Submit this form to your Principal for approval prior to your leave (when possible)
Full Day
Part Day Surname First Name EIN FTE Absent %
Date(s) of Absence From To Absence Time(s) To
MMM DD, YYYY MMM DD, YYYY HH:MM HH:MM
# Days Absent - enter # of days absent beside applicable reason (eg: _0.50_ DAYS – Sick Leave) Key
Codes Replacement Information
Days – Sick Leave/Medical Appt. (Standard medical certificate required on 6th consecutive day) SL Field Trip
Days – Death in Immediate Family (Indicate in drop down) C First Duty
Days – Death in Family, Serious Illness in Family, Personal Reasons (Indicate in drop down) D Presence - Fifth Disease
Phys.Ed
Days – Jury Duty/Court Leave (Attach summons as juror or witness) F Outdoor Duty
Days – Religious Holy Days (State recognized holy day in details below) G Swimming
Days – Leave W ithout Pay (State reason below) IR/INR 2nd Floor, No Elevator
Days – District Based Prof. Activity (State activity in details below) Release
Code RM/RN
Special Activities
Details:
Employee Signature confirms leave to be used for reason selected Date School / Site
Completed by Principal: Signature indicates acceptance of leave request/reasons (provide a signed copy to Employee upon request)
Principal / Vice-Principal Signature Superintendent of Instruction Signature Signature indicates Absence(s) have been entered.
To adjust locked records, Supervisor emails completed 138 to employee.wellness@ocdsb.ca for entry. (unlocked records are prior/current week)
To verify your usage, access https://webapps2.ocdsb.ca/ipps/ and log into Employee Inquiry (same as accessing a Board computer)
Personal information on this form is collected under the authority of the Education Act, RSO 1990, Ch. E.2 as amended and used for the purpose of reporting employee
leave. Questions regarding the collection of information should be addressed to the Freedom of Information Co-ordinator, 133 Greenbank Road, Ottawa, ON, K2H 6L3 or at
613-596-8211. The responsibility centre for this form is the HR Operations Officer.
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