Employee / Employee ID		25	26	27	28	29	30		31	1	2		3	4	5	6	7	8	9	
     	     	     	     	     	     	     	     	     	     	     	     	     	     	     	     	     	

Time period:	     
through	     
Department:	     
     
     

INSTRUCTIONAL FACULTY LEAVE REPORT

Key:

S

-

-

-

-

FS

-

	Sick Leave Taken
	Family Sick Taken (identify family member)
Workers Compensation

W

-

Signature of Person Preparing Report

Authorized Signature

 
Employee / Employee ID		10	11	12	13	14	15		16		17	18	19	20		21	22	23	24	
     	     	     	     	     	     	     	     	     	     	     	     	     	     	     	     	

Time period:	     
through	     
Department:	     
     
     

INSTRUCTIONAL FACULTY LEAVE REPORT

Key:

S

-

-

-

-

FS

-

	Sick Leave Taken
	Family Sick Taken (identify family member)
Workers Compensation

W

-

Signature of Person Preparing Report

Authorized Signature