Crisis Lines Time Off Form

Crisis Lines Time Off Form
Please complete this form for any shift where you will be coming in late, leaving early, taking time off in the middle of your shift, or calling out of the entire shift. Please also use this form for any shift trades or shift coverages. Shift/trades and coverages will either show up on the staffing sheet or in your BI schedule depending on how far away the trade is. We ask that you follow all shift/trade guidelines when doing shift trades. For more information see our Attendance Policy.

This form is not for vacation/PTO requests. Please submit any vacation/PTO requests directly into ADP with more than 2 weeks notice.
Is this an update to a previous entry?*

YesNo
Name*
If your name is not on the list, please contact data@linesforlife.org to get your name added.
Please put your full name if your name is not listed.*

First NameLast Name
Supervisor approving timecard*
Actual Shift Start Date (Pacific Time)*

MonthDayYear
Date
Actual Shift Start Time (Pacific Time)*

Hour Minutes

AM/PM Option
Time off duration*

Partial Shift - Late ArrivalPartial Shift - Extended Mid-Shift BreakPartial Shift - Early Departure1 Full ShiftMultiple Full Shifts
What time will you be available to start working your shift? (Pacific Time)*

Hour Minutes

AM/PM Option
What are the start and end times of the extended mid-shift break?
(Please list them in the Pacific Time Zone):
Extended Break Start Time*

Hour Minutes

AM/PM Option
Extended Break End Time*

Hour Minutes

AM/PM Option
What time do you need to or wish to leave your shift? (Please list in the Pacific Time Zone)*

Hour Minutes

AM/PM Option
Time Off End Date*

MonthDayYear
Date
Are you requesting off multiple partial shifts in a row?*

YesNo
If requesting multiple partial shifts, what is the start date?*

MonthDayYear
Date
If requesting multiple partial shifts, what is the end date?*

MonthDayYear
Date
What type of shift is this?*

Regularly-scheduled shiftHigh needs shiftImmediate needs shiftIndependent learningPreceptee (I am in training)Preceptor (I am training someone)Shift I'm coveringOther
Have you found coverage for this shift?*

YesNo/Not Applicable
Name of person covering your shift*

First NameLast Name
Email of person covering your shift (A copy of this entry will be sent to this email.)*
example@example.com
Date of shift coverage*

MonthDayYear
Date
Time of shift that is being covered (please use Pacific Time)*
Is an additional person covering part of your shift?*

YesNo
Name of second person covering your shift*

First NameLast Name
Email of second person covering your shift (A copy of this entry will be sent to this email.)*
example@example.com
Date of coverage by the second person*

MonthDayYear
Date
Time of shift that is being covered by the second person (please use Pacific Time)*
Is a third person covering your shift?*

YesNo
Name of third person covering your shift*

First NameLast Name
Email of third person covering your shift (A copy of this entry will be sent to this email.)*
example@example.com
Date of coverage by the third person*

MonthDayYear
Date
Time of shift that is being covered by the third person (please use Pacific Time)*
Is a fourth person covering your shift?*

YesNo
Name of fourth person covering your shift*

First NameLast Name
Email of fourth person covering your shift (A copy of this entry will be sent to this email.)*
example@example.com
Date of coverage by the fourth person*

MonthDayYear
Date
Time of shift that is being covered by the third person (please use Pacific Time)*
Is a fifth person covering your shift?*

YesNo
Name of fifth person covering your shift*

First NameLast Name
Email of fifth person covering your shift (A copy of this entry will be sent to this email.)*
example@example.com
Date of coverage by the fifth person*

MonthDayYear
Date
Time of shift that is being covered by the fifth person (please use Pacific Time)*
Is a sixth person covering your shift?*

YesNo
Name of sixth person covering your shift*

First NameLast Name
Email of sixth person covering your shift (A copy of this entry will be sent to this email.)*
example@example.com
Date of coverage by the sixth person*

MonthDayYear
Date
Time of shift that is being covered by the sixth person (please use Pacific Time)*
Is this a tech issue that requires LFL assistance?*

YesNo
Is your tech problem:*

PowerInternetLFL Technical ProblemOther
Did you submit a Help Desk ticket?*

YesNo
Please troubleshoot with your supervisor. If the problem still persists, please submit a Help Desk ticket here: https://linesforlife.sd.cloud.invgate.net/portal
Please provide a brief synopsis of the tech issue.*
Is this absence related to protected leave such as family and medical leave reasons, accommodations with HR, a natural disaster, or other extenuating circumstances?*

Yes - I need to fill out the HR leave of absence form for a new or changed leave.Yes - I already have an approved leave of absence on file with HR and am just providing the leave utilization dates.I would like to request more information from HR to learn more about leaves of absence (you will be sent to the HR help desk upon completion of this form).No
Please enter your email address below to receive confirmation of this form.*
example@example.com
Notes
Please do not share why you are calling out; however you can put here anything extra about logistics such as, "my shift starts on 5/4 and I'm leaving early at 7a on 5/5" or "This is an ops sup filling out on someone's behalf" or "I'll be gone July 9-11th and working next on July 13th." Please know that the contents of this form will be sent to the supervisors, substitute supervisors, and staffing teams. Additionally, depending on what you selected, it may be sent to the IT, workforce development, or training team(s). Please don't share any confidential information you'd like to keep private. If you selected "yes" to "Is this absence related to protected leave such as family and medical leave reasons, accommodations with HR, a natural disaster, or other extenuating circumstances?" you will be forwarded to a different form that will only be sent to HR, and that is where you can put any relevant reasons for why you are calling out to help them excuse your absence.
Date Form Was Opened

MonthDayYear
Date and Time Form Was Opened are used in calculation to determine whether Scheduling also gets emailed this form!
Time Form Was Opened

Hour Minutes

AM/PM Option
Date Difference (Shift Start Date - Form Open Date)
Calculated field = Adjusted Shift Start DateTime - Adjusted Form Open DateTime | Adjusted = Date * 100 + Time (otherwise the decimals overlap)
Should be Empty: