Time Clock Adjustment Form - Ohio State University



|Name |Employee ID # |Week of |

|Check all Boxes that Apply |

| Clock In/Out (fill out calendar below) Explanation: | Lunch Adjustment (fill out calendar below) | Project # Correction (fill out calendar below) |

| |Explanation: |Explanation: |

| Billable Overtime (fill out calendar below) | Comp Time Earned in Lieu of Overtime Pay (fill out calendar below) |

|Note – Total overtime worked in a day must be taken as either overtime pay or compensatory time earned. Daily overtime cannot be split between the two. |

| Family and Medical Leave Work-Related Injury or Illness Neither |

| Leave Request/Adjustment (again, check all boxes that apply) |

|Paid Leave |

|Dates |

|# Hours |

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|Unpaid Leave |

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|Compensatory Time |

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|Medical* Personal* |

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|Jury Duty or Court Appearance* |

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|Military Leave* |

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|Organ Donation Leave |

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|Parental Leave |

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|Dates |

|# Hours |

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|Sick Leave* |

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|Unpaid Time Off (10 or fewer consecutive working days) |

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|University Business |

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|Vacation |

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|Unpaid Leave of Absence (more than 10 consecutive working days) |

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|Vacation in place of sick leave |

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|Additional Information (reason for absence, etc.) |

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|Above leave is a change to a previously entered and approved leave request. yes no |

|Leave request was entered manually to the timesheet by the manager. yes no |

|Calendar |

|Sunday |Monday |Tuesday |Wednesday |Thursday |Friday |Saturday |

|In |In |In |In |In |In |In |

|Out |Out |Out |Out |Out |Out |Out |

| | | | | | | |

|Hrs |Hrs |Hrs |Hrs |Hrs |Hrs |Hrs |

| | | | | | | |

|Proj # |Proj # |Proj # |Proj # |Proj # |Proj # |Proj # |

| | | | | | | |

|From |From |From |From |From |From |From |

|To |To |To |To |To |To |To |

|Employee Certification - I understand that approval of this request is contingent upon the availability of adequate leave balances. Falsification of this |

|Application for Leave or of the supporting documentation is grounds for disciplinary action, up to and including dismissal. |

|Employee Signature | Acknowledge OSU Leave Policy |Date |

| | | |

|Amended by Date |Approved by Date |WorkForce Updated by Date |

|• All updates must be approved by manager. |

|• Submit a copy to A&P Human Resources at the end of the pay week. |

|* Requires appropriate documentation. Documentation attached. |

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