University of Notre Dame Weekly Report of Absence and Overtime Worked Non-Exempt Salaried Staff

*Note: Supervisor's, please retain a copy of this form in your office for reference. *Forms must be submitted weekly. Please submit only one(1) form per week to Payroll.

Name: Last NDID (only): (9 digit #only-located on employee ID card) Department: First Middle

Normal Hours Worked/Week:

* Accumulated sick leave is available in the event of Personal Illness (SKS & SFS) and medical and/or dental appointments. * Up to five days per calendar year of the accumulated sick leave may be used for Family Illness (FSS & FFS), which includes the illness and medical and/or dental appointments of a child, stepchild, spouse, and/or parent * Employees may use two days of their sick leave per calendar year for personal reasons. Personal Days (PRS) may be taken in one-half day increments and must be scheduled and approved in advance by the department supervisor. * Details on Sick Leave, Vacation, FMLA, and Payment of Overtime are available online at http://www.nd.edu/~hr/PolicyManual

Report of Absence & Overtime Saturday Date Number of Hours Sunday Monday Tuesday Wednesday Thursday Friday

Code

Absence & Overtime Codes Code Description SKS FSS VAS PRS UNM Footnotes:
Sick Family Sick Vacation Personal Day Unpaid

Total Hours

Code SFS FFS VFS UFM

Description
FMLA Sick FMLA Family Sick FMLA Vacation FMLA Unpaid

Total Hours

Code OVN ORG FNS JDS

Description
Overtime Regular/ 2 Overtime Funeral Jury Duty
1

Total Hours

(1) Only hours actually worked count in the calculation of overtime. University holiday hours, sick leave, vacation hours, jury duty, and funeral time are not counted as time worked in computing overtime for the work week. (2) Extra hours worked during a week with time-off are paid at regular rates (code ORG.) Total hours worked must exceed 40 per week for employee to be paid premium overtime (code OVN). Reason for Absence(s) (e.g., medical appointment, funeral; include relationship to deceased person):

*Do not disclose medical information

Reason for Overtime or Additional Hour(s) Worked (e.g., to complete xyz project, to meet work demands) :

My signature certifies that the information indicated above is true and complete to the best of my knowledge, and I understand that any false statement or failure to provide related information requested by my supervisor may be grounds for corrective action.

Employee's Signature:

Campus Ext #:

________
Date

I certify that these leave hours are available and the hours worked should be paid as needed.

Supervisor's Signature: Supervisor's Printed/Typed Name: Dept Head's Signature (Optional):

Campus Ext #:

________
Date

Date

Route to Payroll Services, 724 Grace Hall

http://controller.nd.edu/forms/absence_OT_forms.xls

Revised 4/11