SICK PAY FILING

Use the form below to file for sick pay for absences due to injury or illness. The form must be completed for one date at a time and for up to three events on each single date. For additional days or events, please repeat the form with a second (or more) submission(s).

"*" indicates required fields

Filing Information :

Coach/Employee Name*

Date of Sick Absence*

Nature (description) of Illness or Injury*

Event(s) Information :

Event #1 (required)

Type of Event (1)*

Team Affected (1)*

Hours Missed (1)*

Was there a substitute covering the event (1)?*

Yes

No, event was cancelled

Name of Substitute (1) (if applicable)

Event #2 (optional)

Type of Event (2)

Team Affected (2)

Hours Missed (2)*

Was there a substitute covering the event (2)?

Yes

No, event was cancelled

Name of Substitute (2) (if applicable)

Event #3 (optional)

Type of Event (3)

Team Affected (3)

Hours Missed (3)*

Was there a substitute covering the event (3)?

Yes

No, event was cancelled

Name of Substitute (3) (if applicable)

Additional Information (optional) :

Please provide any additional information necessary:

Sick Pay Filing

SICK PAY FILING

Filing Information :

Event(s) Information :

Event #1 (required)

Event #2 (optional)

Event #3 (optional)

Additional Information (optional) :