Bereavement leave form 2026

1. Click ‘Get Form’ to open the bereavement leave form in the editor.
2. Begin by entering your Employee Name, Rank, and Employee # in the designated fields. This information is essential for identification purposes.
3. Next, provide the Name of the Deceased and your Daytime Phone number. These details help in processing your request efficiently.
4. Indicate your Relationship to the deceased by checking the appropriate box. This section determines the number of paid shifts you may be eligible for.
5. Specify the Length of Shift and Total Number of Shifts Requested (in hours). Ensure that this aligns with your work schedule.
6. Fill in the Dates Requested for your leave. Remember, this form must be accompanied by a copy of the obituary and your shift schedule.
7. Finally, sign and date the form before submitting it to your Site Supervisor for verification.

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