Sick and Safe Time Request Form

Thank you for using the online Sick and Safe Time Request Form. The purpose of this form is to request use of your accrued sick/safe time. Please allow up to 7-10 business days for processing of your accrued sick time.

Integra Health Care will pay out up to the amount of your actual accrued balance at the time this form is submitted. You will not be paid for future or assumed hours. Your accrued balance, if applicable, is available to you on your most recent paycheck.

 

Slick and Safe Time Request Form
Your Name (First and Last Name)
Your Name (First and Last Name)
First
Last
Integra will pay out up to the amount of your accrued balance
Are/were you scheduled to work this day(s)
Acknowledgement

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