Form 400B
TEACHER’S REQUEST AND/OR REPORT OF ABSENCE
Teacher’s Name
School
Date(s) of Absence
Full Day
AM
PM
# of Days Absent
Reason
Location
L
R
S
R
EAVE
EQUESTED
UB
EQUIRED
(please select specific reason)
Full Day
AM
PM
Not Required
ATA
L
A
EAVE OF
BSENCE
ATA Local
Sick Leave
Article 12.08
Article 10.0
ATA Provincial
Compassionate Leave
Article 12.08
Article 12.01.1
for Critical Illness
(Pg 2)
Compassionate Leave
Article 12.01.2
for Death
(Pg 2)
Write an Examination
Article 12.01.3
A
D
Teacher Convocation
BSENT FROM CLASSROOM
UTIES
Article 12.01.4
Paternity
(maximum 2 days)
Article 12.02
C
B
C
1
2
HARGE TO
UDGET
ODE
Adoption
(maximum 5 days)
Article 12.02
A
B
1
2
3
4
5
UTHORIZED
Y
Personal Leave
Article 12.03
(on approval)
Day 1 Day 2
2 Days with pay at no cost of sub
Meeting
Curriculum / SI
Day 3 Day 4
2 Days with pay less cost of sub
Mentorship
SBLT
rd
Jury Duty
Article 12.04
3
Party
Student Services
Family Medical
(maximum 2 days) 1 2
Article 12.05
Personal PD
Field Trip
Leave of Absence Without Pay
Article 14.0
DELF
Other _____________
Teacher Based
Co/Extra-Curricular
1-236-02-07-00-000-??
1-231-02-??-00-000-??
School Based
Other
1-235-02-07-00-000-??
Employee Signature
Date
Principal’s Signature
Date
Comments/Explanation
D
O
U
O
ISTRICT
FFICE
SE
NLY
Yes
No
Leave Approved
Superintendent’s Signature
Comments/Explanation
H:\HOME\FORMS\400 Series Employee Relations\400B Request Report of Absence ATA
August 21, 2014
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