Compressed Workweek Proposal
Employee Information
Name
Position/Title
Department
Supervisor
Email
Requested Compressed Schedule
Proposed Start Date
Requested Schedule (e.g. 4x10, 9x80, etc.)
Days Off Requested
Reason for Request
Business Impact
How will your duties/responsibilities be maintained?
How do you plan to ensure team coverage and responsiveness?
Potential challenges and proposed solutions
Additional Comments
For Supervisor/Management Use Only
Approved/Denied
Approved
Denied
Comments/Conditions
Supervisor Signature
Date