Time off in Lieu Request

This form must be completed by employees prior to working additional hours they wish to accrue as Time Off In Lieu (TOIL).

All TOIL accrual must be approved by the employee’s line manager in advance.

Retrospective requests may not be authorised unless in exceptional circumstances.

If you choose to forgo your break, this form allows you to record the time as accrued Time off in Lieu.

Please note that Time off in Lieu must be approved by your line manager and used in accordance with company policies.

Name of Employee

Employee Company Number

EMPXXAN

Employee Personal Phone Number

Employee Personal Email Address

Employees Job Title

Date of Form Submission

Employee Line Manager

Proposed Date(s) of Additional Work

Expected Time Off in Lieu Hours to Be Accrued

Reason for Working Additional Hours

Will this work occur during a scheduled break (e.g. lunch)?

Yes

Partial Break Only - Please provide details

Employee Declaration

I, the Employee, agree to comply with the company’s Time Off in Lieu policy and understand this is not to replace consistent working hours or regular leave..

Any Additional Comments

If Not Applicable, please enter N/A in this text box.

Employee's Details

Employee's Name

Employee's Email Address

Employee's Phone Number

Employee's Company Number

EMPXXAN

Digitally Typed Signature

Do you agree that your typed full name signature replaces, in this context, your written signature.

Yes, I agree

Employee's Password

First & Last Name Initial followed by the Day, Month, then Year of Your Birth

Date of Declaration

Time of Submission (Digital Format)

Do you confirm that all the information you have provided Today is Correct

Yes, Declaration Made

Would you like to provide any Additional Information?

If Not Applicable, please enter N/A

Time off in Lieu Request

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