State Form 14304 - Employee Attendance Report
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1Name of employee (last, first, middle)
EMPLOYEE ATTENDANCE REPORT
A-4
State Form 14304 (R4 / 12-99)
Employee number
Approved by State Board of Accounts 1997
Classification Title
INSTRUCTIONS
Agency / Division / Section / Unit
1. This form must be completed by each employee and approved by the immediate
supervisor (except where use of an alternate attendance report has been approved
by the State Board of Accounts).
Account
2.
Enter number of hours rounded to the nearest quarter hour (15 minutes = .25;
30 minutes = .50; 45 minutes = .75; 60 minutes = 1.00).
On the day that holidays are observed, enter in the Holiday box the number of hours
3.
Bi-weekly pay period
you would normally have been scheduled to work. If you worked the holiday, also
enter in the Other Compensable Hours worked box, all hours actually worked.
20
Sunday,
through Saturday,
4.
All overtime must be pre-approved. For payable overtime, you will only be paid
the overtime if total hours for the week meet overtime requirements.
5.
Working hours in excess of the minimum required does not entitle an overtime exempt employee to overtime pay or compensatory time off unless special
authorization has been received for this pay period. Special overtime pay authorization should be explained in the comments section. Compensatory time
accrued or used by exempt employees should also be recorded on the Compensatory Time Worksheet.
6. If an absence is covered by the Family and Medical Leave Policy, enter the hours of absence in the appropriate Paid or Unpaid Leave box AND in the Family
and Medical Leave box.
7. Total regular hours should equal regular bi-weekly schedule (for example 75.00). This includes regular hours worked, holiday pay, vacation,
sick, personal, compensatory and other leave hours.
TIME ENTRY
S
M
T
W
T
F
S
S
M
T
W
T
F
S
DESCRIPTION
TOTAL HOURS
Regular
Hours worked
Other Compensable
Hours worked
Holiday
Vacation leave
Sick leave
Personal leave
Compensatory
leave used
Funeral leave
Military leave
Jury duty
Leave without
pay
Other Leave
(specify below)
Family and
Medical Leave
Total Regular Hours
Overtime Summary to be completed by payroll clerk
Week 1:
Week 2:
Regular Overtime
Premium Overtime
Regular Overtime
Premium Overtime
Total Compensatory Hours Accrued This Pay Period:
Regular
+ (
Premium x 1.5) =
Total Other Hours Payable This Pay Period:
Regular
+ (
Premium x 1.5) =
Conversion of Regular 7.5 Hour Days to Total Hours
Days
10.0
9.5
9.0
8.5
8.0
7.5
7.0
6.5
6.0
5.5
5.0
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
Hours
75.00 71.25 67.50
63.75
60.00
56.25
52.50
48.75
45.00
41.25
37.50
33.75
30.00
26.25
22.50
18.75
15.00
11.25
7.50
3.75
Comments
I certify this report is correct.
Signature of employee (claimant)
Date signed
Approved by:
Date signed
See additional information on back of form
See attachments
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