Sd Form 824 - Osd/jcs/whs Civilian Fitness Wellness Program (Cfwp) Wellness Agreement
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1OSD/JCS/WHS CIVILIAN FITNESS WELLNESS PROGRAM (CFWP)
WELLNESS AGREEMENT
1. EMPLOYEE REQUEST
An employee requesting participation in the CFWP must complete the following Agreement in its entirety to be eligible for
participation in the CFWP.
I,
, request approval to participate in the CFWP as follows:
(print name)
I request the use of regularly scheduled Administrative Leave (Wellness) as indicated below:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Regular
From:
Work
To:
Hours
From:
CFWP
Hours
To:
OR
I request the use of intermittent Administrative Leave (Wellness). (I understand that I must obtain supervisory
approval for each requested use of Administrative Leave (Wellness) prior to using.)
I have read the CFWP and agree to comply with all requirements.
I certify that, to the best of my knowledge, I have no medical conditions or limitations that would put me at risk of
injury or risk of harm to my health if I participated in the CFWP.
I understand that participation in the CFWP is not an entitlement and is subject to supervisory approval.
Employee's Signature
Date
2. SUPERVISOR DECISION
The use of regularly scheduled Administrative Leave (Wellness) is approved:
As requested.
OR
Only on the following days and times
:
(for the reasons specified below)
However, I retain the right to cancel or amend as necessary, subject to workload and/or mission requirements.
OR
The use of intermittent Administrative Leave (Wellness) is approved, with the understanding that the employee must
request supervisory approval prior to each use of Administrative Leave (Wellness). I retain the right to disapprove
as necessary, subject to workload and/or mission requirements.
OR
Participation in the CFWP is denied for the following reasons:
Supervisor's Signature
Date
SD FORM 824, APR 2011
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