University of Virginia Time Management Form
Please COMPLETE ALL entries. INCOMPLETE FORMS WILL NOT BE PROCESSED.
Code
A
AC
BMOD
C
CS
CSAC
CSE
CSHW
E
FP
FS
H
OL
MA
MP
RL
S
SL
UL
VS
Code
CBS
HW
SB
Payroll Elements—Leave
Annual Leave
Agency Closing (Inclement Weather)
BMOD Leave (Bone Marrow/Organ Donor)
Comp Leave
Comp Special Leave
Comp Special Agency Closing (Enter for Exempt and
Non-exempt if employee works on Agency Closing day)
Comp Special Earned (Enter for Non-exempt who work on
their alternate work schedule day off)
Comp Special Holiday Worked (Enter for Exempt. For
Non-exempt the system will automatically calculate)
Educational Leave
Family Personal Leave (VSDP)
Family Sick Leave (Personal)*
Holiday
*Indicate relationship for absence
Overtime Leave
required by illness or death in
Military Active Duty
“immediate family” or “other
Military Physical
relative sharing employee’s home”:
Recognition Leave
Sick Leave (Personal)
School/Volunteer Leave
University Leave
Sick Leave (VSDP)
Code Civil and Work-Related Payroll Elements—Leave
AM Civil and Work-Related Leave (Check VALID reason code
below and attach supporting documentation as policy requires)
[
[
[
[
[
[
[
[
[
[
Relationship
]
]
]
]
]
]
]
]
]
]
AM-INT
AM-JD
AM-OE
AM-OFE
Mon
Tue
Wed
Thu
Fri
Sun
Mon
Short Term Disability and Workers Comp Leave Types
Workers Comp (Non-VSDP)
NWC
STD (ORP)
Please note leave type, certify,
OSTD
STD (VSDP)
and return to UHR Payroll.
VSTD
STD WC (VSDP)
STD/WC hours will not show
VWC
on timecard.
Employee Certification
Printed Name: ________________________________________________
Signature: ___________________________________ Date: ___________
Supervisor Certification
Printed Name: ________________________________________________
Signature: ___________________________________ Date: ___________
Interview—Other State Agency
Jury Duty
Emergency Disaster Leave
Officer of Election
Sat
Family Medical Leave (FMLA) Payroll Elements—Leave
FMLA Lv Family Member
FMLA leave is to be
FMLA Lv Family Mem No Lv
keyed by the Departmental
FMLA Lv Personal
Timekeeper only.
FMLA Lv Personal No Lv
Signatures certify this information is accurate and complete:
Accompany Minor Child
Administrative Summons
Career Services
Employee Assistance Program (EAP)
Grievance Process
Member of State Council, Commission, Board, Committee
Naturalization Ceremony
Subpoena for Witness or Victim
Unemployment Compensation or Workers’ Compensation
UVA Interview
Department Certification
Timekeeper Name: _____________________________________________
Timekeeper Extension: _________________________________________
Organization: _______________________________ Assignment #: _______________ Payroll: Bi-weekly
Date
Code
FMF
FMFN
FMP
FMPN
[ ] Original Submission - or [ ] Correction Only (Complete as it should have been done
circling corrections)
If this is a correction only, please choose one below:
[ ] Pay Adjustment Only
[ ] Leave Adjustment Only
[ ] Both Pay and Leave Adjustment
___________________________
Payroll Elements—Earnings
Call Back Supplemental (Enter for Non-exempt only)
Hour Worked (Enter for Non-exempt only)
Stand By (Enter for Non-exempt only)
Code
*PLEASE
CHECK ONE OF THE FOLLOWING (Required): Tue
Pay Period: Begin Date_____________ End Date ______________
Wed
Thu
Fri
Sat
Note: The deadline for all retroactive timecards is the Wednesday prior to the payroll processing week.
Sun
Total
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