Vacation Plan Worksheet
An employee and supervisor use this form when the employee is at or near the maximum vacation accrual.
- The employee fills out the top line and gets the information for the second line from the department personnel assistant.
- The employee completes the "Employee's Vacation Request" box. The hours requested should be enough to bring the balance below the maximum by at least one month's worth of accruals.
- The supervisor fills out the "Supervisor's Response" box.
- The employee and supervisor fill out the left side of the section marked "Agreement and Time Record." The supervisor retains the original and gives the employee a copy.
- As time goes by, the employee and the supervisor each record the actual hours, until the plan is carried out.

