--- generated_by: surveylegend-page-markdown title: Time Off Request Form Template | SurveyLegend description: Collect proposed dates, full- or partial-day details, and scheduling notes with seven optional fields. Adapt this time off request form to your workplace. canonical: https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/time-off-request-form-template/ --- # Time Off Request Form Template Make a planned time off request easier to review. Collect proposed dates, partial-day details, and a short scheduling note—without asking employees to explain their private lives. [Try this template ](https://app.surveylegend.com/register/)[Preview template](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/time-off-request-form-template/#try-template) Preview on a device Show the desktop survey layout Show the tablet survey layout Show the mobile survey layout **SurveyLegend** 1 / 7 Time Off Request Form What name should the authorized reviewer use for this request? Your thoughts… Next → Time Off Request Form [Preview](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/time-off-request-form-template/#try-template) Share [Facebook ](https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fweb-forms-questionnaires%2Ftime-off-request-form-template%2F)[LinkedIn ](https://www.linkedin.com/sharing/share-offsite/?url=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fweb-forms-questionnaires%2Ftime-off-request-form-template%2F)[X ](https://x.com/intent/tweet?url=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fweb-forms-questionnaires%2Ftime-off-request-form-template%2F\&text=Time%20Off%20Request%20Form%20Template)[Reddit](https://www.reddit.com/submit?url=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fweb-forms-questionnaires%2Ftime-off-request-form-template%2F\&title=Time%20Off%20Request%20Form%20Template) Make a planned time off request easier to review. Collect proposed dates, partial-day details, and a short scheduling note—without asking employees to explain their private lives. A useful request form makes the absence period clear and tells the employee what happens next. This SurveyLegend example provides seven optional fields for planned routine time off. Adapt it to the workplace's approved process before collecting real requests; submitting the public demo does not notify a manager or approve leave. ## When to use this planned time off request form Use this form only for the routine planned requests your organization has approved it to handle. Give employees the reviewer's role, expected response process, and an alternative route when timing is urgent or the request involves sensitive information. This page does not set leave rights, notice periods, pay treatment or eligibility. If the goal is to understand how working arrangements affect employees generally, use SurveyLegend's [work-life balance ](https://www.surveylegend.com/survey-examples-templates/human-resource-and-employee-satisfaction-surveys/work-life-balance-template/)survey instead. Castro and Bleys' 2024 Belgian case study combined 241 survey responses with 13 interviews about additional leave in a flexible benefits plan. The abstract notes “difficulties in taking up the standard amount of leave.” The [additional leave study ](https://www.nature.com/articles/s41599-024-03965-8)is a reminder that offering leave and making it usable are different issues. A request form alone does not remove workload barriers; this study did not test or validate the form. **Create your time off request form in SurveyLegend** A useful request form makes the absence period clear and tells the employee what happens next. This SurveyLegend example provides seven optional fields for planned routine time off. ## Seven questions for your planned time off request form Use the seven questions below. Every field is optional and always visible. Select one answer where choices are listed; leave any irrelevant written answer blank. Respondent introduction:\ For this public example, use fictional details only. In an employer-authorized version, enter the proposed absence period using the stated dates and time zone. All fields are optional here. Do not include medical, family or other sensitive reasons. A request is not approved until the authorized reviewer confirms it. Try the survey ## A little feedback. A clearer picture. Explore this 7-question example at your own pace. Every question is optional. Preview on a device Show the survey at full desktop width Resize the survey to a tablet-width preview Resize the survey to a mobile preview with scrolling inside the frame Choose a look Use Classic: a white survey card over the background photo Use Light: dark text over a light tint covering the background photo Use Dark: light text over a dark tint covering the background photo SurveyLegend demo Question 1 of 7 ### Time Off Request Form 01 What name should the authorized reviewer use for this request? Share your answer, or skip this question. 02 What work contact should the reviewer use to respond? Share your answer, or skip this question. 03 What is the first date of the requested time off? Use YYYY-MM-DD. Share your answer, or skip this question. 04 What is the last date of the requested time off? Use YYYY-MM-DD; repeat the first date for a one-day request. Share your answer, or skip this question. 05 How much of the scheduled working time on those dates are you requesting off? Choose one answer, or skip this question. All scheduled working time Part of one scheduled day or shift A mix of full and partial days or shifts I need help describing the period 06 If any requested day or shift is partial, what exact working hours would you be absent? Include the date and stated time zone; otherwise leave blank. Share your answer, or skip this question. 07 What scheduling detail or clarification should the reviewer consider? Do not include private reasons or confidential work details. Share your answer, or skip this question. #### One last look Review your answers before submitting this demo. 0 answered #### Thank you for trying the survey! You’ve tried the template from the respondent’s side. Make it your own with SurveyLegend. [Create your own survey](https://www.surveylegend.com/register/) Checking submission availability… This is a demo. We count starts and submissions only. Your answers stay in your browser and are never sent or saved. **—**Starts **—**Submissions Activity is temporarily unavailable. ## Customize your planned time off request form State who reviews requests and how the decision reaches the employee before sharing the form. Use one unambiguous date format and specify the time zone for partial shifts. For overnight work, ask the reviewer to confirm the actual start and end of the absence rather than assuming calendar days match shifts. The example uses optional text fields so people can inspect it without supplying personal data. Keep that setting in the public demo; an authorized employer must separately review its real intake requirements and data handling. Do not add a demand that employees find their own replacement or disclose a private reason. For other structured intake examples, browse SurveyLegend's [web forms ](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/). ## Printable planned time off request form template Provide the blank seven-field form through the approved workplace route for employees who prefer paper. Tell employees to give it directly to the authorized reviewer, not leave contact information on a public noticeboard. The reviewer should confirm receipt and the separate decision process. Paper requests are not automatically imported into SurveyLegend or an HR system. ![First page of the printable Time Off Request Form Template with questions and answer spaces](https://www.surveylegend.com/survey-template-media/pdf-previews/time-off-request-form-template-pdf-preview.avif) [Download planned time off request form template PDF](https://www.surveylegend.com/downloads/survey-templates/time-off-request-form-template.pdf) Export planned time off request form template as PDF ## AI prompt for your planned time off request form Create a planned time off intake form with proposed dates, partial-shift details and a scheduling note. Copy this prompt into an AI assistant to draft the questions. Review the draft, then build and customize the survey in SurveyLegend before sharing. An authorized employer must review the form and response process before real use. No automatic manager notification or approval is included. ## Create a planned time off request form AI prompt for your planned time off request form [Create this survey in SurveyLegend](https://www.surveylegend.com/register/) Copy the prompt into an AI assistant to draft the questions, then build your survey in SurveyLegend. Already have an account? [Sign in](https://app.surveylegend.com/login/) to create your survey. ## How to interpret your planned time off request form responses Treat each submission as a request to review, not a survey score. Check whether the dates and partial-shift description agree. Ask for clarification through the approved work contact when details are incomplete; do not guess an end date or reject a person simply because an optional demo field was left blank. Review the request through the organization's applicable process, then record and communicate the decision in the authorized system. A form submission does not reserve dates, update payroll, deduct leave balances or prove approval. If reviewing aggregate requests for planning, minimize personal details and avoid comparing the worth of employees' private reasons. ## Frequently asked questions ### Does submitting this form approve my time off? No. The public demo does not send a request to an employer. In an authorized workplace version, approval still requires confirmation through the employer's stated process. ### Should I describe a medical or family reason? Not in this routine example. Use the organization's separate, appropriate route for sensitive, urgent or protected-leave matters. This template does not determine what information that process may require. ### Can the form calculate my remaining leave balance? Not as specified here. It collects proposed dates and scheduling details for human review. Leave-balance calculations, payroll updates and approval workflows require separately verified systems and rules. Web Forms and Questionnaires Template 1. [![Preview of the Meeting Form Template](https://www.surveylegend.com/survey-template-media/previews/template-meeting-form-template-survey-preview.avif) Web Form: Meeting Form Template Web forms & questionnaires Let’s face it: meetings have a reputation. Some people love them, others just survive them. But with the right tools, every meeting—yes, even the ones that could have been an email—can be clear, organized, and even enjoyable. That’s where the meeting form template from SurveyLegend comes in.](https://www.surveylegend.com/survey-examples-templates/meeting-form-template/) 2. [![Preview of the Suggestion Form Template](https://www.surveylegend.com/survey-template-media/previews/template-suggestion-form-template-survey-preview.avif) Web Form: Suggestion Form Template Web forms & questionnaires Ever wonder what your employees or customers are really thinking? Spoiler alert: they have thoughts. And they’re usually more than happy to share them—you just need to give them the right space to do it. That’s where our suggestion form template comes in.](https://www.surveylegend.com/survey-examples-templates/suggestion-form-template/) 3. [![Preview of the Website Visitor Profile Form Template](https://www.surveylegend.com/survey-template-media/previews/template-website-visitor-profile-form-template-survey-preview.avif) Web Form: Website Visitor Profile Form Template Web forms & questionnaires Your website looks great. Your content is on point. Your services are solid. But let’s ask the real question—who’s actually stopping by? That’s where the magic of a website visitor profile form comes in.](https://www.surveylegend.com/survey-examples-templates/website-visitor-profile-form-template/) 4. [![Preview of the Referral Form demo showing its first question and response field](https://www.surveylegend.com/survey-template-media/previews/referral-form-demo-preview.avif) Referral Form Template Web forms & questionnaires This referral form template helps your team collect the information needed to introduce someone to a service or program. Its eight fields cover the referrer, the requested service, the reason for the introduction, and the next contact step. Adapt the example to your referral process and build your form with SurveyLegend.](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/referral-form-template/) 5. [![Preview of the Client Intake Form demo showing its first question and answer choices](https://www.surveylegend.com/survey-template-media/previews/client-intake-form-template-preview.avif) Client Intake Form Template Web forms & questionnaires Use this client intake form template to collect the details you need before starting a service project. It brings together the client’s goal, requested work, deadline, available materials, and main contact. Adapt it in SurveyLegend to prepare a more focused kickoff conversation and identify missing information early.](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/client-intake-form-template/) 6. [![Preview of the Lead Generation Form demo showing its first question and answer choices](https://www.surveylegend.com/survey-template-media/previews/lead-generation-form-template-preview.avif) Lead Generation Form Template Web forms & questionnaires Use this lead generation form template to find out who wants to hear from your business, what they need, and when they hope to get started. The fields give your team enough context for a useful first reply. Customize the form in SurveyLegend for a service inquiry, consultation request, or product conversation.](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/lead-generation-form-template/) 7. [![Preview of the Newsletter Feedback Form demo showing its first question and answer choices](https://www.surveylegend.com/survey-template-media/previews/newsletter-feedback-form-template-preview.avif) Newsletter Feedback Form Template Web forms & questionnaires Use this newsletter feedback form template to learn what readers find useful and what they would change. It asks about recent reading, topic relevance, frequency, and the ease of finding something worth their time. Create the form in SurveyLegend before planning the next run of editions.](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/newsletter-feedback-form-template/) 8. [![Preview of the Support Request Form demo showing its first question and answer choices](https://www.surveylegend.com/survey-template-media/previews/support-request-form-template-preview.avif) Support Request Form Template Web forms & questionnaires Use this support request form template to understand what a customer was trying to do, what happened, and how the problem affects them. The fields help your team ask fewer avoidable follow-up questions. Create your form in SurveyLegend and connect it to a support process your team can monitor.](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/support-request-form-template/) 9. [![Preview of the Feature Request Form Template demo showing its first question and answer choices](https://www.surveylegend.com/survey-template-media/previews/feature-request-form-template-preview.avif) Feature Request Form Template Web forms & questionnaires 'Add an export button' describes an idea. Understanding what someone needs to export, why, and what happens today gives the team a problem to investigate. Keep that context attached to the suggestion.](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/feature-request-form-template/) 10. [![Preview of the Anonymous Question Submission Form Template showing its first question and answer choices](https://www.surveylegend.com/survey-template-media/previews/anonymous-question-submission-template-preview.avif) Anonymous Question Submission Form Template Web forms & questionnaires An anonymous question submission form gives students a way to send questions without a name field. This example is designed for one college class discussion, with the main question first and six optional fields that help an instructor prepare. Name the session and collection deadline in the invitation. Before describing the actual collection as anonymous, verify the form settings, access arrangements, and any identifying information in responses.](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/anonymous-question-submission-template/) 11. [![Preview of the Email Newsletter Subscription Form Template showing its first question and answer choices](https://www.surveylegend.com/survey-template-media/previews/email-newsletter-subscription-form-template-preview.avif) Email Newsletter Subscription Form Template Web forms & questionnaires An email newsletter subscription form records a person's request to receive a named newsletter. A trustworthy version separates the address from the consent choice, explains what will arrive and avoids collecting preferences that will not actually be used.](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/email-newsletter-subscription-form-template/) 12. [![Preview of the Expense Reimbursement Report Template showing its first question and answer choices](https://www.surveylegend.com/survey-template-media/previews/expense-reimbursement-report-template-preview.avif) Expense Reimbursement Report Template Web forms & questionnaires Use this SurveyLegend example to prepare a request for review. Keep one expense in each response so the date and amount refer to the same transaction. The organization's policy determines what supporting information is needed and who can approve payment; submitting the form does not approve a claim.](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/expense-reimbursement-report-template/) 13. [![Preview of the Incident Report Form Template showing its first question and answer choices](https://www.surveylegend.com/survey-template-media/previews/incident-report-form-template-preview.avif) Incident Report Form Template Web forms & questionnaires A useful first report separates observations from assumptions. The person completing it may know the time and location without knowing the cause. Create the form in SurveyLegend and connect any real use to your organization's approved reporting process.](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/incident-report-form-template/) 14. [![Preview of the Listening Skills Survey Template showing its first question and answer choices](https://www.surveylegend.com/survey-template-media/previews/listening-skills-template-preview.avif) Listening Skills Survey Template Web forms & questionnaires A listener’s intention and a speaker’s experience may differ. This SurveyLegend questionnaire asks about one defined conversation so the feedback can lead to a concrete change rather than a broad label about someone’s character.](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/listening-skills-template/) 15. [![Preview of the Membership Cancellation Request Form Template showing its first question and answer choices](https://www.surveylegend.com/survey-template-media/previews/membership-cancellation-request-form-template-preview.avif) Membership Cancellation Request Form Template Web forms & questionnaires A clear request should be easy to route and easy to acknowledge. Use this example to plan the information your membership team actually needs, then explain how the organization will confirm the request and any next steps. Build your own form in SurveyLegend after checking the workflow.](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/membership-cancellation-request-form-template/) 16. [![Preview of the Online Complaint Form Template showing its first question and answer choices](https://www.surveylegend.com/survey-template-media/previews/online-complaint-form-template-preview.avif) Online Complaint Form Template Web forms & questionnaires Publishing a form is not the same as managing a complaint. State where submissions go, when the channel is monitored, the normal response expectation and what people should do for emergencies, legal notices or urgent safety issues. Do not promise that the form creates a ticket unless that integration exists.](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/online-complaint-form-template/) 17. [![Preview of the Staff Equipment Loan Request Form Template showing its first question and answer choices](https://www.surveylegend.com/survey-template-media/previews/staff-equipment-loan-request-form-template-preview.avif) Staff Equipment Loan Request Form Template Web forms & questionnaires A request for “a laptop” may leave the coordinator guessing about software, accessories, or timing. Build the request form in SurveyLegend so the team has enough context to discuss a suitable item before making a reservation.](https://www.surveylegend.com/survey-examples-templates/web-forms-questionnaires/staff-equipment-loan-request-form-template/) Free survey maker ## Start creating surveys today *for free* Create and bring your ideas to life with the survey tool used by people all over the world. [Get started for free ](https://app.surveylegend.com/register/)[Book a demo](https://www.surveylegend.com/schedule-a-demo-of-surveylegend/) Academic research survey ### Ready to collect better research data? Create academic surveys and questionnaires from ready-made templates. [Sign up!](https://app.surveylegend.com/register/) Share this page [Facebook ](https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fweb-forms-questionnaires%2Ftime-off-request-form-template%2F)[LinkedIn ](https://www.linkedin.com/sharing/share-offsite/?url=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fweb-forms-questionnaires%2Ftime-off-request-form-template%2F)[X ](https://x.com/intent/tweet?url=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fweb-forms-questionnaires%2Ftime-off-request-form-template%2F\&text=Time%20Off%20Request%20Form%20Template)[Reddit](https://www.reddit.com/submit?url=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fweb-forms-questionnaires%2Ftime-off-request-form-template%2F\&title=Time%20Off%20Request%20Form%20Template) Ready when you are ## Create your planned time off request form in SurveyLegend Turn requester name, work response contact, first absence date and the remaining questions into a useful next step. [Start free ](https://app.surveylegend.com/register/)to create your questionnaire in SurveyLegend, adapt the context, and review it before sharing. [*Self-serve* Start free Create your first survey in minutes **Start free** ](https://app.surveylegend.com/register/)[*Guided help* Book a demo Talk with a SurveyLegend expert and choose the right plan. **Book a demo**](https://www.surveylegend.com/schedule-a-demo-of-surveylegend/)