EMPLOYEE INFORMATION – Please print clearly
Name (please print): Date:
Position: Department: _____ __
REQUESTED DATES
Time off requests must be submitted to your manager at least two weeks in advance.
Please be aware that all time off will be scheduled with staffing needs in mind. You have not received approval for your requested time until you are given a signed copy of this request from your manager.
Dates requested: From: To:
Total Number of Full Days: Total hours: […]
This content is for CoAction Insurance policy holders.
To request portal access, send an email to losscontrol@coactionspecialty.com with “Coaction LC Portal” in the subject line and include your policy number in the email body.
