Benefit Time Record

The Benefit Time Record (BTR) is used to record time worked for exempt staff. Each Record covers one calendar month. BTRs should be completed and submitted to Human Resources by the tenth of the following month. All fields except Comments and Attachment are required.

Employee name*

Supervisor name*

Supervisor email*

This information will be used to route this form to your supervisor. If it is incorrect, your supervisor will not receive your form.

Month*

Indicate the month for this BTR

Year*

Indicate the year for this BTR

Days of the month

For each day of the month, select the option from the drop down that best describes your day. Days are defaulted to "Worked" so that you only need to change the days for which the "Worked" code is not the best one.

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Comments

If you need to add an explanation for any entry on your BTR, please include it here. If you are taking the holiday for your birthday, please include your birth month and day here. Thank you.

Attachment

If you had jury duty this month, please attach a PDF of the summons or certificate. If you had bereavement time, we are sorry for your loss. Please attach a PDF of the obituary for your family member. Thank you.

Accepted file types: pdf, Max. file size: 50 MB.

Certification*

By checking this box, the employee named above certifies that this record is accurate and correctly represents the days worked by the employee at the direction of the supervisor. Checking this box should be interpreted the same as signing a form.

Optional: Email

If you would like a copy of this form emailed to you, please include your email address below.