Sick time request (fill in and keep a copy)
A printable from Paid Sick Days. Fill it in by hand. Nothing you write is collected by this website.
Sick time request (fill in and keep a copy)
Today's date: ____________
To: ____________ (your supervisor or employer)
I am asking to use my paid sick time:
From ____________ (date and time) to ____________ (date and time)
This is for (check one):
- My own health care or illness
- Care for a family member or my chosen person
- Safety needs after violence or threats
- Jury duty or a court order to be a witness
Your name: ____________
Keep a photo of this note. You do not have to share more details about your health or your safety. Do not write your immigration status here.
From Paid Sick Days. Facts checked October 21, 2026. Free information, not legal or medical advice.