Request Time Off

Queen's University - Department of Surgery Training Program

Off Service Residents Time Off Request Form

This form is to be used by residents from programs outside of Department of Surgery.

Request MUST be submitted no later than 4 weeks prior to the start date of the block you are requesting time off for.
The Program manager will request approval of your request from the Chief Residents and the Program Director and will input approved leave into your WebEval system notififying you when a final decision has been made.
Should your vacation be denied, you will be notified immediately and an alternate leave period will be suggested.

ATTENTION: General Surgery and Ortho Residents

DO NOT USE THIS FORM

All General Surgery and Ortho Residents should use the Resident Calendar login located here

If you require assistance please contact the Department of Surgery:

Kim Telford
email: kim.telford@kingstonhsc.ca

Part 1: Resident Identification

Resident Name	Pager
Home Program	Email	This Email Address will be used to send you the acceptance or denial of this request. Please ensure it is entered correctly
Post Grad Year

ATTENTION: PLEASE READ THE VACATION GUIDELINES CAREFULLY BEFORE SUBMITTING THIS FORM. By Submitting this form, you are indicating that you have read and accept the guidelines.

Part 2: Enter Vacation Request Details

Select Time Off

Select between 1 to 5 work days and can include a weekend
Start Date
End Date
Work Days Off
Note

Interview leave duration is permitted between 1 to 5 work days and can encompass a weekend
Start Date
End Date
Work Days Off
Note

Select Floating Lieu Day or Holiday worked that earned this day in Lieu.
Holiday Worked
Lieu Day
Work Days Off
Note

Start Date
End Date
Work Days Off
Note

Start Date
End Date
Work Days Off
Note

Part 3: Submit Request

Confirm all time off request details are correct before submitting.

Once the form has been submitted, make sure to check your email for confirmation that the request has been received. If you do not receive an email, contact the Internal Medicine Program Office.

Note: An email is also sent to the Home Program Office as selected within the "Home Program" Drop Down Box above.

The Internal Medicine Program office will provide you with an acceptance or denial response within 14 days.

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