Time Off Request Form (Canada)
TIME OFF / LEAVE REQUEST FORM
[Employer Name]
[Employer Address]
[Employer City], [Employer Province] [Employer Postal Code]
Canada
Date of Request: [Request Date]
EMPLOYEE INFORMATION
Employee Name: [Employee Name]
Position: [Employee Title], [Department] Department
Employee ID: [Employee ID]
Supervisor: [Supervisor Name]
1. LEAVE REQUEST DETAILS
Type of Leave: [Leave Category]
Start Date: [Leave Start Date]
End Date: [Leave End Date]
Expected Return to Work: [Return to Work Date]
Total Business Days Requested: [Total Days]
Day Type: [Leave Time]
2. REASON FOR REQUEST
[Leave Reason]
Note: For statutory job-protected leaves under the Employment Standards Act (sick leave, bereavement leave, family responsibility leave, etc.), the employee is not required to provide detailed personal or medical reasons. The employer may request reasonable evidence of entitlement in accordance with the applicable ESA provisions.
3. LEAVE BALANCE
Annual Vacation Entitlement: [Vacation Entitlement]
Vacation Days Used (Current Year): [Vacation Used]
Vacation Days Remaining: [Vacation Remaining]
Sick Days Used (Current Year): [Sick Days Used]
Under the Employment Standards Act for the Province of [Governing Province], employees are entitled to a minimum of two (2) weeks of vacation after each 12-month vacation entitlement year (three weeks after five years of service in most provinces). Vacation pay is calculated at a minimum of four percent (4%) of gross wages earned during the entitlement year (six percent after five years). Statutory leave entitlements (sick leave, bereavement leave, family responsibility leave) are separate from vacation and do not reduce the employee’s vacation entitlement.
4. EMPLOYEE RIGHTS AND STATUTORY PROTECTIONS
The employee is advised that:
- Statutory leaves under the applicable Employment Standards Act are job-protected. The employer cannot terminate, threaten, or penalise an employee for taking or requesting a statutory leave;
- The employee is entitled to be reinstated to the same position, or a comparable position with no loss in seniority, compensation, or benefits, upon return from a job-protected leave;
- For federally regulated employees, the Canada Labour Code Part III provides additional leave entitlements including up to 10 days of medical leave with pay per year, up to 5 days of personal leave (3 paid), and up to 10 days of leave for victims of family violence (5 paid);
- The employee’s benefits (including group health insurance, pension, and other employer-provided benefits) continue to accrue during statutory leaves unless the applicable ESA provides otherwise;
- The employer is prohibited from requesting a doctor’s note for sick leave of three days or fewer in provinces where the ESA does not require one. Where documentation is required, the employer may request a certificate from a qualified health practitioner but is not entitled to a diagnosis.
5. APPROVAL
Supervisor / Manager Decision:
□ APPROVED — The time-off request is approved as submitted.
□ APPROVED WITH MODIFICATIONS — The request is approved with the following changes: _______________
□ DENIED — The request is denied for the following reason: _______________
Note: Statutory job-protected leaves under the ESA or the Canada Labour Code cannot be denied by the employer. The above approval process applies to vacation leave and company-specific time off. If a statutory leave request has been denied, the employee should contact the Ministry of Labour or the Federal Labour Program for assistance.
6. GOVERNING LAW
This time-off request and the employment relationship are governed by the federal laws of Canada and the laws of the Province of [Governing Province], including the applicable Employment Standards Act and the Canada Labour Code for federally regulated employees.
EMPLOYEE:
Name: [Employee Name]
Title: [Employee Title]
Date: [Request Date]
SUPERVISOR / MANAGER:
Name: [Supervisor Name]
Date: _______________
This form is intended for internal use to request and record time off. It does not constitute legal advice. Employers should consult with a qualified employment lawyer or human resources professional to ensure compliance with the applicable Employment Standards Act, the Canada Labour Code (for federally regulated employers), and any applicable collective agreements. Statutory leave entitlements vary by province and territory. This form references Ontario ESA provisions as a baseline; employers in other provinces should verify the applicable leave entitlements under their provincial legislation.
Employee
________________
Signature
Date: ________________
Supervisor / Manager
________________
Signature
Date: ________________
What Is a Time Off Request Form (Canada)?
A Time Off Request Form in Canada records an employee’s request for time off and the employer’s approval, governed primarily by provincial Employment Standards legislation.
Canadian employment law provides employees with numerous job-protected leaves under both provincial and federal legislation. Each province and territory has its own Employment Standards Act governing minimum leave entitlements, while federally regulated employees (banking, telecommunications, interprovincial transport, Crown corporations) are covered by the Canada Labour Code Part III. The Ontario ESA, for example, provides sick leave (3 unpaid days per year), bereavement leave (2 unpaid days), family responsibility leave (3 unpaid days), pregnancy leave (17 weeks), parental leave (up to 61–63 weeks), family medical leave (up to 28 weeks), family caregiver leave (up to 8 weeks), critical illness leave, domestic or sexual violence leave (10 days plus 15 weeks), organ donor leave, reservist leave, and the new long-term illness leave (up to 27 weeks, effective June 19, 2025).
A well-designed time-off request form helps employers track leave balances, confirm compliance with statutory leave entitlements, and document that job-protected leaves were properly requested and not denied. Proper documentation is essential during Ministry of Labour inspections and employment litigation.
The legal framework governing the Time Off Request Form (Canada) in Canada draws on several key statutes and regulatory bodies. Under the Canada Labour Code (R.S.C. 1985, c. L-2), the Canada Industrial Relations Board adjudicates federal workplace disputes. Provincial employment standards legislation — including Ontario's Employment Standards Act 2000 and British Columbia's Employment Standards Act (RSBC 1996) — governs minimum employment terms. The Personal Information Protection and Electronic Documents Act (PIPEDA) governs private-sector data handling. The Canada Revenue Agency (CRA) administers source deductions and Canada Pension Plan (CPP) contributions. Parties executing a Time Off Request Form (Canada) in Canada should confirm the document reflects current law, including any amendments enacted since the original drafting date. The Canada Labour Code (R.S.C. 1985, c. L-2) sets the foundational requirements.
When Do You Need a Time Off Request Form (Canada)?
A Time Off Request Form is needed whenever an employee plans to be absent from work, regardless of whether the absence is for vacation, personal reasons, or a statutory leave. The form should be submitted as far in advance as reasonably possible for planned absences such as vacation or elective medical procedures. For unforeseen absences such as sudden illness, bereavement, or personal emergencies, the form should be completed as soon as practicable after the leave commences.
The form is particularly important for statutory leaves because these are job-protected under the ESA and cannot be denied by the employer. Documenting the request creates a clear record that the employee properly notified the employer and that the employer acknowledged the statutory leave. This protects both parties in the event of a dispute.
For vacation requests, the form helps manage scheduling and confirms that the employer complies with the ESA’s vacation scheduling requirements. Under the Ontario ESA, employers must schedule vacation in periods of one or more weeks, and the vacation must be completed within 10 months after the end of the vacation entitlement year (unless the employee agrees otherwise in writing). The form also supports internal record-keeping for leave balance tracking, payroll processing, and workforce planning.
Parties in Canada should prepare a Time Off Request Form (Canada) proactively rather than waiting for a dispute to arise. Courts interpret agreements based on the written terms rather than oral representations. Under the Canada Labour Code (R.S.C. 1985, c. L-2), the Canada Industrial Relations Board adjudicates federal workplace disputes. Provincial employment standards legislation — including Ontario's Employment Standards Act 2000 and British Columbia's Employment Standards Act (RSBC 1996) — governs minimum employment terms. The Personal Information Protection and Electronic Documents Act (PIPEDA) governs private-sector data handling. The Canada Revenue Agency (CRA) administers source deductions and Canada Pension Plan (CPP) contributions. Where the transaction involves regulated activities, prior approval from the relevant authority may be required before execution.
What to Include in Your Time Off Request Form (Canada)
An effective Canadian Time Off Request Form must identify the employee by name, job title, department, employee ID, and supervisor. The form must clearly specify the type of leave being requested, and should distinguish between statutory leaves (which are job-protected and cannot be denied) and non-statutory leave (vacation, company PTO) which is subject to employer approval.
The leave dates section must include the start date, end date, expected return-to-work date, and total number of business days requested. For partial-day requests, the form should specify whether the absence is for the morning, afternoon, or custom hours. The reason for the request should be brief — for statutory leaves, the employee is not required to disclose detailed personal or medical information.
The leave balance section tracks the employee’s annual vacation entitlement, days used, and days remaining, as well as statutory sick days used. This confirms that the employee has sufficient entitlement for the requested leave and helps the employer comply with ESA vacation pay requirements.
The approval section should include options for approval, approval with modifications, and denial, with space for the supervisor’s signature and date. The form should clearly note that statutory leaves cannot be denied. A statutory rights section should inform employees of their protections under the ESA, including the right to reinstatement, benefit continuation, and protection from retaliation. The form should reference the applicable provincial ESA and the Canada Labour Code for federally regulated employees.
Additional compliance elements for a Time Off Request Form (Canada) used in Canada include: Under the Canada Labour Code (R.S.C. 1985, c. L-2), the Canada Industrial Relations Board adjudicates federal workplace disputes. Provincial employment standards legislation — including Ontario's Employment Standards Act 2000 and British Columbia's Employment Standards Act (RSBC 1996) — governs minimum employment terms. The Personal Information Protection and Electronic Documents Act (PIPEDA) governs private-sector data handling. The Canada Revenue Agency (CRA) administers source deductions and Canada Pension Plan (CPP) contributions. Forms-legal.com provides this template as a starting point for Canada-compliant documentation.
Sources & Citations
Statutory citations link to official government sources.
- R.S.C. 1985, c. L-2CA official
Cite this page
Reference this free template in an article, syllabus, or research note:
Forms Legal. (2026). Time Off Request Form (Canada) (Canada) [Legal document template]. Forms Legal. https://forms-legal.com/canada/employment/hr-forms/time-off-request-form-canada
"Time Off Request Form (Canada) (Canada)." Forms Legal, 2026, https://forms-legal.com/canada/employment/hr-forms/time-off-request-form-canada.
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author = {{Forms Legal}},
title = {Time Off Request Form (Canada) (Canada)},
year = {2026},
howpublished = {\url{https://forms-legal.com/canada/employment/hr-forms/time-off-request-form-canada}},
note = {Free legal document template. Based on Canada Labour Code (R.S.C. 1985, c. L-2)}
}Also available for these jurisdictions:
Frequently Asked Questions
The Ontario Employment Standards Act 2000 (S.O. 2000, c. 41) provides numerous job-protected leaves including: 3 days of unpaid sick leave per year under Section 50; 2 days of unpaid bereavement leave under Section 50.0.1; 3 days of unpaid family responsibility leave under Section 50.0.2; up to 27 weeks of long-term illness leave (effective June 2025) under Section 49.1; 17 weeks of pregnancy leave under Section 46; up to 61 or 63 weeks of parental leave under Section 48; up to 28 weeks of family medical leave under Section 49.1; up to 8 weeks of family caregiver leave under Section 49.3; critical illness leave under Section 49.6; domestic or sexual violence leave (10 days plus 15 weeks) under Section 49.7; organ donor leave; and reservist leave. All statutory leaves are job-protected under Section 53 of the ESA 2000, meaning the employer cannot terminate or penalise the employee for taking them. Employment Standards Officers at the Ontario Ministry of Labour enforce compliance. Forms-legal.com provides this template as a starting point for Canada-compliant documentation.
No. Statutory leaves under the Employment Standards Act 2000 are legally protected. An employer cannot deny, refuse, or penalise an employee for taking a statutory leave. Section 53 of the Ontario ESA 2000 prohibits reprisals against employees who exercise their rights under the Act. This protection covers sick leave under Section 50, bereavement leave under Section 50.0.1, family responsibility leave under Section 50.0.2, pregnancy leave under Section 46, parental leave under Section 48, family medical leave under Section 49.1, and all other ESA-protected leaves. The employer also cannot terminate, threaten, or discriminate against an employee for requesting or taking a statutory leave — doing so constitutes a reprisal under Section 74 of the ESA 2000. However, employers may deny or modify requests for non-statutory leave such as vacation (subject to the ESA’s vacation scheduling rules under Section 40) or company-specific PTO under their internal policies. Employment Standards Officers enforce reprisal prohibitions under Section 91 of the ESA 2000. Forms-legal.com provides this template as a starting point for Canada-compliant documentation.
Under the Ontario Employment Standards Act 2000, Section 33 provides employees with a minimum of two weeks of vacation after completing each 12-month vacation entitlement year. Section 33.1 increases this to three weeks after five or more years of employment with the same employer. Vacation pay under Section 35 is calculated at four percent (4%) of gross wages earned during the entitlement year for employees with less than five years, and six percent (6%) for employees with five or more years. Employers may provide more generous vacation entitlements in the employment contract. Under the Canada Labour Code (R.S.C. 1985, c. L-2), federally regulated employees earn two weeks after one year of service, three weeks after five years under Section 184, and in some cases four weeks after eight years. Saskatchewan's Employment Act provides the most generous provincial statutory minimum at three weeks after one year and four weeks after 10 years. Employees can file a complaint with the Ontario Ministry of Labour, Immigration, Training and Skills Development for violations of vacation entitlements. Forms-legal.com provides this template as a starting point for Canada-compliant documentation.
The Canada Labour Code (R.S.C. 1985, c. L-2) Part III provides federally regulated employees (banking, telecommunications, interprovincial transport, Crown corporations) with several leaves beyond provincial ESA entitlements. Section 239 provides up to 10 days of medical leave with pay per year; Section 206.6 provides 5 days of personal leave (3 paid after 3 months of service); Section 210 provides up to 10 days of bereavement leave (3 paid); Section 206.8 provides up to 10 days of leave for victims of family violence (5 paid); Section 206.3 provides up to 28 weeks of compassionate care leave; Section 206.1 provides pregnancy leave (17 weeks) and Section 206.2 provides parental leave (up to 63 weeks); and Section 206.4 provides leave related to critical illness of a family member (up to 37 weeks for a child, 17 weeks for an adult). The Canada Industrial Relations Board adjudicates disputes regarding Canada Labour Code leave entitlements. Employment and Social Development Canada (ESDC) administers federal employment standards. Forms-legal.com provides this template as a starting point for Canada-compliant documentation.
Under the Ontario Employment Standards Act 2000, Section 50(3) permits an employer to request evidence reasonable in the circumstances that the employee is entitled to sick leave, but Section 50(4) provides that the employer cannot require a certificate from a qualified health practitioner as the only acceptable form of evidence. Reasonable evidence under Section 50(3) may include a signed attestation by the employee. For long-term illness leave under Section 49.1, a certificate from a qualified health practitioner confirming inability to perform work is required. For federally regulated employees, Section 239(4) of the Canada Labour Code (R.S.C. 1985, c. L-2) permits employers to request a medical certificate for medical leave with pay after three consecutive days of leave. British Columbia's Employment Standards Act (RSBC 1996, c. 113) permits employers to require a medical certificate for paid sick leave. Alberta's Employment Standards Code (RSA 2000, c. E-9) does not require employees to provide medical documentation for short-term illness. The Ontario Ministry of Labour, Immigration, Training and Skills Development enforces Section 50 compliance. Forms-legal.com provides this template as a starting point for Canada-compliant documentation.
Yes, in most provinces. Under the Ontario Employment Standards Act 2000, Section 51 requires an employer to continue to pay its share of the premiums for benefit plans — including pension plans, life insurance, accidental death plans, extended health plans, and dental plans — during statutory leaves (pregnancy leave under Section 46, parental leave under Section 48, family medical leave under Section 49.1, critical illness leave under Section 49.6, and domestic or sexual violence leave under Section 49.7). The employee must continue paying their share of premiums to maintain coverage. Seniority and service continue to accrue during statutory leaves under Section 53 of the ESA 2000. For some shorter leaves (sick leave under Section 50, bereavement leave under Section 50.0.1, family responsibility leave under Section 50.0.2), the ESA 2000 does not specifically mandate benefit continuation — employers should review their benefit plan agreements. For federally regulated employees, Section 239.1 of the Canada Labour Code (R.S.C. 1985, c. L-2) requires benefit continuation during most protected leaves. The Ontario Ministry of Labour enforces Section 51 compliance. Forms-legal.com provides this template as a starting point for Canada-compliant documentation.
This template is provided for informational purposes only and does not constitute legal advice. Laws vary by jurisdiction and change over time. Consult a qualified attorney for advice specific to your situation.Full disclaimer
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