About this template
Managing employee leave for health-related concerns requires a clear, reliable, and secure process. This Self-Quarantine Time Off Request template helps organizations streamline how staff report potential health risks, exposure, or symptoms requiring isolation. Designed for human resources teams and department managers, it collects critical scheduling details—such as start and end dates, expected return-to-work timelines, and direct contact details—while maintaining clear documentation for attendance and payroll tracking.
Instead of managing ad-hoc emails or chaotic text messages, HR teams can deploy this structured template in seconds. Doc2Form allows you to instantly convert this template into a fully functioning Google Form, giving you a centralized dashboard of all leave requests. Whether responding to pandemic protocols or general workplace health guidelines, this form ensures safety, compliance, and transparent communication across your entire organization.
Key features
- Capture exact start and end dates for leave planning.
- Collect mandatory contact and return-to-work details.
- Centralize all employee health requests in a secure spreadsheet.
- Deploy instantly as a ready-to-use Google Form template.
Use cases
- Processing employee requests for precautionary self-isolation.
- Managing COVID-19 or infectious disease workplace leave.
- Tracking anticipated staff return-to-work dates for scheduling.
What this form collects
- Employee Full Name (Short answer)Enter your first and last name.
- Email Address (Short answer)Provide your work email address for follow-up communications.
- Phone Number (Short answer)Enter a reliable phone number where HR can reach you during your leave.
- Reason for Time Off Request (Multiple choice)Select the primary reason for your self-quarantine or leave request.
- Time Off Start Date (Date)Select your first day away from the workplace.
- Time Off End Date (Date)Select your last requested day of leave.
- Anticipated Return to Work Date (Date)Select the date you expect to be physically able to return to the workplace.
- Additional Notes or Comments (Paragraph)Provide any extra details or context regarding your request.
FAQ
How do I send this form to my employees?
Once generated as a Google Form via Doc2Form, you can share the direct link via email, corporate chat channels, or embed it on your internal HR portal.
Can I customize the questions on this template?
Yes. Because the template lives in your Google Drive as a standard Google Form, you can easily add, remove, or edit any fields using the native Google Forms editor.
Where do the form responses go?
All submissions are automatically saved to a linked Google Sheets spreadsheet, making it easy for HR and managers to review and track leave requests in real time.
Is this template free to use?
Yes, this template is completely free to convert and use via Doc2Form and Google Forms.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.