Pto Policy Sample PDF Details

Would you like to create a PTO policy for your workplace? If so, a great place to start is by using a PTO policy sample form. In this blog post, we will provide you with a link to a sample PTO policy form, as well as some tips on how to customize it for your workplace.

You'll find it useful to understand how much time you will need to fill out this pto policy sample and how lengthy this form is.

Form NamePto Policy Sample
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namespto policy template, how to fill pto example, pto policy examples, paid time off policy template

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To provide work life balance for employees the Company, provides paid time off for full-time employees who work an average of 32 or more per week.

Employees earn paid time to use for vacation, illness and personal business. This program combines traditional vacation and sick leave into one flexible, paid time- off (PTO) policy.

Upfront Allocation

Employees are allocated planned PTO hours when they are hired and on January 1st each year in accordance to the below PTO rates. New employees are allocated hours on a prorated basis for the remaining months in the year.





Length of







Accruals Hours

0 - 2





3 - 5





Year 5+





Accrued PTO

Although PTO is allocated upfront, it is earned each pay period. Employees, who leave during the year and have used more PTO time than earned (accrued), will be charged back for unearned vacation time. PTO accrues are based on actual regular hours worked, excluding unpaid leaves of absence or overtime.

The accrual rate changes for employees on the pay period following the 2nd and 5th anniversaries from their date of hire in accordance to their new accrual rates. PTO may be used in one-hour increments or higher. The Company reserves the right to reduce exempt employees pay for personal time off taken in excess of PTO balance allocations.

Employees may not trade, sell, or gift their PTO to other employees.

PTO Scheduling and Time Off Request Form

Employees should schedule time off providing their direct supervisor as much advance notice as possible. PTO requests should be submitted in writing to the

employee’s direct supervisor using the Time Off Request Form with at least a 48- hours advance notice when scheduling one-day and one-week notice for two or more PTO days. Requests for PTO will be granted depending on the department's workload and staff availability. Every effort will be made to grant time off as requested as long as it does not interfere with a department’s operations. In general, employees are not allowed to take more than 5 PTO days at a time.

PTO Balance and Limit

All time-off taken by employees will be deducted from their PTO balance. Employees are not allowed to take time-off without pay while maintaining a PTO balance. Time-off taken in excess of accrued PTO will be treated as leave without pay and may be considered excessive absenteeism. Employees can earn up to a maximum PTO balance of 25 days or 200 hours at any given point in time. At this point, no additional PTO can be earned until previously accrued PTO is taken.

Sickness or Emergency

Employees who have an unexpected need to be absent from work, like a sickness, should notify their direct supervisor before the scheduled work shift or as soon as possible.

Holidays and PTO

If a company holiday occurs during a scheduled PTO period, employees will receive holiday pay instead of PTO pay for that day, not both.

PTO at Termination

Upon termination of employment, employees can be paid out for up to two weeks of their remaining PTO balance, provided they give at least a two week notice. If employees have used more PTO than has been earned, this will be deducted from their final pay check.

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