Keeping in Touch (KIT) and

Shared Parental Leave in Touch (SPLIT)

Completion Form

Before completing this form, please read the UECS Family Leave Policies document.

You should download this form and save it on your computer before completing it.

Employee Details

Name:	Click to enter text	Personal Reference Number:	Click to enter text
Department:	Click to Select	Date:	Select Date …

Details of KIT / SPLIT Days

A maximum of 10 KIT days and 20 SPLIT days are available. Following completion of the agreed day(s), the following details should be completed so that payment can be made.
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs
Date worked:	Select Date …	Hours per day:	Click to enter hrs

Employee and Manager Confirmation

I confirm that the above work was undertaken as detailed. Please arrange for the employee to receive payment accordingly.
Employee Print Name:	Click to enter text	Date Signed:	Select Date …
Employee Signed:
Manager Print Name:	Click to enter text	Date Signed:	Select Date …
Manager Signed:
Sign the form by either typing your name or uploading a JPEG image of your signature. Save the completed form and send it by email to the Employee Reward team. Please note if the Employee Reward team receive this form after the monthly payroll cutoff date (normally 10th of each month), payment to the employee will be made in the following month.