Employee Mental Health Day Policy Acknowledgment

Employee Mental Health Day Policy Acknowledgment — Form Fields

This hr template includes 13 fields. Acknowledgment form for employees accessing company mental health day benefits. Free to customize and use on ZenBuild.

• Employee Name (text, required)
• Work Email (email, required)
• Employee ID (text, required)
• Department (text, required)
• Manager Name (text, required)
• Requested Date (text, required)
• I Acknowledge This Is a Wellness Benefit (multiple choice, required) — options: Yes
• I Understand This Does Not Require Diagnosis (multiple choice, required) — options: Yes
• I Will Notify My Manager in Advance (multiple choice, required) — options: Yes
• Notification Method (dropdown selection, required) — options: Email, Slack/Teams Message, Phone Call, In Person
• Need EAP Resources Sent (multiple choice, optional) — options: Yes Please, No Thank You
• Interested in Ongoing Wellness Support (multiple choice, optional) — options: Yes, No, Already Participating
• Optional: How Can We Better Support Your Wellness (long text, optional)