Automatic Meal Break Request Form

Non-exempt, synchronous employees must clock in and out for meal periods. If an employee is not able to clock in and out for a meal period, an automatic meal period may be requested by the employee's department. The meal period will automatically deduct a set amount of time from the employee's timesheet each day they work 6 hours or more.

Per PSOP 22.0, University Payroll reviews all automatic meal period requests. University Payroll may, but is not required to, grant automatic meal periods. Requests may only be made by the departmental Fiscal Officer, HR Director, or Payroll Director.

I'd like to request an automatic meal break for:

An entire work area

An individual employee

Your Job Title *
Please provide information regarding the individual for which you are requesting the automatic meal break.
Length of meal period *
Your Job Title *
Please provide information regarding the work area for which you are requesting the automatic meal break.
Length of meal period *