HHC, 0-1 Brigade Special Troops Battalion
Leave or Pass Cover Sheet
Rank and Name: ________________________________ Date:_____________________
Section: __________ Leave or Pass Dates: _________________ to _________________
Number of Days Accrued: ______ Number of Days Requested or Type of Pass: ______
Leave or Pass Address: ____________________________________________________
(Street Address) (City, State, ZIP code)
________________________________________________________
(Telephone Number, to include the area code)
Reason for Leave or Pass: ______________________________________________________
I will be in first formation the first duty day following termination of leave or pass. I will plan my return travel to allow adequate rest prior to formation. If any emergency or other situation arises which might prevent me from returning safely to work on time, I will contact the BN SDNCO and my chain of command to ensure my safe return.
Signature of Requestor:
Checklist
DA Form 31 – Request and Authority For Leave (2 copies for Leave)
Leave and Earnings Statement
DA Form 4856 – Counseling Form for Safety Awareness
Soldier At-Risk Behavior Checklist
POV Inspection No POV
POV Risk Assessment Report (TRiPs)
Flight Itinerary N/A
RECOMMEND: APPROVAL DISAPPROVAL
Platoon/Section Sergeant
RECOMMEND: APPROVAL DISAPPROVAL
Platoon/OIC Leader
RECOMMEND: APPROVAL DISAPPROVAL
First Sergeant
APPROVAL DISAPPROVAL__________________________ Commander