A bereavement leave request form tells your employer you need time away after a death in your family and gives HR the details needed to approve and track your absence. To fill one out, you need your identifying information, your supervisor’s name, the name of the deceased and your relationship to them, the dates you’ll be out, and a short note on how your work will be covered. Before you write anything, check your employee handbook: most private employers set their own bereavement policies, and no federal law requires them to offer this leave at all,1U.S. Department of Labor. Funeral Leave so the handbook tells you how many days you can request and what documentation is expected.
Information to Put on the Form
Gather these details before you sit down to write. HR needs enough to match you in their system, confirm your eligibility, and adjust the schedule. Nothing more.
- Your identifying information. Full legal name, employee ID number, department, and job title. These link the request to your personnel file so the absence is coded correctly in payroll.
- Your supervisor’s name. The person who needs to approve your absence or arrange task coverage while you are out.
- Name of the deceased. Their full name as it would appear on official records.
- Your relationship to the deceased. Be specific: “father,” “mother-in-law,” “domestic partner.” Most policies tie the number of leave days to the closeness of the relationship.
- Requested dates. The first day you need off and the date you expect to return. If arrangements are still being finalized, say so and give your best estimate.
- Coverage plan. A brief note about who will handle your critical tasks or how you have prepared your workload. Not always required, but it speeds approval.
Keep the form factual and short. You do not owe your employer an emotional narrative, just enough detail to process the leave.
How Your Relationship Affects the Request
Your company’s definition of “family member” determines how many days you can put on the form, and sometimes whether you qualify at all. Most employers split relationships into two tiers.
Immediate family almost always includes a spouse or domestic partner, parents (biological, adoptive, or step), children (biological, adopted, step, or foster), siblings, grandparents, and grandchildren. A loss in this group typically triggers the full allotment of bereavement days, commonly three to five.
Extended family, meaning in-laws, aunts, uncles, nieces, nephews, and cousins, may qualify for shorter leave of one to two days, or may not be covered at all. Some employers also recognize close non-relatives like a legal guardian who raised you, but that usually requires a conversation with HR rather than a standard form submission.
If your relationship to the deceased falls into a gray area, attach a brief explanation when you submit the form. Waiting for HR to ask follow-up questions only delays approval.
Sample Wording You Can Adapt
You do not need elaborate or formal language. A clear, direct message works best.
Dear [Supervisor’s Name],
I am writing to request bereavement leave following the death of my [relationship], [name of deceased], who passed away on [date]. I would like to take leave from [start date] through [end date] and plan to return on [return date].
I have briefed [colleague’s name] on my current projects, and they have agreed to handle any urgent matters while I am out. I will have limited access to email but will respond to anything critical when I can.
I have attached [documentation type, such as a copy of the obituary] for your records. Please let me know if you need anything else to process this request.
Sincerely,
[Your name, employee ID, department]
If your company uses a preprinted form or an HR portal rather than a written letter, the same information applies. Fill it into the designated fields instead.
What to Attach as Documentation
Most employers ask for some kind of proof, though the timing is flexible. You should not have to produce a death certificate before you leave for the funeral. Commonly accepted documents include:
- Obituary. A published notice from a newspaper or an online memorial page.
- Death certificate. Issued by the local vital records office or health department. A photocopy is usually sufficient.
- Funeral home letter. Written confirmation from the mortuary or funeral director stating the date and location of services.
- Funeral or memorial program. The printed program handed out at the service, which lists the deceased’s name, service date, and location.
Your HR department should treat these documents as confidential personnel records, stored separately from your general employee file with access limited to authorized staff. If you are uncomfortable providing a death certificate, which contains sensitive information like cause of death, ask whether an obituary or funeral home letter will satisfy the requirement instead.
How to Submit the Form
Speed matters more than formality. Notify your supervisor by phone or text as soon as you can, then follow up with the written form once you have the details together. Waiting to submit a perfectly formatted letter while your team scrambles to cover your absence helps no one.
Through an HR Portal or Email
If your company uses an HR information system such as Workday, ADP, or BambooHR, log in to the leave management portal and submit the request there. These systems automatically route your request to the right approver, calculate your remaining leave balance, and create a digital record. Attach scanned documentation directly to the portal entry so everything lives in one place.
When no portal exists, email the form as a PDF to both your direct supervisor and HR. Put “Bereavement Leave Request — [Your Name]” in the subject line so it does not get buried. Save a copy of the sent email for your own records.
On Paper
Some workplaces still prefer a physical form, particularly in industries where not every employee has regular computer access. Print the request, sign it, and hand it to your supervisor or drop it with the HR office. Ask for a stamped or initialed copy as confirmation that the form was received.
However you submit, follow up if you have not received a written or emailed confirmation within a day or two. An unacknowledged request can create problems with payroll or attendance records after you return.
If You Need More Time Than You First Requested
Three to five days disappears quickly when you are handling funeral logistics, settling affairs, and supporting family members in another city. If you realize you need more time than your bereavement policy covers, contact your supervisor or HR before your leave expires rather than simply not showing up on your expected return date.
Frame the extension the same way you framed the original request: state the additional dates you need, briefly explain why (travel, estate matters, delayed services), and note whether you want the extra days coded as vacation, personal leave, or unpaid absence. Some employers will extend bereavement leave informally; others require a separate request form for the additional days. Either way, putting it in writing protects both sides.