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4E HUC PICKUP REQUEST

If you enter multiple submissions for the same period, the most recent will be used, and the oldest will be discarded.

First Name

Last Name

Phone number

Seniority Date

Email

Schedule Period

Shifts: (DAY: 7a-3:30p)

Week 1

DAY
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Week 2

DAY
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Comments: (shift limit, preferred shift, etc.)

4E HUC TERMS AND CONDITIONS - UPDATED 04.24.26

Once a request is submitted, it cannot be withdrawn. Please ensure you review your schedule thoroughly before submitting any requests. Requests must be submitted by 10 AM on the specified due date. To avoid potential double scheduling, please wait for your home department to post their schedule before submitting a pickup request. 

Schedules will be finalized and distributed after the "due by" date. 

If employee is not willing to work on another unit, they must call bed placement two hours before their shift to see if 4E is open and the employee is needed there.  If employee does not call in, it will be assumed they are willing to work on another unit.  
Note: Employee will not receive ESI for working on another unit.
Effective May 10th, 2026, the following requirements must be met before the employee is eligible to receive incentive:
Full‑Time HUCs:
Must work 36 hours during the week.

Part‑Time and Casual HUCs:
Must work 24 hours during the week.
Only HUCs who meet these minimum weekly hour requirements will be eligible to receive Incentive for working additional shifts.

If there is an excess of staff, ESI employees may be considered first for downstaffing.  

Bed Placement Phone: 724-430-5510    

If the employeeis needed but,does not want to work on another unit, and calls in less than two hours notice for their shift, it will be considered a late call off.   

If 4E is closed and the employee chooses to down staff, they will be down staffed by 4 hour increments.    

Employees must pre-schedule shifts on the Flex Unit to be eligible for incentive pay. Employees redirected from their regularly scheduled unit are not automatically eligible for incentives. 

Employees eligible for the critical staffing incentive must submit a completed form to their home department for each shift worked. If the form is not submitted by the end of the shift, the critical staffing payment will not be processed.  It is the employee’s responsibility to ensure timely submission. 

Please be advised that any instances of PTO or Attendance Issues (tardiness, early out, unapproved absences, call-offs, etc.) during the workweek will disqualify an employee from receiving any incentive pay for that week.

I affirm I have read and agree to the terms for picking up on 4 East

I affirm I have read and agree to the terms for picking up on 4 East