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Once an employee gives blood, he/she should submit a Certificate of Blood Donation with a validation stamp on the form. One certificate allows four hours of time off (blood time used) and is only valid for 12 months from the date of donation. Employees in exempt positions must use their accrued blood time in full day (usually 8 hour) increments, which requires two four-hour certificates. An Interdepartmental Recharge Request form must be filled out once the employee donates blood and turns in the certificate so that the department can be reimbursed for the employee's time.

The original completed certificate should be sent to Hospital Accounting.

A copy should be sent to:
Rose CO at the
Clinical Laboratory Business Office
A7-149 CHS
MC: 171315


The form is interactive. bloodrecharge.xls

For information on blood donation, please visit www.gotblood.ucla.edu