it can be done a couple different ways. my suggestion would be to create a queue of items that need to be finished.
1) employee fills out a form. in the database have a series of users who can sign off on the form. send an email to the supervisor user with a link back to a page to review the form and send feedback if the form is denied. so basically show two input radio buttons approved/denied, a textarea box, and the orginal form.
2) if denied send an email to the email so that they can review the form. if approved send an email to the next user who needs to approve the form. repeat as necessary.
use the mail() function to send the email to the exchange external email addresses. you might be able to reverse engineer the exchange voting buttons, but that means you would have to have a php function to check email and count the emails returned. it would be a lot easier to port the system and maintain if you keep it seperate from exchange.