Paid Sick Leave Request Form Template

Download a paid sick leave request form to comply with ffcra documentation requirement apr 6 2020 covid 19 employee benefits household employer policies employees who wish to take paid leave under the families first coronavirus response act must provide documentation.

Paid sick leave request form template. Effective for requests made on or after april 1 2020 through december 31 2020. Provided with permission from the law offices of lindner marsack. This comes with the premise that they are going to get paid for it as long as they don t go beyond the days allowed for them to stay off work while sick. This is a sample request form for employees for emergency paid sick leave epsl under the families first coronavirus response act ffcra.

To address issues related to you or your family member being a victim of domestic violence sexual assault or stalking. Please complete this form as soon as possible before using paid sick leave for such reason. Emergency paid sick leave request form for covid 19 related leave. Employee paid sick leave notification.

If you use more than 3 consecutive workdays as sick leave we may request documentation signed by a licensed health care provider attesting to the need for the amount of sick leave that was taken and that the sick leave was used for an authorized purpose under the paid sick leave law. I am unable to work including engaging in telework and would like to request emergency paid sick leave because. Paid time off request form is a form that your employees can use for pto requests. The most common leave request is the sick leave request.

You are entitled to accrue paid sick leave beginning january 1 2018 or for employees hired after january 1 2018 insert date of start of employment here this leave will accrue at one 1 hour of paid sick leave for every 40 hours you work. Sick leaves guarantee workers the right to stay home when they are sick.