Childcare: Coronavirus Employee Leave Request Form
Due to Childcare needs there are two leaves that an employee may request, the Emergency Paid Sick Leave Act (“EPSLA”) and the Emergency Family Medical Leave Expansion Act (“EFMLEA”).  Complete this if you would like to request leave for Childcare reasons.

Eligibility:
Under the Emergency Family and Medical Leave Expansion Act (“EFMLEA”), an employee who has been  employed for at least 30 days prior to their leave request may take leave to care for the employee’s child whose school or place of care has been closed or whose childcare provider is unavailable for reasons related to COVID-19. Employees receive up to 12 workweeks of protected leave under the EFMLEA. If an employee has already used FMLA leave during the applicable 12-month period, the time available for will be reduced by the amount of FMLA already used.

The first two workweeks of leave under EFMLEA are unpaid, but employees may use EPSLA to supplement their pay during this time. Thereafter, employees will be paid at two-thirds the employee’s regular rate, up to a maximum of $200 per day ($10,000 in aggregate) for the remainder of the 10 workweeks.  

These leave provisions will be available through December 31, 2020.
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Email *
First Name *
Last Name *
Site/Department *
Position *
Contact Phone Number *
Start Date of Requested Leave *
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End Date of Requested Leave *
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YYYY
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