CU Boulder Sick Leave Usage
This form is for any contract employees of CU Boulder.  Please submit the times you have taken sick leave.  Please record sick hours for the entire absence for tracking purposes. Employees will only be paid for hours accrued.  Leave taken without sufficient sick leave will be unpaid.

Sick leave can be taken for any of the following reasons:

-When the employee has a mental illness or a physical illness or injury (not covered by workers’ compensation), or health condition; needs a medical diagnosis, care, or treatment related to such illness, injury, or condition; or needs to obtain preventive medical care.

-When the employee needs to care for a family member who has a mental or physical illness, injury, or health condition; needs a medical diagnosis, care, or treatment related to such illness, injury, or condition; or needs to obtain preventive medical care.

-When an employee or family member has been the victim of domestic abuse, sexual assault, or harassment and needs to be absent from work for purposes related to such crime.

-When due to a public health emergency, a public official has ordered the closure of the employee’s place of business or the school or place of care of the employee's child and the employee needs to be absent from work to care for the employee’s child.



If you have questions, please email HRSC@colorado.edu with the subject "CU Boulder Sick Leave Usage"
Sign in to Google to save your progress. Learn more
Email *
First Name *
Last Name *
Employee ID *
This six digit number can be found in MyCUInfo - My Info, on your pay stub or from your HR Liaison.  NOTE: This is different than your student ID
Department Name *
Please enter the department name that corresponds with the leave taken
Supervisor Name *
Please enter the supervisor name that corresponds with the leave taken
Do you certify that your supervisor has been notified of this sick leave usage? *
If you have not notified your supervisor, please do so before completing the form.
Required
Total Number of Hours *
Please round to the nearest 15 minute increment (.00, .25, .50, .75).  If you have not notified your supervisor, please do so before completing the form.
Date Begin *
MM
/
DD
/
YYYY
Date End *
Enter the same date as start if it's only during a single calendar day
MM
/
DD
/
YYYY
Do you have an open case with your department HR or Central HR Leave team for one of the following leave types? *
If you are taking leave for any of the below options and have NOT opened a case with your HR department, please select the relevant reason and reach out to them immediately.
Do you certify that sick leave is being taken for one of the following reasons in the Administrative Policy Statement: *
Captionless Image
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of University of Colorado Boulder. Report Abuse
Google Forms