Coronavirus Employee Illness Leave Request Form
In addition to sick leave provisions in the collective bargaining agreements which provide for full compensation when utilizing accrued and available sick sick leave, employees have the right to utilize leave provisions provided through the Families First Coronavirus Response Act (“FFCRA”) and/or through the Emergency Paid Sick Leave Act (“EPSLA”). Employees can choose which leave to utilize, District sick leave or the recently approved Federal leaves. Use of the Federal Leaves may result in only partial pay and is limited to a total of 80 hours (two weeks).  

Employees who are ill and desire to utilize District provided sick leave are to follow normal leave procedures.

Employees who choose to utilize the newly adopted Federal leaves must provide the District with information regarding the qualifying reason for the leave below. To request use of the FFCRA leave, please submit this form.

Eligibility and Compensation:
For personal care under the FFCRA for reasons 1-3, full-time employees are eligible for up to 80 hours (prorated for part-time employees) of paid sick leave at their regular rate, up to a maximum of $511 per day ($5,110 in aggregate).                                        

For personal care under the FFCRA for reason 4, full-time employees are eligible for up to 80 hours (prorated for part-time employees) of paid sick leave at two-thirds the employee’s regular rate, up to a maximum of $200 per day ($2,000 in aggregate).  

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  (maximum of two weeks) *
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DD
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YYYY
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