Leave Administration
Leaves Forms
Family and Medical Leave Request
An employee requesting family-medical leave must submit the Protected Family and Medical Leave Request Form (PDF Version) or (Fill-In Word Version) to his/her leave-granting authority.
Family and Medical Leave Medical Certification
An approved health care provider must use the Protected Family and Medical Leave Medical Certification to certify an employee's need for family-medical leave and periodic medical evaluations during family-medical leave.
Family and Medical Leave Request Response
An employee's leave-granting authority uses the Protected Family and Medical Leave Response Form (PDF Version) or (Fill-In Word version) to respond to a family-medical leave request.
Leave of Absence Without Pay Request
An employee must submit the Leave of Absence Without Pay Request Form (PDF Version) or (Fill-In Word Version) to request leave without pay.
Physical Capacities Evaluation
An employee who has medical restrictions and might need accommodation when returning to work may be asked to submit the Physical Capacities Evaluation Form. If you need help completing this form, contact your safety and claims representative. Generally, this form is used in conjunction with workers' compensation claims.
Leave Donation Form
An employee uses the Leave Donation Form (PDF Version) or (Fill-In Word Version) to donate leave accruals to another employee.
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If you need help with the Leave Donation Form, the Donated Leave Chart provides comprehensive information regarding donated leave including union contract information, minimum and maximum hours and conversion data. If you have questions about the donated leave chart, please contact your human resource or service delivery manager.
Uniformed Services Leave Form
An employee who is going on leave for military training or active service must submit the Uniformed Services Leave Form (PDF Version) to his/her department military leave coordinator.