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.
To take a leave of absence for a family or medical leave condition, an employee must ask an approved health care provider to certify the condition by completing and signing one of the following medical certification forms:
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.
An employee must submit the Leave of Absence Without Pay Request Form (pdf version) or (fill-in Word version) to request leave without pay.
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.
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.
An employee who is going on leave for military training or active service must submit the Uniformed Services Leave Form (pdf version) or (fill-in Word version) to his/her department military leave coordinator.