• Leave Request Form

  •  -
    • Open to Read Qualifying Reasons for FFCRA Leave  

    • Qualifying Reasons for Families First CoronaVirus Response Act (FFCRA) Leave: 

      1. Is subject to a Federal, State, or local quarantine or
        isolation order related to COVID-19;
      2. Has been advised by a health care provider to
        self-quarantine related to COVID-19;
      3. Is experiencing COVID-19 symptoms and is seeking
        a medical diagnosis;
      4. Is caring for an individual subject to an order described
        in (1) or self-quarantine as described in (2)
      5. Is caring for his or her child whose school or
        place of care is closed (or child care provider is
        unavailable) due to COVID-19 related reasons; or
      6. Is experiencing any other substantially-similar
        condition specified by the U.S. Department of
        Health and Human Services.

      IMPORTANT: One of the above reasons must be listed as your Reason for FFCRA Leave in the chart below or it will not be approved. 

      Documentation evidence of the need to take FFCRA leave must also be attached to every leave request per the law. Example: Notice from School or Day Care of closure.

      All FFCRA leave (Sick and FMLA) is available from April 1, 2020 to December 31, 2020.

      All FFCRA leave (Sick and FMLA) must taken for a minimum of 8 hours in a week unless your remaining balance is less than 8 hours.

      FFCRA Family Medical Leave Act (FMLA) is unpaid for the first 2 weeks (or you can substitue a different type of leave).  For part-timers the first 2 weeks is equal to the amount of hours you've averaged over the last 6 months in a pay period.   

      FFCRA Family Medical Leave Act (FMLA) leave is only valid for reason #5 above and must taken for a minimun of 8 hours in a week unless your total balance remaining is less than 8 hours.

      Part Time Workers can only take FFCRA leave up to the amount of hours you have averaged in a pay period over the last 6 months. Example: If you worked 10 hours in the pay period and your past 6 month average hours worked is 25, you can only take 15 hours of FFCRA.  If you have worked 25 hours in the pay period you are not eligible to take any type of FFCRA leave.

    • Examples  

    • Examples for tracking FFCRA FMLA.  We need to have an official start date for FMLA and the first 2 weeks will need to be tracked as LWOP, FFCRA Sick, or if you are full time you may use AGC Sick or Vacation. For a part time person the balance will be the average over the last 6 months.

      Example 1: Using Sick Leave to track the first 2 week of FMLA

      Example 2: Using LWOP to track the first 2 weeks of FMLA

    • Leave Request Section  

    •  

    • Supporting Documents are REQUIRED for FFCRA Leave. 

      When attaching a document please find the one that matches your situation:

      1. Notice from the School or Day Care of closure or online learning due to Covid-19. (includes only offering online or hybrid learning) ** Must have dates that match your dates in the request. 
      2. Statement regarding the childs care provider unable to give care because of covid-19 and there is no other option of care available.
      3. Doctor's note with dates of quarantine and the date you can return to work
      4. Doctor's note for the person you are staying home to care for due to quarantine or covid-19 illness.
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    • FFRCA Sick Leave Balances

    • FFRCA FMLA First 2 Weeks Leave Balances

    • FFRCA FMLA 10 Weeks Leave Balances

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