Serious Health Condition Leave Form

Serious Health Condition Leave Form

Full-time employees with 5 consecutive days (or more) of illness are required to submit FMLA paperwork.  FMLA is explained in employee handbooks as follows:

NCSD provides medical leaves of absence without pay to eligible employees who are temporarily unable to work due to a serious health condition or disability.  All such leaves must meet the criteria of the Family Medical Leave Act (FMLA).  Qualifying illnesses or circumstances may include an employee’s serious health condition or disability including inpatient care in a hospital, hospice, or residential medical care facility; continuing treatment by a health care provider; and temporary disabilities associated with pregnancy, childbirth, and related medical conditions. Regular full-time employees (employees who are employed to work 30 or more hours per week) who have worked a minimum of 1250 hours in the District for one-year or more, are eligible to apply for FMLA medical leave as described in this handbook. Eligible employees should make requests for medical leave to their supervisors at least 30 days in advance of foreseeable events and as soon as possible for unforeseeable events. If the employee is unable or fails to apply for FMLA leave for an employee related illness, the District will active the employee’s FMLA leave rights on the 5 consecutive day of absence, with a retroactive effective date of the first day of absence.  The District will activate the employee’s Family Medical Leave Act rights on the first day of absence. A health care provider’s statement must be submitted verifying the need for medical leave and its beginning and expected ending dates.  Any changes in this information should be promptly reported to NCSD.  Employees returning from medical leave must submit a health care provider’s verification of their fitness to return to work. Eligible employees are normally granted leave for the period of the disability, up to a maximum of 12 weeks within any 12-month period.  Any combination of medical leave and family leave may not exceed this maximum limit.  If the initial period of approved absence proves insufficient, consideration will be given to a request for an extension.  Employees will be required to first use any accrued paid leave time before taking unpaid medical leave.