Sick Leave Form Page 2
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1
2Instructions:
Classification of Absences:
Classification of
24/48 Employee
40 Hour Employee
Absence
8 hours up to 16 hours (1-2 full
Short Term
24 hours (1 full duty day)
duty days)
24 hours up to 40 hours (3-5 full
Medium Term
48 hours (2 full duty days)
duty days)
More than 48 hours (More than 2 Full
More than 40 hours (More than
Long Term
Duty days)
5 Full Duty days)
A.
No Healthcare Professional documents will be required for any single
absence of less than one full duty day (less than 24 hours for 24/48
employees or less than 8 hours for 40 hour employees). In other words an
employee working a portion of his/her shift won’t be required to submit
any Healthcare Professional documentation.
B.
No Healthcare Professional’s documentation will be required for the first
two (2) Short Term Absences in the “Rolling Calendar Year” (a period of
time consisting of 365 days). Healthcare Profession’s documentation will
be required starting with the third (3
) absence in the “Rolling Calendar
rd
Year.”
C.
Healthcare Professional’s documentation will be required for all Medium
Term Absences.
D.
Documentation for Medium Term Absences:
Any of the following forms of documentation are acceptable:
1. A note written by the Healthcare Professional, Discharge instructions
provided to the employee following a medical procedure or;
2. Completion of the Healthcare Provider statement above or;
3. FMLA Healthcare provider certification form.
E.
Acceptable Documentation for Long Term Absences:
The FMLA Healthcare provider certification form is the only acceptable
documentation for any Long Term Absence.
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