Equal Employment Opportunity (Eeo) Policy And Program Administration Form Sample Page 26


July 31, 2003
emphysema, severe arthritis, severe nervous disorders, injuries caused by serious accidents
on or off the job, clinical depression, recovery from major surgery, final stages of a
terminal illness, and Alzheimer's disease. A "serious health condition" also includes
ongoing pregnancy, miscarriages, complications or illnesses related to pregnancy (such as
severe morning sickness), the need for prenatal care, childbirth, and recovery from
II. Responsibilities and Procedures:
(a) Leave Requests:
A request for ordinary sick leave must be made as early as possible before
the beginning of the tour of duty (usually at least one hour before), but in the event
of the employee’s physical incapacitation not later than the second hour of the work
shift, unless extraordinary circumstances prevent the employee (or other
responsible person) from notifying the supervisor. Sick leave requests of three
working days or fewer may be made orally. Sick leave for more than three
working days must be requested on OPM Form-71, Request for Leave, within three
days after return to duty. Satisfactory evidence of the need for sick leave during
the period of absence must accompany the request. When it would be unreasonable
to require a medical certificate because of an illness of a nature that did not require
a physician’s service, the employee’s signed statement of reasons why other
supporting evidence is not furnished may be accepted in lieu of required medical
In order to request extended sick leave under the Family Friendly leave
provisions beyond the 13 days for general family care, employees must submit to
their supervisor an Request for Leave (OPM Form-71) and include with the request
acceptable evidence of the family member’s serious health condition; the form
required for FMLA leave, Certification of Health Care Provider (See
Attachment 3), may be used for this purpose.
This documentation must be
provided in advance of the use of the leave; when this is not practicable in
emergency situations, the documentation must be provided within 15 calendar days
of the start of the leave.
The PCCD, PC, or Program Chief has the authority to approve use of
accrued sick leave. This authority may be delegated to subordinate supervisors.
Requests for Family Friendly sick leave for more than 13 days (104 hours)
to care for a family member with a serious health condition must be forwarded
through HRMP to the Associate Director or Chief of Staff, as appropriate, for
Employees must submit accurate statements about absences, applications
for, and use of sick leave, and furnish medical certificates when required.
vi. Only the Employee Health Unit may contact an employee’s personal
physician or clinic where the medical certificate originated concerning any question
related to the medical certification. Employees who are placed off duty on the
certification of the Employee Health Unit shall not be required to furnish a medical
certificate for the period indicated by the certification.


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