Coronavirus 2019 (COVID-19) Updates

To request leave on the basis of the FFCRA, please complete the (a) leave of absense request form and submit along with (b) supporting documentation (required - see below) via email or fax to your Certified representative.

Required Documentation

The required documentation is based on the type FFCRA qualifying reason you have selected on the request for a leave of absence form.

An employee is entitled to take leave related to COVID-19 if the employee is unable to work, including unable to telework, because the employee:

1. is subject to a Federal, State, or local quarantine or isolation order related to COVID-19; (For the first two weeks, your supervisor will verify by signing the request for a leave of absence form that you are eligible for this option because you have been required to quarantine. If the absence is extended you will be required to provide Certified with a completed Medical Certification by your physician.) Please note employees subject to a state or local shelter-in-place order, whose worksites have been closed due to the order, may not be entitled to FFCRA leave.
2. has been advised by a health care provider to self-quarantine related to COVID-19; (You must provide Certified with a doctor’s note indicating the start date and end date of the absence. The doctor’s note is due immediately and can be sent to Certified via email. If your absence extends beyond two weeks, you will be required to provide Certified with a completed Medical Certification by your physician)
3. is experiencing COVID-19 symptoms and is seeking a medical diagnosis; (You must provide Certified with a doctor’s note indicating the start date and end date of the absence. The doctor’s note is due immediately and can be sent to Certified via email. If your absence extends beyond two weeks, you will be required to provide Certified with a completed Medical Certification by your physician.)
4. is caring for an individual subject to an order described in (1) or self-quarantine as described in (2); (You must provide Certified with a doctor’s note indicating the start date and end date of the absence. The doctor’s note is due immediately and can be sent to Certified via email. If your absence extends beyond two weeks, you will be required to provide Certified with a completed Medical Certification by your family member’s physician.)
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; (You must provide Certified with a statement from your daycare verifying the facility is closed, to include how long it is expected to be closed. An email from a daycare official is sufficient. The email should include the person’s full name, title, address, phone number and email address. If acquiring this statement is impossible or the child is of regular school age, please issue a statement indicating the name(s) of your child(ren), date(s) of birth and name of the daycare or school they normally attend)
6. is experiencing any other substantially-similar condition specified by the U.S. Department of Health and Human Services. (Please issue a statement indicating the reason for your request)