HomeMy WebLinkAboutResolutions - No. 2020-96RESOLUTION NO. 2020-96
A RESOLUTION OF THE LODI CITY COUNCIL
APPROVING A NEW POLICY: FAMILIES FIRST
CORONAVIRUS RESPONSE ACT (HR 6201)
WHEREAS, on March 18, 2020, President Donald Trump signed the Families
First Corona Virus Response Act into law (HR 6201), providing emergency paid sick
leave benefits for eligible employees and expanding the Family Medical Leave Act; and
WHEREAS, this law became effective April 1, 2020 and expires on
December 31, 2020, and is related specifically to the Coronavirus Pandemic; and
WHEREAS, the U.S. Department of Labor (DOL) allows agencies to exclude
certain job classifications identified as "health care providers" or "emergency
responders" from paid leave under the Families First Coronavirus Response Act
(FFCRA); and
WHEREAS, the City of Lodi has reviewed its employment rolls and identified the
job classifications considered "emergency responders" based on the DOL guidelines
and will be excluded from paid leave under FFCRA as listed in Attachment A; and
WHEREAS, the City of Lodi, in accordance with HR 6201, has amended the City
of Lodi Administrative Policy and Procedures Manual by adding a new policy: Families
First Coronavirus Response Act.
NOW, THEREFORE, BE IT RESOLVED that the Lodi City Council does hereby
approve a new policy: Families First Coronavirus Response Act.
Dated: May 6, 2020
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I hereby certify that Resolution No. 2020-96 was passed and adopted by the Lodi
City Council in a regular meeting held May 6, 2020 by the following vote:
AYES: COUNCIL MEMBERS — Chandler, Mounce, Nakanishi, and
Mayor Kuehne
NOES: COUNCIL MEMBERS — None
ABSENT: COUNCIL MEMBERS — None
ABSTAIN: COUNCIL MEMBERS — None
PAMELA M. FARRIS
Assistant City Clerk
2020-96
CITY OF LODI
ADMINISTRATIVE POLICIES MANUAL
SUBJECT: FAMILIES FIRST CORONAVIRUS
RESPONSE ACT — (HR 6201)
DATE ISSUED: April 1, 2020 — December 31, 2020
SECTION 1: PURPOSE
The Families First Coronavirus Response Act (the Act) was passed
on March 18, 2020 in response to the Coronavirus (COVID-19)
pandemic. The Act approves two provisions designed to help reduce
the impact of the virus on families. These provisions include the
Emergency Family Medical Leave Expansion Act (EFMLEA) and the
Emergency Paid Sick Leave Act (EPSLA). These provisions are in
effect April 1, 2020 and remain in effect until December 31, 2020.
Except as provided for in Section 13, full and part-time employees
who have worked for the City of Lodi for at least 30 calendar days are
eligible for Emergency Family Medical Leave Expansion Act
(EFMLEA) if they are unable to work or telework to take care of their
minor children in the event of a school closure or if their childcare
provider is unavailable due to COVID-19.
Full and part-time employees, except as noted in Section 13,
regardless of how long they have been employed with the agency are
eligible for paid leave under the Emergency Paid Sick Leave Act
(EPSLA) for qualifying reasons.
SECTION 2: EFFECTIVE DATES
Effective April 1, 2020 through December 31, 2020.
SECTION 3: AMOUNT OF LEAVE UNDER EFMLEA
Eligible employees have the right to take up to 12 weeks of job -
protected EFMLEA leave. Employees who have already used some
or all of their 12 weeks of FMLA leave, for another qualifying reason,
are not eligible to take an additional 12 weeks of FMLA/EFMLEA.
The Act added another qualifying reason for leave and did not
provide an additional 12 weeks of leave. Employees may be eligible
for a pro -rated amount of leave dependent on FMLA usage within the
12 rolling months prior to the EFMLEA request. Employees who
use 12 weeks of leave under EFMLEA may be eligible for additional
leave under the California Family Rights Act CFRA for another
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qualified event (note: CFRA does not provide leave to care for
children as provided under the EFMLEA and described in Section 4).
SECTION 4: QUALIFYING REASONS FOR EFMLEA LEAVE
Leave shall be granted for up to 12 weeks to care for the employee's
son or daughter under 18 years of age if their school or place of care
has been closed or their childcare provider of such son or daughter is
unavailable, due to a public health emergency. Public health
emergency means an emergency with respect to COVID-19 declared
by a Federal, State, or local authority.
SECTION 5: UNPAID LEAVE FOR INITIAL TEN WORKING DAYS
The initial fourteen days of leave (ten working days) may consist of
unpaid leave. However, an employee may elect to substitute any
accrued vacation leave, personal leave, or medical or sick leave for
unpaid leave during the initial fourteen days of leave. The employee
may also elect to substitute the two weeks of unpaid leave with the
paid sick leave provided under the Emergency Paid Sick Leave Act,
or any other leave accrual available to the employee. The City may
not require an employee to substitute accrued leave during the initial
fourteen days of leave.
SECTION 6: PAID LEAVE FOR SUBSEQUENT DAYS
From the eleventh working day of leave the employee will be paid
two-thirds of the employee's regular rate of pay (as determined under
section 7(e) of the Fair Labor Standards Act of 1938) for the number
of hours the employee would otherwise be normally scheduled to
work during the leave time up to $200 per day up to a total of
$10,000. Employees who work less than full-time are entitled to pay
based on two-thirds of their regular pay based on the number of
hours they would have otherwise been scheduled to work during the
time they are taking leave.
In the case of an employee whose schedule varies from week to
week to such an extent that an employer is unable to determine with
certainty the number of hours the employee would have worked if the
employee had not taken leave, the employer must use the following
criteria:
1. A number equal to the average number of hours that the
employee was scheduled per day over the 6 -month period ending
on the date on which the employee commences leave, including
hours for which the employee took any type of paid leave; or
2. If the employee did not work over the preceding 6 -month period,
the reasonable expectation of the employee at the time of hiring of
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the average number of hours per day that the employee would
normally be scheduled to work.
SECTION 7: DEFINITIONS FOR PURPOSES OF PUBLIC HEALTH
EMERGENCY LEAVE UNDER EFMLEA
A. Eligible Employee: The term 'eligible employee' means an
employee who has been employed for at least 30 calendar days
by the employer.
B. Child: One for whom the employee has actual day-to-day
responsibility for care and includes a biological, adopted, or foster
son or daughter, a stepson or stepdaughter, a legal ward, or a son
or daughter of person standing in loco parentis, who is under 18
years of age, or who is 18 years of age or older who is incapable
of self-care because of a mental or physical disability.
C. Parent: A biological, foster, or adoptive parent, a stepparent of
the employee, parent -in-law of the employee, parent of a
domestic partner of the employee, or a legal guardian or other
person who stood in loco parentis to an employee when the
employee was a child.
D. Public Health Emergency: The term `public health emergency'
means an emergency with respect to COVID-19 declared by a
Federal, State, or local authority.
E. Child Care Provider: The definition of "child care provider"
includes a center -based child care provider, a group home child
care provider, a family child care provider, or other provider of
child care services for compensation that is licensed, regulated or
registered under state law. It also includes a family member (e.g.
grandparent) or friend (e.g. neighbor) who regularly cares for the
employee's child, even if that person is not licensed or paid for
providing the child care services.
F. School: The term `school' means an `elementary school' or
`secondary school' as such terms are defined in section 8101 of
the Elementary and Secondary Education Act of 1965.
SECTION 8: RESTORATION TO POSITION
An employee who takes EFMLEA shall be restored to the position of
employment held by the employee when the leave commenced; or,
will be restored to an equivalent position with equivalent employment
benefits, pay, and other terms and conditions of employment.
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SECTION 9: HEALTH BENEFITS
Health benefits coverage will continue during the leave at the level
and under the conditions coverage is provided prior to the leave. An
employee may be required to reimburse the City for the premiums
paid by the City during the leave if the employee fails to return to work
from the leave for a reason other than the continuation, recurrence or
onset of a serious health condition that would entitle the employee to
leave, or other circumstances beyond the employee's control.
SECTION 10: NOTICE
SECTION 11:
When foreseeable, an employee shall provide the employer with such
notice of leave as is practicable.
DOCUMENTATION
Employees requesting EFMLEA shall complete the request for leave
form and attach any documentation received from their qualified
child's school or daycare provider indicating closure and the
anticipated period of closure. In the event of a medical emergency
where the employee is unable to provide the form prior to initiating
leave, such form shall be submitted as soon as reasonably
practicable. Documentation shall be submitted to Human Resources
via email at hrdeptQ,1odi; qov.
SECTION 12: EMERGENCY PAID SICK LEAVE ACT (EPSLA)
The Emergency Paid Sick Leave Act (EPSLA) provides up to 80
hours of paid leave and is in addition to any other leave accrued
including the Special COVID Leave Bank created by the City in
March of 2020. The emergency leave expires on December 31,
2020 and does not carry over to the next calendar year.
All employees are eligible for Emergency Paid Sick Leave
regardless of how long they have been employed by the City of
Lodi if one of the following apply:
The employee is subject to a federal, state, or local quarantine or
isolation order related to COVID-19. "Quarantine or Isolation
Order" includes containment, shelter -in-place or stay-at-home
orders issued by any federal, state, or local government. This
includes advisement of categories of citizens (e.g. of certain age
ranges or of certain medical conditions) to shelter -in-place, stay at
home, isolate or quarantine.
2. The employee has been advised by a health care provider to self -
quarantine due to concerns related to COVID-19.
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3. The employee is experiencing symptoms of COVID-19 and is
seeking a diagnosis.
4. The employee is caring for an individual under quarantine or
isolation order, or advised by a health care professional to self -
quarantine.
5. The employee is caring for a child due to school closure or
unavailability of the child's care provider due to COVID-19.
6. The employee is "experiencing any substantially similar condition
specified by the Secretary of Health and Human Services in
consultation with the Secretary of the Treasury and Secretary of
Labor."
For leave taken under paragraphs (1), (2), or (3), full time
employees are entitled to 80 hours of paid leave at their regular
rate of pay, subject to a $511 per day and $5,110 aggregate cap.
Part-time employees are entitled to paid leave for the average
number of hours worked over a 2 -week period at their regular rate
of pay, subject to the same cap,
For leave taken under paragraphs (4), (5), or (6), full time
employees are entitled to 80 hours of paid leave at 2/3 their regular
rate of pay, subject to a $200 per day and $2,040 aggregate cap.
Part-time employees are entitled to paid leave for the average
number of hours worked over a 2 -week period at 2/3 their regular
rate of pay, subject to the same cap.
Employees are not required to use other available paid leave (such
as leave accruals available to the employee) before using sick
leave under EPSLA. Employees are not required to find
replacements to cover their duties during use of leave. Employees
will not be discharged or discriminated against by any employee for
requesting or taking paid sick leave under the EPSLA.
Employees may elect to use accrued leave from any leave bank
source to supplement the 2/3rds regular rate being paid while on
EPSLA under reasons (4), (5), or (6).
SECTION 13: COVERED EMPLOYEES
This policy applies to all employees. In accordance with the FFCRA,
the City may deny EFMLEA or EPSLA leave if the employee is an
Emergency Responder whose services are necessary for emergency
response operations.
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Certain health care providers and emergency responders are
excluded from the definition of eligible employee under section
110(a)(1)(A) of the EFMLEA. However the City will exercise its sole
and complete discretion to grant leave consistent with this policy to
the emergency responders, under its pre-existing leave programs
only on the same terms as provided in this policy consistent with its
ability to achieve the mission of each emergency responders
department mission. The City has reviewed its employment rolls and
concluded that all employees in the attached document are exempt
because they are all called on to respond to emergencies and are all
required to be trained to respond to emergencies as laid out in the
attached training memorandum.
For the purposes of employees who may be excluded from paid sick
leave or expanded family and medical leave by their employer under
the FFCRA, an emergency responder is an employee who is
necessary for the provision of transport, care, health care, comfort,
and nutrition of such patients, or whose services are otherwise
needed to limit the spread of COVID-19. This includes, but is not
limited to, military or national guard, law enforcement officers,
correctional institution personnel, fire fighters, emergency medical
services personnel, physicians, nurses, public health personnel,
emergency medical technicians, paramedics, emergency
management personnel, 911 operators, public works personnel, and
persons with skills or training in operating specialized equipment or
other skills needed to provide aid in a declared emergency as well as
individuals who work for such facilities employing these individuals
and whose work is necessary to maintain the operation of the facility.
This also includes any individual that the highest official of a state or
territory, including the District of Columbia, determines is an
emergency responder necessary for that state's or territory's or the
District of Columbia's response to COVID-19.
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CITY OF LODI
FIRE DEPARTMENT
MEMORANDUM
TO: Blair King
FROM: Michael Pretz
DATE. September 7, 2006
SUBJECT- NIMS Tragi
In ord-er for the City of Lodi to contimae to recei%T, Homeland Secatity Grant fiords and State of
California funding for varions projects, the Governor's Office of Emergency Senices has
ordered all municipalities to complete SEMS and. NNIS training. As you will recall, we brouglit
this to the department heads attention during the April EOC training session- We have tuttil
October 6. 2006 to complete this training. Fortunately, the tra1� sessions are relatively vinple
and straightforwarcd After reviewing the NIMS Training matrix, I believe the fullotiving groups
of city employees should ga ttuotagh the various ICS (Incident Command System) series
SEMS (Standardized Emergency Management System)
NNIS National Incident Management System
SEMS Executive, ICS 4012, NBIS (IS 700), NBI5 (IS Y).
Council Members, City Manager, Deputy City Manager. City Attorney, Deputy City Attorney.
City Clerk_ Deputy City Clerk
SENIS Intra., SF fS EDC, ICS 100, ICS 200, P,01S 700, NJAIS 800, ICS 300, ICS 400
Department Heads, Second le%vl supervisors (deputy DK etc). anyone who may take a
department heads place in the EOC.
SEMS Intro., SEMS EIEC, ICS 100, ICS 200, ICS 300, N'WS 700, VII►IS 800
All field supenisors
SEMS Intro., SEATS EOC, ICS 100, ICS 100, ItiUIS 700
Support Staff, HR Staff
SEAR Intro., ICS 100, NWS 700
All employees who maybe tasked, directed or called upoii. for an emergency. As I understand
State of California requirements for disaster workers, any city employee can be tasked Wath
emergency responsibilities during a disaster, therefore, every city employee should tale these
courses.
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Job pass Description Job Class Description Job Class description
ACCOUNTANT
ACCOUNTING MANAGER
ADMINISTRATIVE CLERK
ADMINISTRATIVE CLERK -CONF
ADMINISTRATIVE SECR ETAR -CON F
ADMINISTRATIVE SECRETARY
ANIMAL SERVICES SUPERVISOR
ASSISTANTANIMAL SERVICES OFFI
ASSISTANT CITY CLERK
ASSISTANT ENGINEER
ASSOCIATECIVIL ENGINEER
ASSOCIATE PLANNER
ASSTENGINEER/PLANS EXAMINER
BUDGETMANAGER
BUILDING INSPECTOR II
BUILDING OFFICIAL
BUILDING SERVICES SUPERVISOR
BUSINESS DEVELOPMENT MANAGER
CHIEF WASTEWATER PLANTOPERATO
CI TY ATTOR N EY
CITY ENGINEER/DEP PW DIRECTOR
CITY MANAGER
CODE ENFORCEMENT OFFICER
COMMUNITY DEVELOPMENT DIRECTOR
CONSTRUCTION PROJECT MANAGER
CONSTRUCTION/MAINT. SUPERVISOR
CUSTOMER SERV SUP
CUSTOMER SERVICE REP. I
CUSTOMER SERVICE REP. II
DEPUTY CITY ATTORNEY
DEPUTY CITY MANAGER
DEPUTY DIRECTOR PRCS
DEPUTY FIRE CHIEF
DISPATCH SUPERVISOR
DISPATCHER/JAILER
ELEC DISTOPERATOR SUPERVISOR
ELEC UTILITY BUSINESS ANALYST
ELEC UTILITY SUPERINTENDENT
ELECTRIC DISTRIBUTION OPER II
ELECTRIC FOREMAN/FOREWOMAN
ELECTRIC LINEAPPRENTICE II
ELECTRIC LINEMAN/LINEWOMAN
ELECTRIC MATERIALS TECHNICIAN
ELECTRIC TROUBLESHOOTER
ELECTRIC UTILITY DIRECTOR
ELECTRICAL ENGINEERING TECH
ELECTRICIAN
ENGINEERING TECHNICIAN I
ENGINEERING TECHNICIAN II
ENVIRONMENTAL COMPLIANCE INSP.
EQUIPMENT SERVICE WORKER
EU RESOURCES ANALYST
EXECUTIVE ADMINISTRATIVE ASST
FACILITIES MAINT WORKER
FACILITIES SUPERVISOR
FIELD SERVICES REPRESENTATIVE
FIELD SERVICES SUPERVISOR
FINANCE TECHNICIAN
FIRE BATTALION CHIEF
FIRE BATTALION CHIEF -112 HRS
FI RE CAPTAI N
FIRE CHIEF
FIRE ENGINEER
FIRE FIGHTER I
FIRE FIGHTER II
FLEET SUPERINTENDENT
HEAVY EQUIPMENT MECHANIC
HUMAN RESOURCES MANAGER
HUMAN RESOURCES TECHNICIAN
INFORMATION SYSTEMS SPECIALIST
INFORMATION TECHNOLOGY MANAGER
LABORATORY SUPERVISOR
LABORATORY TECHNICIAN II
LEAD DISPATCHER/JAILER
LEAD ELECTRICIAN
LEAD EQUIPMENT MECHANIC
LIBRARY DIRECTOR
LITERACY/VOLUNTEER MANAGER
MAINTENANCE WORKER II
MANAGEMENT ANALYST
MANAGEMENT ANALYST - CON F
METERING TECHNICIAN
MGR. ENGINEERING & OPERATIONS
NETWORK ADMINISTRATOR
NETWORK TECHNICIAN
PARK MAINTENANCE WORKER I
PARK MAINTENANCE WORKER II
PARK MAINTENANCE WORKER III
PARKS PROJECT COORDINATOR
PARTS CLERK
PAYROLL TECHNICIAN
PERMIT TECHNICIAN
PLANT & EQUIPMENT MECHANIC
POLICE CAPTAI N
POLICE CHIEF
POLICE CORPORAL
POLICE LIEUTENANT
POLICE OFFICER
POLICE OFFICER TRAINEE
POLICE RECORDS CLERK II
POLICE RECORDS CLERK SUPERVISR
POLICESERGEANT
PROGRAMMER/ANALYST
PROPERTY & EVIDENCE TECHNICIAN
PUBLIC WORK MANAGEMENT ANALYST
PUBLIC WORKS DIRECTOR
PUBLIC WORKS INSPECTOR I
PUBLIC WORKS INSPECTOR II
RATES AND RESOURCE MANAGER
RECREATION MANAGER
REVENUE MANAGER
RISK MANAGEMENT TECHNICIAN
Page 8 of 10
RISK MANAGER
SENIOR ADMINISTRATIVE CLERK
SENIOR CIVIL ENGINEER
SENIOR ENGINEERING TECHNICIAN
SENIOR FACILITIES MAINT WORKER
SENIOR POLICE ADMI N. CLERK
SENIOR POWER ENGINEER
SENIOR PROGRAMMER/ANALYST
SENIOR STOREKEEPER
SERVICE WRITER
SR ELECTRICAL ENGINEERING TECH
SR. PAYROLL TECHNICIAN
STREET MAINTENANCE WORKER I
STREET MAINTENANCE WORKER II
STREET MAINTENANCE WORKER III
STREET SUPERVISOR
SUBSTATION TECHNICIAN
SUBSTATION/METERING SUPERVISOR
SUPERVISING ACCOUNTANT
TRAFFIC/SIGN MAKING WORKER
TRANSPORTATION MANAGER
TROUBLESHOOTING SUPERVISOR
UTILITIES MANAGER
UTILITIES SUPERINTENDENT -PW
UTILITY BILLING SPECIALIST
UTILITY EQUI P MENT SPECIALIST
W/WW MAINTENANCE WORKER 2
W/WW MAINTENANCE WORKER I
WASTEWATER PLANT OPERATOR II
WASTEWATER PLANTOPERATOR III
WATER /WASTEWATER SUPERVISOR
WATER PLANTOPERATOR III
WATER PLANT SUPERINTENDENT
WATER SERVICES TECHNICIAN I
WATER SERVICES TECHNICIAN II
WATER/WASTEWATER MAINT WKR III
WATERSHED PROGRAM COORDINATOR
WELDER -MECHANIC
CITY OF LODI
EMPLOYEE CERTIFICATION OFNEED FOR PAID EMERGENCYSICKLEAVE
Print Name:
Department:
Title: Date:
Supervisor Name:
Status: Regular Full -Time Part- Time
I, , certify that I am unable to work (or telework) for one of the following reasons:
• Leave taken under section (1), (2), or (3) is paid at the employee's regular rate of pay, subject to a
$511 per day and $5,110 aggregate cap. Leave taken under section (4), (5), or (6) is paid at 2/3rds
your regular rate of pay, subject to a cap of $200 per day and $2,000 aggregate cap. Part time
employees are entitled to leave based on 2/3rds the average number of hours worked over a 2 -week
period. Pay for leave taken under section (4), (5), or (6) may be supplemented by using your
accrued leaves. Initial your election below:
I do not wish to supplement EPSLA pay. I wish to supplement EPSLA pay with my accrued
leaves
To supplement with accrued leaves, enter hours on your timecard under the appropriate type of leave (vacation, sick,
compensatory time). Indicate under "comments" that the hours are EFMLEA if leave is under section (5), otherwise
indicate hours are EPSLA.
I understand that if my circumstances change so that I am no longer eligible under one of the
qualifying categories, I must immediately inform my supervisor and the City of Lodi and I may be
directed to report back to work (or telework).
Request Leave Start Date: Expected End Date:
Signature: Date:
HR Use
Approved Denied (reason)
Page 9 of 10
The employee is subject to a federal, state, or local quarantine or isolation order related to
1
COVID-19. (Quarantine and isolation orders are defined by the CDC and does not
include "shelter in lace" orders)
2
The employee has been advised by a health care provider to self -quarantine due to
concerns related to COVID-19.
3
The employee is experiencing symptoms of COVID-19 and is seeking a diagnosis.
The employee is caring for an individual under quarantine or isolation order, or advised
4
by a health care professional to self -quarantine.
Relationship to Individual:
The employee is caring for a child due to school closure or unavailability of the child's
5
care provider due to COVID-19. (Complete and attach Certification offeedfor
Emergency Family Medical Leaveorm)
The employee is "experiencing any substantially similar condition specified by the Secretary of
6
Health and Human Services in consultation with the Secretary of the Treasury and Secretary of
Labor." (this section is unavailable until further direction is received from the Health and Human
Services de artment.
• Leave taken under section (1), (2), or (3) is paid at the employee's regular rate of pay, subject to a
$511 per day and $5,110 aggregate cap. Leave taken under section (4), (5), or (6) is paid at 2/3rds
your regular rate of pay, subject to a cap of $200 per day and $2,000 aggregate cap. Part time
employees are entitled to leave based on 2/3rds the average number of hours worked over a 2 -week
period. Pay for leave taken under section (4), (5), or (6) may be supplemented by using your
accrued leaves. Initial your election below:
I do not wish to supplement EPSLA pay. I wish to supplement EPSLA pay with my accrued
leaves
To supplement with accrued leaves, enter hours on your timecard under the appropriate type of leave (vacation, sick,
compensatory time). Indicate under "comments" that the hours are EFMLEA if leave is under section (5), otherwise
indicate hours are EPSLA.
I understand that if my circumstances change so that I am no longer eligible under one of the
qualifying categories, I must immediately inform my supervisor and the City of Lodi and I may be
directed to report back to work (or telework).
Request Leave Start Date: Expected End Date:
Signature: Date:
HR Use
Approved Denied (reason)
Page 9 of 10
CITY OF LODI
EMPLOYEE CERTIFICATION OFNEED FOR EMERGENCYFAMILYMEDICAL LEAVE
Print Name: Title: Date:
Department: Supervisor:
Status: Regular Full -Time Part -Time
Hire Date: Average Regular Work Schedule (circle): M T W TH F SA SU
Average hours scheduled per week (part-time) :
Have you taken leave under FMLA in the past 12 months? Yes_
If yes, how many days? Or, how many hours?
IM
Compensation:
First lfl days of leave is without pay unless the following is designated:
I elect to use the following leave during the first 10 days of EFMLEA (indicate 9 of hours for each
leave type):
Leave without pay Sick Holiday
Vacation Compensatory Time Off
Emergency Paid Sick Leave
If using Emergency Paid Sick Leave, also complete Certification of Need for Emergency Paid Sick Leave form
Pa as of the 11 to day of Leave
Pay under EFMLEA is based on 2/3rds of your regular pay. You may elect to supplement with your
own accrued leaves. Initial your election below.
I do not wish to supplement EFMLEA pay.
I wish to supplement EFMLEA pay with my accrued leaves.
To supplement with accrued leaves, enter hours on your timecard under the appropriate type of leave (vacation,
sick, compensatory time). Indicate under "comments" that the hours are EFMLEA.
1, , certify that I have a child who is under the age of 18, whose
school or place of care has been closed, or whose child care provider is unavailable due to a
COVID-19 emergency declared by either a Federal, State, or local authority. Due to the need to
care for my child, I am unable to work (or telework). I understand that if my childcare needs
change, I must immediately inform my supervisor and the City and I may be directed to report
back to work (or telework).
Request Leave Start Date Expected End Date:
Signature: Date:
HR Use
Approved Denied (reason)
Process Notes
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