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Code No. 410.1E1EMERGENCY PAID SICK LEAVE REQUEST FORM UNDER THE FAMILIES FIRST CORONAVIRUS RESPONSE ACT (FF CRA)Name: ___ Anticipated Begin Date: ___ Expected Return to Work Date: ___Employee Request

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How to fill out emergency paid sick leave

01

Determine if you are eligible for emergency paid sick leave.

02

Complete the required paperwork provided by your employer.

03

Submit the paperwork to your employer in a timely manner.

04

Keep records of the days you take emergency paid sick leave for future reference.

Who needs emergency paid sick leave?

01

Employees who are unable to work or telework due to specific COVID-19 related reasons are eligible for emergency paid sick leave.

02

These reasons include being subject to a quarantine order, experiencing symptoms of COVID-19 and seeking a medical diagnosis, or caring for someone who is subject to a quarantine order.

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What is emergency paid sick leave?

Emergency paid sick leave is a provision that allows employees to take paid time off for specific reasons related to the COVID-19 pandemic.

Who is required to file emergency paid sick leave?

Employees who are unable to work or telework due to specific COVID-19 related reasons are required to file for emergency paid sick leave.

How to fill out emergency paid sick leave?

Employees should contact their HR department or employer for guidance on how to fill out the necessary paperwork for emergency paid sick leave.

What is the purpose of emergency paid sick leave?

The purpose of emergency paid sick leave is to provide support and protection for employees who are affected by the COVID-19 pandemic.

What information must be reported on emergency paid sick leave?

Employees must report the specific COVID-19 related reason for their absence, the duration of their leave, and any other requested information by their employer.

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