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ESD 113 Form 5400-A33 Page 1 of 1 BEREAVEMENT LEAVE REQUEST FORM Educational Service District 113 Employees Printed Name: Beginning date of leave: Ending date of leave: CHECK ONE: Leave is for immediate

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How to fill out bereavement leave:

01

Inform your supervisor or human resources department: Once you have a bereavement situation, it is important to notify your supervisor or the designated department in your organization responsible for managing leave. They will provide you with the necessary forms and guidance to fill out.

02

Obtain and complete the required paperwork: The paperwork for bereavement leave may vary from one organization to another. However, it typically involves filling out a leave request form or application. Make sure to accurately and completely provide the required information such as the duration of your leave, the reason for the leave, and any supporting documentation requested.

03

Gather necessary documentation: Some companies may request proof of the bereavement event, such as a death certificate or an obituary. Collect these documents to submit along with your leave application. It is important to adhere to any specific documentation requirements set by your employer.

04

Follow the timeline set by your employer: Companies often have specific procedures and timelines for requesting bereavement leave. Ensure that you submit your application within the designated timeframe, adhering to any notification requirements set by your employer. This will help streamline the process and ensure a smooth approval.

05

Communicate with your supervisor or HR department: Throughout the process, maintain open communication with your supervisor or HR department. Seek clarification or guidance if needed, and provide any additional information or updates they may require. Effective communication will help facilitate a proper understanding of your circumstances and ensure a seamless transition during your leave.

Who needs bereavement leave:

01

Employees who have experienced the loss of an immediate family member: Bereavement leave is typically granted when an immediate family member passes away. Immediate family members may include a spouse, domestic partner, child, stepchild, parent, step-parent, grandparent, grandchild, sibling, or in-law.

02

Individuals who need time to attend funeral or memorial services: Bereavement leave is designed to provide employees with the opportunity to attend funeral or memorial services honoring their deceased family members. It allows them to grieve, support their loved ones, and participate in these significant events.

03

Those who may require additional time for emotional recovery: The loss of a loved one can be emotionally distressing, and individuals may need time off work to process their grief and adjust to the loss. Bereavement leave acknowledges the need for employees to prioritize their mental health during these challenging times.

04

Employees who have complied with their company's leave policies: While many organizations offer bereavement leave as a benefit, it is important to review and comply with the specific policies outlined by your employer. This may include fulfilling notification requirements, submitting necessary documentation, and adhering to any eligibility criteria set by your company.

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What is bereavement leave?

Bereavement leave is a type of leave taken by an employee due to the death of a family member or loved one.

Who is required to file bereavement leave?

Employees who have experienced the death of a family member or loved one are typically required to file for bereavement leave.

How to fill out bereavement leave?

Employees can fill out bereavement leave by following their company's specific procedures, which may include notifying their supervisor and providing relevant documentation.

What is the purpose of bereavement leave?

The purpose of bereavement leave is to allow employees time off to grieve and attend to matters related to the death of a family member or loved one.

What information must be reported on bereavement leave?

Employees may be required to provide documentation of the death, such as an obituary or death certificate, when filing for bereavement leave.

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