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There are several forms that will need to be filled out and turned in to Human Resources prior to going on leave - you can find these forms on the Leave page of our website:
FMLA Leave Request Form - This form is used to alert your department and human resources that you will be out for 3 or more calendar days for an FMLA qualified reason. You and your supervisor will need to sign this form, and it must be turned in to HR 30 days prior to going out on leave (when the need for leave is foreseeable).
Certification of Health Care Provider - This document needs to be filled out by your physician. This document also needs to be turned in to HR 30 days prior to going out on leave (when the need for leave is foreseeable).
Physician's Release to Return to Work - This document needs to be filled out by your physician prior to your return to work. Pregnancy related disability generally last six to eight weeks post-delivery, but this is ultimately determined by your physician. Your signature is required on this form. Please notify Human Resources with your “full duty” date as soon as possible, so that your pay is accurate.
Other information:If you qualify, you can take up to 12 weeks of FMLA for the birth of a child, however, If you and your spouse are both employees at the City and County of Broomfield, it is a combined 12 weeks of FMLA.
Any additional FMLA time you take off after your Short Term Disability period ends is paid using your own leave balances. If you or anyone in your immediate family become sick, please make sure to list that time/day as “sick leave” on your timesheet.
Please notify Human Resources of the date that you delivered the baby – that date is important for adding your dependent to your insurances as well as your Short Term Disability pay.
You have 30 days from the date of birth to add your new dependent to our insurance plans. We require a birth certificate to complete the enrollment.
It is a good idea to provide Human Resources with a phone number and email address that you will be checking while you are out on leave, in case we need to get in touch with you.
IMPORTANT – PLAN AHEAD! Please calculate how much annual and compensatory leave you have available to use after your period of Short Term Disability ends.
Contact Marci at 303.438.6321 or at firstname.lastname@example.org to discuss your eligibility for short term disability and Family and Medical Leave.