HomeMy WebLinkAboutAdministrative Order 2020-07 Amended Guidance for Employees and City Officials Regarding COVID-19EMERGENCY Family Medical Leave Act (EFMLA)
REQUEST FORM
The U.S. Senate passed the Families First Coronavirus Response Act (FFCRA) on March 18, 2020 and the law is effective April 1, 2020.
Unless extended, this policy expires December 31, 2020.
All permanent employees, who have worked for the City for 30 calendar days prior, in an active assignment status at the time of the
qualifying need are eligible, unless otherwise excluded. The first 10 days (80 hours) of EFMLA leave under the new qualifying need are unpaid. The employee may elect to use
other accrued leave (sick, vacation, comp, or personal day) to receive pay during those 10 days. However, employee may
take their 80 hours of EPSL for the first 10 days of EFMLA – they run concurrently if used for school/childcare closures under
EPSL.
After the first 10 days (80 hours) of EFMLA leave under the new qualifying need, an employee will receive paid leave in an
amount equal to 2/3 of the employee’s regular hourly rate.
Pay is capped at $200 per day and $10,000 in aggregate per employee. Part-time employee’s pay is based on the average
number of hours employee would normally be scheduled to work per week.
(See Administrative Order for full details)
Communication will be done electronically regarding approval and/or additional information required. Email
completed form & any supporting documents to Human Resources: HumanResources@bozeman.net.
(All fields required for processing)
Employee Name: Employee Phone #:
Employee Email (required): Hire date:
Dept/Division: Employee Title:
Your Supervisor’s name:
FFCRA added a Qualifying Need Related to a Public Health Emergency to the existing FMLA list of
qualifying events or needs:
“The employee is unable to work (or telework) due to the need for leave to care for the son or daughter under 18 years of age of such employee if the school or place of care has been closed, or the childcare provider of such son or daughter is unavailable, due to a public health emergency.”
Request Begin Date:
Is your leave request: Continuous OR Intermittent (if intermittent, describe below planned intermittent schedule)
Documentation Required: Full name & age of your child(ren) and what school/daycare they attend
Additional comments:
I acknowledge that I am unable to work (or telework) for my City of Bozeman position. I acknowledge that this request
is not valid until Human Resources approves it. I also acknowledge, I will communicate electronically any changes to
this request ASAP to Human Resources at HumanResources@bozeman.net. Lastly, I acknowledge that Human
Resources will respond to this request using the email I have provided.
Employee’s electronic signature Date
Est. End Date:
I alone am caring for my child(ren) during this EFMLA request period : YES NO
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Emergency Paid Sick Leave (EPSL)
REQUEST FORM
The U.S. Senate passed the Families First Coronavirus Response Act (FFCRA) on March 18, 2020 and the law is effective April 1, 2020.
Unless extended, this policy expires December 31, 2020.
Permanent employees who are regularly scheduled for shifts of 40 hours per week are eligible to receive 80 hours of emergency paid
sick leave. Part-time employees’ eligible hours are prorated. Calculation of pay is based on EPSL request reason. For leave reasons (1),
(2), or (3): You are entitled to pay at your regular hourly rate, up to $511 per day and $5,110 in the aggregate (over a 2-week period).
For leave reasons (4), (5), or (6): You are entitled to pay at 2/3 your regular hourly rate, up to $200 per day and $2,000 in the
aggregate (over a 2-week period).
(See Administrative Order 2020-05 for full details)
Communication will be done electronically regarding approval and/or additional information required.
Email completed form & any supporting documents to Human Resources: HumanResources@bozeman.net. HumanResources@bozeman.net (All fields required for processing)
Employee Name: Employee Phone #:
Employee Email (required): Hire Date:
Dept/Division: Employee Title:
Your Supervisor’s name:
Reason for EPSL Request (mark box) and Begin Date:
Emergency Paid Sick Leave provides paid sick time to the extent the employee is unable to work (or telework) due to a
need for leave because of any of these qualifying reasons:
(1) The employee is subject to a Federal, State or local quarantine or isolation order related to COVID-19.(A Shelter in Place order does not qualify as a quarantine or isolation) (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 seeking a medical diagnosis.
(4) The employee is caring for an individual who is subject to an order described in (1) or self-quarantine (2).
(5)The employee is caring for a child whose school or childcare provider is closed or unavailable forreasons related to COVID-19, and no other suitable person is available to care for the child.
(6) The employee is experiencing “any other substantially similar condition” specified by the Secretary of Health andServices in consultation with the Secretary of the Treasure and the Secretary of Labor.
Documentation of your qualification for EPSL:
Reason (1) or (2): Provide name of the government entity that issued the order, or name of healthcare provider who advised you to self-quarantine.
Reason (4): provide name, age and relationship of the individual and name of government entity or healthcare provider
Reason (5): provide name and age of child(ren), along with school or daycare they attend
Additional comments:
I acknowledge that I am unable to work (or telework) for my City of Bozeman position. I acknowledge that this request
is not valid until Human Resources approves it. I also acknowledge, I will communicate electronically any changes to
this request ASAP to Human Resources at HumanResources@bozeman.net. Lastly, I acknowledge that Human
Resources will respond to this request using the email I have provided.
Employee’s Electronic Signature Date
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