AMOUNT OF LEAVE NEEDED Sample Clauses

AMOUNT OF LEAVE NEEDED. 5. Will the employee be incapacitated for a single continuous period of time due to his/her medical condition, including any time for treatment and recovery? No Yes If so, estimate the beginning and ending dates for the period of incapacity: 6. Will the employee need to attend follow-up treatment appointments or work part-time or on a reduced schedule because of the employee’s medical condition? No Yes If so, are the treatments or the reduced number of hours of work medically necessary? No Yes Estimate treatment schedule, if any, including the dates of any scheduled appointments and the time required for each appointment, including any recovery period: Estimate the part-time or reduced work schedule the employee needs, if any: hour(s) per day; days per week from through 7. Will the condition cause episodic flare-ups periodically preventing the employee from performing his/her job functions? No Yes Is it medically necessary for the employee to be absent from work during the flare-ups? No Yes. If so, explain: Based upon the patient’s medical history and your knowledge of the medical condition, estimate the frequency of flare-ups and the duration of related incapacity that the patient may have over the next 6 months (e.g., 1 episode every 3 months lasting 1-2 days): Frequency: times per week(s) month(s) Duration: hours or day(s) per episode Employer name and contact:
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AMOUNT OF LEAVE NEEDED. Please estimate the beginning and ending dates for the period of incapacity:
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AMOUNT OF LEAVE NEEDED. 5. Will the employee be incapacitated for a single continuous period of time due to his/her medical condition, including any time for treatment and recovery? No Yes If so, estimate the beginning and ending dates for the period of incapacity: 6. Will the employee need to attend follow-up treatment appointments or work part-time or on a reduced schedule because of the employee’s medical condition? No Yes If so, are the treatments or the reduced number of hours of work medically necessary? No Yes Estimate treatment schedule, if any, including the dates of any scheduled appointments and the time required for each appointment, including any recovery period: Estimate the part-time or reduced work schedule the employee needs, if any: hour(s) per day; days per week from through 7. Will the condition cause episodic flare-ups periodically preventing the employee from performing his/her job functions? No Yes Is it medically necessary for the employee to be absent from work during the flare-ups? No Yes. If so, explain: Based upon the patient’s medical history and your knowledge of the medical condition, estimate the frequency of flare-ups and the duration of related incapacity that the patient may have over the next 6 months (e.g., 1 episode every 3 months lasting 1-2 days): Frequency: times per week(s) month(s) Duration: hours or day(s) per episode SECTION I: For Completion by the EMPLOYER INSTRUCTIONS to the EMPLOYER: The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave to care for a covered family member with a serious health condition to submit a medical certification issued by the health care provider of the covered family member. Please complete Section I before giving this form to your employee. Your response is voluntary. While you are not required to use this form, you may not ask the employee to provide more information than allowed under the FMLA regulations, 29 C.F.R. §§ SECTION II: For Completion by the EMPLOYEE INSTRUCTIONS to the EMPLOYEE: Please complete Section II before giving this form to your family member or his/her medical provider. The FMLA permits an employer to require that you submit a timely, complete, and sufficient medical certification to support a request for FMLA leave to care for a covered family member with a serious health condition. If requested by your employer, your response is required to obtain or retain the benefit of FMLA protections. 29 ...
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AMOUNT OF LEAVE NEEDED. For the medical condition(s) checked in Part A, complete all that apply. Several questions seek a response as to the frequency or duration of a condition, treatment, etc. Your answer should be your best estimate based upon your medical knowledge, experience, and examination of the patient. Be as specific as you can; terms such as “lifetime,” “unknown,” or “indeterminate” may not be sufficient to determine FMLA coverage.
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AMOUNT OF LEAVE NEEDED. 5. Will the employee be incapacitated for a single continuous period of time due to his/her medical condition, including any time for treatment and recovery? No Yes If so, estimate the beginning and ending dates for the period of incapacity: 6. Will the employee need to attend follow-up treatment appointments or work part-time or on a reduced schedule because of the employee’s medical condition? No Yes If so, are the treatments or the reduced number of hours of work medically necessary? No Yes Estimate treatment schedule, if any, including the dates of any scheduled appointments and the time required for each appointment, including any recovery period: Estimate the part-time or reduced work schedule the employee needs, if any: hour(s) per day; days per week from through 7. Will the condition cause episodic flare-ups periodically preventing the employee from performing his/her job functions? No Yes
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AMOUNT OF LEAVE NEEDED. Will the employee be incapacitated for a single continuous period of time due to his/her medical condition, Including any time for treatment and recovery? ___No ___ Yes If so, estimate the beginning and ending dates for the period of incapacity: _________________________ Will the employee need to attend follow-up treatment appointments or work part-time or on a reduced schedule because of the employee’s medical condition? ___ No ___ Yes If so, are the treatments or the reduced number of hours of work medically necessary? ___ No ___ Yes Estimate treatment schedule, if any, including the dates of any scheduled appointments and the time required for each appointment, including any recovery period: ______________________________________________________________________________________ Estimate the part-time or reduced work schedule the employee needs, if any: _____ hour(s) per day; _____ days per week from _________________ through _____________________ Will the condition cause episodic flare-ups periodically preventing the employee from performing his/her job functions? ___ No ___ Yes Is it medically necessary for the employee to be absent from work during the flare-ups? ___ No ___ Yes. If so, explain: _______________________________________________________________________________ _______________________________________________________________________________ Based upon the patient’s medical history and your knowledge of the medical condition, estimate the frequency of flare-ups and the duration of related incapacity that the patient may have over the next 6 months (e.g., 1 episode every 3 months lasting 1-2 days): Frequency: _____ times per _____ week(s) _____ month(s) Duration: _____ hours or _____ day(s) per episode I, ______________________________, as the medical provider for_______________________ _____________________________, have reviewed his/her position description (Form 30 or current job description) and certify that he/she was (circle one) unable / able to perform his/her duties on _____________________________________________________________because he/she was incapacitated by personal illness or injury. After reviewing the attached Form 30 or current job description, the above referenced employee was unable to perform (specify the duty or duties that the employee could not perform): ______________________________________________________________________________ ______________________________________________________________________________ ________...
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AMOUNT OF LEAVE NEEDED. Will the employee be incapacitated for a single continuous period of time due to his/her medical condition, including any time for treatment and recovery? No Yes If so, estimate the beginning and ending dates for the period of incapacity:
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Related to AMOUNT OF LEAVE NEEDED

  • Amount of Leave Eligible employees are entitled to a total of 12 workweeks of unpaid leave during any 12-month period. As of January 2008, FMLA was amended to include a special leave entitlement that permits eligible employees to take up to 26 weeks of unpaid leave to care for a covered servicemember during a single 12-month period. No more than 26 workweeks of leave may be taken within any single 12-month period.

  • Period of Leave An employee shall be granted extended military leave for the initial period of enlistment, service, or tour of duty for a period not to exceed five (5) years. In addition, leave shall be granted for a period up to six (6) months from the date of release from duty if the employee requests such extension.

  • Annual Leave Loading During a period of annual leave an employee will receive a loading of 17.5 per cent calculated on the employee’s normal hourly rate of pay and the daily fares allowance if applicable. The loading will also apply to proportionate leave on lawful termination.

  • Taking of Leave (a) Annual leave shall be given and shall be taken within a period of six months after the date when the right to annual leave accrued; provided that the giving and taking of such leave may be postponed by mutual agreement between the parties for a further period not exceeding six months. (b) Where an employee requests, annual leave can be taken in single days. (c) The employer shall provide a response within a reasonable timeframe giving consideration to the urgency of the application to an employee’ application for annual leave.

  • Commencement of Leave Parental leave must commence no later than the first anniversary date of the birth or adoption of the child or of the date on which the child comes into the actual care and custody of the employee. The employee will decide when his or her parental leave is to commence.

  • Aggregate Leave The aggregate amount of leave of absence from employment that may be taken by an employee under Clause 21.1 (Maternity Leave) and Clause 21.2 (Parental Leave) in respect of the birth or adoption of any one child will not exceed 78 weeks, except as provided under Clause 21.1(f) (Maternity Leave) and/or Clause 21.2(c) Parental Leave.

  • Amount of Sick Leave Employees shall be granted sick leave on the basis of one and one-half (1 1/2) days per month of service in a continuing appointment, at the F.T.E. of current appointment. If in any one year employees have not used their sick leave, or only a portion thereof, it shall accrue to their credit for future use and benefits.

  • Xxxx Leave For laid off employees, sick leave accruals shall remain on the books and be reinstated if such employees are reappointed. Whenever a person becomes ineligible for reemployment, and such person has not been re-employed, then, if at the point of layoff such person was eligible to receive a sick leave accrual payoff, such person shall be paid for existing sick leave accruals in accordance with Section 1408 of this Agreement.

  • Child Rearing Leave Subd. 1 Child rearing leave of absences shall be available to teachers for a period of time, not to exceed twelve (12) calendar months, for the purpose of caring for a newborn infant or pre-school adopted child for which the applicant has the legal responsibility for the care and/or support of said child. Such leave may be taken subsequent to birth of the teacher's child, or in the case of adoption, when the child is physically turned over to the teacher-parent. a. At least two (2) calendar months prior to the estimated delivery date of the child, the employee shall be required to notify the Employer in writing whether or not the employee intends to take child rearing leave. This election may be changed at any time before the teacher is no longer disabled from working due to childbirth or pregnancy related disability or before the fifteenth (15th) day after the birth of the child, whichever is sooner. b. Upon filing an application for adoption of a pre-school child, the employee shall be required to notify the Employer, in writing, of the teacher's intention to take a child rearing leave. Such notice to include the estimated date when such leave shall become effective. Subd. 3 In connection with the election to take child rearing leave, the teacher shall submit a request for such leave in writing. Such request shall include an estimated commencement date and return date. The estimated commencement date shall be the physician's projected date the teacher will no longer be disabled from teaching due to childbirth or pregnancy related disability, or in the case of an adoption, the agency's estimated date when the child will be turned over to the parent. Subd. 4 In making the final determination under Subd. 3 concerning the duration of a child rearing leave of absence, the Employer shall not be required to grant a leave of absence in excess of two (2) semesters. The actual commencement date of child rearing leave shall be the date on which the teacher is no longer disabled due to childbirth and pregnancy related disability as determined by the physician; or, in the case of an adoption, the date when the child is physically turned over to the teacher-parent. The return date shall be twelve (12) calendar months following the actual commencement of the leave except as may be provided in Subd. 7.

  • Parental Leave Allowance ‌ (a) An employee who qualifies for parental leave pursuant to Article 35.03, shall be paid a parental leave allowance in accordance with the Supplemental Employment Benefit (SEB) Plan. In order to receive this allowance, the employee must provide to the Employer proof of application and eligibility to receive employment insurance benefits pursuant to the Employment Insurance Act. An employee disentitled or disqualified from receiving employment insurance benefits is not eligible for parental leave allowance. (b) Pursuant to the Supplemental Employment Benefit (SEB) Plan and subject to leave apportionment pursuant to Article 35.03(b), the parental leave allowance will consist of a maximum of ten (10) weekly payments, equivalent to the difference between the employment insurance gross benefits and any other earnings received by the employee, and seventy-five (75) percent of the employee’s basic pay.

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