Covid/Vax Related Absence Reporting

IMPORTANT
 
THREE MAIN TYPES OF FORM SUBMISSIONS: Vaccine Related - Covid 19 Related - Family Care
  • COVID 19 RELATED - Covid Positive / Covid Symptoms / Quarantine

  • VACCINE RELATED - Absence(s) / Time Off For Vaccination(children included) & Or Side Effects

  • FAMILY CARE -  Car/Sick Days for Covid 19 Related Absences
Would you like to see the UFT's "Time Keeping for Covid Related Event Chart"?

Empolyee Information Collection

Application Reporting Type *

Covid-19 Related Details

Which applies best for your Covid-19 reporting? *
Covid Positive Reporting *
Covid Symptoms Reporting *
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Would you like to upload documentation? *

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Would you like to upload documentation? *

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Would you like to upload documentation? *

Vaccine Related Absences & Time Off

Which applies best for vaccine time off reporting? *
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Did you give your supervisor advance notice of Leaving Early / Arriving Late? *

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Do you have documentation for vaccine side effects? *

Care for Family Member - Car/Sick Days

Important
 
There are TWO types of Care for Family Memeber Covid Related Absences
Employees shall be permitted to utilize CAR or sick days, over the existing limit of three such days per year, to either...
  • Care for a family member who is home due to documented COVID-19 related illness after having tested positive for COVID

  • Care for their child whose school or place of care has been closed for COVID-19 related reasons, and/or is at home for remote learning for COVID-19 related reasons.
Car/Sick Days for Covid-19 Related Absences *
How would you like to report this time? *
Family Covid Related Absences *
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Care for a Child Covid Related Absences *
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Do you have documentation for family care(illness)? *

Do you have documentation for family care(school closure)? *

IMPORTANT

 
Receiving 2/3rds pay requires filling out another form hosted by the DOE.
 
Please follow the guidance below to report this time correctly - thank you!

Emergency Family Leave due to COVID-19 – Excused Leave at Partial Pay

Published 03/16/2020 02:44 PM   |    Updated 01/05/2022 11:52 AM
 
Important:This article has been updated to reflect the contents of Personnel Memorandum #1, 2021-2022.For an overview on leaves of absence, please see: Leaves Overview (9220).
Looking for something else?If you are a Payroll Secretary/Timekeeper, please see: Emergency Family Leave - Instructions for Payroll Secretaries (8204).For information about other absences and leaves, please see: Absences and Leaves Due to COVID-19 (7163).
As outlined in Personnel Memorandum #1, 2021-2022, employees who have been employed for thirty (30) days or longer are eligible for twelve (12) weeks of excused leave at partial pay (two-thirds of the employee’s regular rate of pay, not to exceed $200 per day or a total of $12,000) as follows (note that 1 and 2 are eligible for excused leave at full pay; partial pay is available after the employee uses two work weeks of excused leave at full pay): 
  1. The employee is exhibiting symptoms of COVID-19 but does not, at the time symptoms develop, have a positive COVID-19 diagnostic test. To be eligible for excused leave, an employee must provide documentation that they have exhibited symptoms of COVID-19 and that they sought diagnosis of COVID-19 with a COVID-19 diagnostic test within three days from symptom onset. Employees must use their own sick leave for any additional time taken after receiving a negative COVID-19 test result or if they do not seek COVID-19 testing.
  2. The employee is subject to a governmental quarantine or isolation order or healthcare provider’s quarantine order while observing the quarantine or isolation order. 
  3. The employee is caring for an individual subject to a governmental quarantine or isolation order and the employee must demonstrate that the individual depends on the employee for care.
  4. The employee is caring for an individual who has been advised by a licensed health care provider to self-quarantine either because of exposure to COVID-19 or because of heightened risk associated with exposure to COVID-19. The employee must provide documentation of the licensed health care provider’s advice and must demonstrate that the individual depends on the employee for care.  
  5. The employee is caring for their child under 18 years of age whose school or place of care has been closed or whose child care provider is unavailable due to COVID-19 precautions. The employee must provide documentation to show that the school or place of care has been closed.   
How long can I be out for?
Effective April 1, 2021, employees are eligible for a cumulative total of to 12 weeks of leave at partial pay in a rolling 12-months period, starting from the first day of leave. The maximum 12 weeks of leave in a twelve-month period available under this section is reduced by the amount of FMLA leave taken by the employee during the same twelve-month period.
Can I take this leave intermittently?An eligible employee may utilize excused leave intermittently as agreed upon by the DOE and the employee. This leave must be taken in full-day increments. 
Can I use my accruals to receive full pay instead of partial pay?Excused leave under this Policy is in addition to existing rules and entitlement regarding leave (e.g. annual leave, CAR, and sick leave). An employee may waive excused leave at partial (two-thirds) pay authorized by this policy and use accrued annual leave or sick leave, if applicable, during the period of excused leave at partial pay.
What supporting documentation do I need?
Although supporting documentation may not be required for the application, it may be requested/required at some point by your Supervisor. You may be asked to provide documentation for any of the conditions covered under this excused leave. This may include a letter from your health care provider or a government agency.Can I telework in lieu of taking this leave?As an alternative to excused leave, teleworking may be permitted for non-school-based staff, with prior supervisor approval, if the essential functions of the job can be performed remotely. However, supervisors are not required to create or allow a teleworking assignment for employees who cannot report to work in person for the reasons listed above. To the extent that teleworking is permitted, employees are still required to provide documentation of the reason for the in-person absence consistent with these criteria. 
How do I apply?
  1. Complete the “Emergency Family Leave – Excused Leave at Partial Pay Form.” This form is also available on DHR Forms. If you are having difficulty opening this form, please check to make sure that it is not opening within your internet browser. If it is, save it to your desktop and open the file with Adobe Acrobat Reader. We have also included a simplified version under the Attachments section at the bottom of this page. 
  2. Gather your supporting documentation and ensure that you have this ready. You may be asked by your Supervisor to provide documentation for any of the conditions covered under this excused leave.
  3. Submit your completed form via either of the following ways:Via email: email the form to hrconnectleavesfax@schools.nyc.gov. If possible, please send this from your DOE email address. Via fax: Fax your completed form to (718) 935-4350.
This form can not be completed for 2/3rds pay *