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COVID-19 FMLA Leave Request

3 signers
1 Employee
2 Manager
3 HR Staff
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COVID-19 FMLA Leave Request Form: Requesting Expanded Leave Options Made Easy

The COVID-19 pandemic has created unprecedented challenges for businesses and employees alike. One of the most significant challenges has been the need to provide expanded leave options to employees who are unable to work due to COVID-19-related issues.
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covid 19 fmla leave request form template
In response to this need, the U.S. government enacted the Families First Coronavirus Response Act (FFCRA), which provides expanded leave options for eligible employees. The FFCRA allows employees to take up to 12 weeks of expanded paid Family and Medical Leave Act (FMLA leave) for specific COVID-19-related reasons.
To request expanded FMLA leave under the FFCRA, employees must complete a COVID-19 FMLA Leave Request form. This form is designed to capture the information required to determine an employee’s eligibility for expanded FMLA leave.

What is the COVID-19 FMLA Leave request form for?

The COVID-19 FMLA Leave Request form should be completed by employees who are unable to work (or telework) due to a need to care for their child whose school or place of care is closed or whose childcare provider is unavailable due to COVID-19-related reasons. The form should also be used by employees who are unable to work due to their own COVID-19-related illness or who are under a quarantine order.

The document on this page is a free template that businesses and employees can use to facilitate the request process. The form includes fields for employees to provide their name, department, and manager, as well as their requested leave’s start and end dates. Employees who need a reduced work schedule can indicate the days and hours they are available for work.

This form is essential because it helps ensure that employees are aware of their expanded leave options and can access the benefits to which they are entitled. It also helps businesses manage their workforce by providing a streamlined process for employees to request expanded leave. By using this leave form, businesses can avoid potential misunderstandings and ensure their employees receive the necessary support during these challenging times.

When to Use the COVID-19 Leave Request Form

The COVID-19 pandemic has affected individuals in different ways, and there are various use cases for the COVID-19 FMLA Leave Request form. The most common use case is for employees who need to care for their child due to school or daycare closures related to COVID-19. This use case applies to employees who are unable to work (or telework) because they need to be home to care for their child. The form requires employees to specify the reason for their leave request, such as a school or daycare closure, to ensure that they are eligible for expanded FMLA leave.

Another use case is for employees who are unable to work due to a serious health condition related to a COVID-19 diagnosis. This use case applies to employees who are ill and unable to work because of their COVID-19 diagnosis. Employees diagnosed with COVID-19 may need extended leave to recover from their illness and ensure that they do not spread the virus to others in the workplace. The form requires employees to provide documentation of their COVID-19 diagnosis from their healthcare provider to ensure that they are eligible for expanded FMLA leave.

Employees caring for a family member who has COVID-19 or is under a quarantine order may also use the COVID-19 FMLA Leave Request form. This use case applies to employees who need to be home to care for a family member who is ill or who is under a quarantine order. Employees who are caring for a family member may need to take extended leave to ensure that they do not spread the virus to others in the workplace. This requisition form requires employees to provide documentation of their family member’s COVID-19 diagnosis or quarantine order to ensure that they are eligible for expanded FMLA leave.

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One platform

Fill HQ is an online platform that offers a wide range of free templates to meet your business needs. By using our templates, you can save time and effort in creating your own documents from scratch. Our templates are customizable, so you can easily modify them to suit your specific requirements.

Convenience

Using our COVID-19 sick leave template can help you ensure that your employees have access to the expanded leave options provided by the FFCRA. Our template includes all the necessary fields to capture the information required to determine an employee’s eligibility for expanded FMLA leave. The template is easy to use, and you can customize it to suit your specific needs.

Cost-effective

Our form is completely free to use. This means that businesses can save time and money by using a pre-designed form instead of creating one from scratch. By using Fill’s form, businesses can ensure that their employees have access to a high-quality, professionally designed form without incurring any additional costs.

Security

Every Fill template is designed to be secure and protect employee information. The form is hosted on a secure platform and includes features such as data encryption. By using a secure form, employees can be confident that their personal information is protected and not at risk of being compromised. This ensures that businesses are complying with legal requirements and protecting employee privacy.

FAQ About the COVID-19 FMLA Leave Request

The Families First Coronavirus Response Act (FFCRA) is a law passed by the U.S. government in March 2020 that provides expanded job protected leave options for employees employed anywhere in the U.S. who are unable to work (or telework) due to COVID-19-related issues.
Eligible employees include those who have been employed for at least 30 days and are unable to work (or telework) due to the need to care for a child whose school or place of care is closed or whose childcare provider is unavailable due to COVID-19-related reasons. Employees who are ill with COVID-19, caring for a family member who has COVID-19, or are under a quarantine order are also eligible for expanded FMLA leave.
Employees can take up to 12 weeks of paid sick leave under the FFCRA.
Yes, employees are entitled to a paid family leave under the FFCRA and the Fair Labor Standards Act (FLSA). The amount of pay is based on the employee’s regular rate of pay, up to a certain maximum per day.

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