Leave of Absence / ADA
The forms listed below can be used for the various types of leaves of absences. If you are submitting for a work-related injury, you must also report the injury to 1-800-OHIOCOMP (1-888-644-6266 or 216-426-0646).
- Donation of Sick Days and Guidelines (7/17)
- FMLA Employee’s Serious Health Condition (5/15)
- FMLA Family Member’s Serious Health Condition (5/15)
- Request for Accommodations (6/16)
- Request for Accommodations for Medical Inquiry (6/16)- to be filled out by your doctor.
Please be aware that the leave of absence process may vary according to bargaining unit. Please refer to your bargaining unit agreement for detailed information.
FMLA & LOA Frequently Asked Questions
What does the Family and Medical leave Act provide?
The Family and Medical Leave Act (FMLA) provides eligible employees up to 12 workweeks of unpaid leave a year, and requires group health benefits to be maintained during the leave as if employees continued to work instead of taking leave. Employees are also entitled to return to their same or an equivalent job at the end of their FMLA leave.The FMLA also provides certain military family leave entitlements. Eligible employees may take FMLA leave for specified reasons related to certain military deployments of their family members. Additionally, they may take up to 26 weeks of FMLA leave in a single 12-month period to care for a covered servicemember with a serious injury or illness.
If I am not eligible for the Family and Medical leave Act (FMLA), are there any other entitlements for employees to request a leave of absence?Yes, please refer to your bargaining union agreement and/or Board policy for eligibility requirements and leave of absence terms and conditions.
Leave of Absence Application
How do I obtain leave of absence paperwork?
Please contact the Human Resources Department at 216-838-0054 for the required documents.• Forms may be sent via email, school mail, U.S. mail or retrieved from the District’s website under the Human Resources tab.
What forms are required to apply?
District Leave of Absence Form – The employee completes this form.
Certification of Health Care Provider for Employee’s Serious Health Condition (FMLA)
The physician completes this form.~or~
Certification of Health Care Provider for Family Member’s Serious Health Condition
(FMLA) – The physician completes this form.
District Return to Work Form – The employee completes this form and obtains a
Physician’s Statement with release to full duty and date released and submits with the Return to Work form.District Leave of Absence EXTENSION Form – The employee completes this form and obtains a Physician’s Statement that documents the need to continue the leave beyond the current expiration date.
It is the employee’s responsibility to submit the above checked forms to Human Resources.
Human Resources will only process ORIGINAL FORMS unless the forms are faxed directly from a
physician’s office with the physician’s letterhead attached.
Who can take a leave of absence?
In order to be eligible to take leave under the FMLA, an employee must:
In order to be eligible to take leave under an employee’s bargaining unit agreement, an employee must refer to their bargaining union agreement for eligibility requirements and leave of absence terms and conditions.
- worked 1,250 hours during the 12 months prior to the start of leave
- work at a location where the employer has 50 or more employees within 75 miles;
- worked for the employer for 12 months (The 12 months of employment are not required to be consecutive in order for the employee to qualify for FMLA leave. In general, only employment within seven years is counted unless the break in service is (1) due to an employee’s fulfillment of military obligations, or (2) governed by a collective bargaining agreement or other written agreement).
Hours of Service Requirement
Does the time I take off for vacation, sick leave or special privilege count toward the 1,250 hours?No, the 1,250 hours include only those hours actually worked for the employer. Paid leave and unpaid leave, including FMLA leave, are not included.
Compensation while on leave
Is my employer required to pay me when I take a leave of absence?No, FMLA is an unpaid leave of absence. However, the law permits the employer to require the employee, to use accrued paid vacation leave and paid sick for the leave period. An employee must follow the employer’s normal leave rules in order to substitute paid leave. When paid leave is used for a leave of absence covered reason, the leave is protected by FMLA and/or the employees bargaining unit agreement.
When can an eligible employee use FMLA leave?
A covered employer must grant an eligible employee up to a total of 12 workweeks of unpaid, job-protected leave in a 12 month period for one or more of the following reasons:
- for the birth of a son or daughter, and to bond with the newborn child;
- for the placement with the employee of a child for adoption or foster care, and to bond with that child;
- to care for an immediate family member (spouse, child, or parent – but not a parent “in-law”) with a serious health condition;
- to take medical leave when the employee is unable to work because of a serious health condition; or
- for qualifying exigencies arising out of the fact that the employee’s spouse, son, daughter, or parent is on covered active duty or call to covered active duty status as a member of the National Guard, Reserves, or Regular Armed Forces.
- The FMLA also allows eligible employees to take up to 26 workweeks of unpaid, job-protected leave in a “single 12-month period” to care for a covered service member with a serious injury or illness.
If I am hurt or injured on a jobsite what is the proper protocol to follow?
- Immediately inform your direct supervisor or appropriated personnel to receive a Bureau of Workers Compensation packet and to complete an incident report. Please carefully follow the time sensitive instructions on how to file a claim.
- Contact the Human Resources Department to apply for a Work Related Injury leave of absence or if applicable an assault leave of absence. For an assault leave please refer to your bargaining union agreement for eligibility requirements and the terms and conditions.
Serious health condition
What is a serious health condition?
The most common serious health conditions that qualify for a leave of absence are:
- conditions requiring an overnight stay in a hospital or other medical care facility
- conditions that incapacitate you or your family member (for example, unable to work or attend school) for more than three consecutive days and have ongoing medical treatment (either multiple appointments with a health care provider, or a single appointment and follow-up care such as prescription medication)
- chronic conditions that cause occasional periods when you or your family member are incapacitated and require treatment by a health care provider at least twice a year
- pregnancy (including prenatal medical appointments, incapacity due to morning sickness, and medically required bed rest)
Intermittent vs. Continuous Leave of Absence
What is the difference between a continuous vs. an intermittent leave of absence?A (continuous leave) is a leave that is taken in one block of time. (I.e. request approved from January 1, 2014-March 1, 2014).An (intermittent leave) is a leave that is taken in separate blocks of time given by a determined timeframe specified by the health care provider. (I.e. request approved from January 1, 2014- March 1, 2014 with an estimated frequency of leave 1 time per month).**Please note that an intermittent leave must qualify under FMLA**
Am I required to prove that I have a serious health condition?
Yes, an employer shall require that the need for leave for a serious health condition of the employee or the employee’s immediate family member be supported by a certification issued by a health care provider. The employer must allow the employee at least 15 calendar days to obtain the medical certification.
Can my employer make me get a second opinion?An employer may require a second or third medical opinion (at the employer’s expense) if he or she has reason to doubt the validity of the medical certification.
How soon after I request leave does my employer have to request a medical certification of a serious health condition?
Under the regulations, an employer should request medical certification, at the time an employee gives notice of the need for leave or within five business days. If the leave is unforeseen, the employer should request medical certification within five days after the leave begins.An employer may request certification at a later date if he or she has reason to question the appropriateness or duration of the leave.
How often may my employer ask for medical certifications for an on-going serious health condition?
The regulations allow recertification no more often than every 30 days in connection with an absence by the employee unless the condition will last for more than 30 days. In all cases the employer may request recertification every six months in connection with an absence by the employee. The regulations also allow an employer to request recertification in less than 30 days if the employee requests an extension of leave, the circumstances described in the previous certification have changed significantly, or if the employer receives information that casts doubt upon the employee’s stated reason for the absence or the continuing validity of the certification.Additionally, employers may request a new medical certification each leave year for medical conditions that last longer than one year. Such new medical certifications are subject to second and third opinions.
Can employers require employees to submit a Return to Work form before returning to work after being absent due to a serious health condition?
Yes, as a condition of restoring an employee who was absent on a leave of absence due to the employee’s own serious health condition, the employee is required to complete the District’s Return to Work form and to submit a letter from the employee’s own health care provider that the employee is able to resume work.**Please note that an employee must submit a District Return to Work form before returning to work after being absent for caring of a family member. Medical documentation is not required in this case.
What happens if I do not submit a requested medical release to return to work?
If an employee fails to timely submit a properly requested medical documentation the employer may delay job restoration until the employee provides the required medical documentation. If the employee never provides the certification, he or she may be denied reinstatement.
What and when do I need to tell my employer if I plan to take a Leave of Absence?
Employees seeking to take a leave of absence are required to provide 30-day advance notice of the need to take leave when the need is foreseeable. If leave is not foreseeable less than 30 days in advance, the employee must provide notice as soon as possible, under the facts and circumstances of the particular case. Absent unusual circumstances, employees must comply with the employer’s usual and customary notice and procedural requirements for requesting leave.Employees must provide sufficient information for an employer to reasonably determine the eligibility of the leave of absence request. Depending on the situation, such information may include that the employee is incapacitated due to pregnancy, has been hospitalized overnight, is unable to perform the functions of the job, and/or that the employee or employee’s qualifying family member is under the continuing care of a health care provider.
Is an employee required to follow an employer’s normal call-in procedures when taking a leave of absence?
Yes, under the regulations, an employee must comply with an employer’s call-in procedures unless unusual circumstances prevent the employee from doing so (in which case the employee must provide notice as soon as he or she can practicably do so). The regulations make clear that, if the employee fails to provide timely notice, he or she may have the leave request delayed or denied and may be subject to whatever discipline the employer’s rules provide.