The FFCRA form should be used for one of the following reasons, all other requests should use the FMLA Request Form:
- You are subject to a federal, state, or local quarantine or isolation order related to COVID-19
- You have been advised by a health care provider to self-quarantine due to concerns related to COVID-19
- You are experiencing symptoms of COVID-19 and are seeking a medical diagnosis.
- You are caring for an individual who is subject to either numbers 1 or 2 above.
- You are caring for a child (up to age 14, or age 15-18 with special circumstances) whose school or place of care has been closed, or your childcare provider is unavailable due to COVID-19 precautions and,
- You attest that no other suitable person is available to care for your child during the requested period of leave; and/or
- You attest that special circumstances exist requiring your need for leave to care for a child ages 15-18.
- You are experiencing another substantially similar condition specified by the Secretary of Health and Human Services in consultation with the Secretary of the Treasury and Secretary of Labor.
- Employee’s Health Condition Certification Form
- Family Member’s Health Condition Certification Form
- Certification of Qualifying Exigency for Military Family Leave
- Certification for Serious Injury or Illness of a Current Service Member (for Military Family Leave)
- Certification for Serious Injury or Illness of a Veteran (for Military Caregiver Leave)