Sample Only
CITY OF BERKELEY, CA
ADMINISTRATIVE REGULATIONS
SUBJECT: ADMINISTRATIVE REGULATION FOR FAMILY CARE LEAVE
A.R. NUMBER: 2.31
EFFECTIVE DATE: August 17, 1994
REVISED DATE: November 1, 2000
PURPOSE:
To set forth policy and procedure for the implementation and administration of Family Care Leave as required by the Federal Family and Medical Leave Act, and the California Family Rights Act, and to incorporate the separate City of Berkeley Parental Leave Policy under a comprehensive Family Care Leave program.
POLICY:
It is the policy of the City to extend the full benefits of family care leave to any permanent career employee who has a minimum of one (1) year career service with the City of Berkeley, and limited benefits to qualified temporary employees as defined herein. Employees eligible for parental leave shall be entitled to a maximum of one (1) year of leave for the birth or adoption of a child who is five (5) years of age of younger. Employees eligible for family care leave under state and federal law are eligible for twelve (12) weeks of leave for the birth or adoption of a child or for the placement of a child with the employee for foster care, to care for a family member with a serious health condition, or to care for the employee's own serious health condition. Leaves under this provision may not be combined to yield a larger amount of leave than the stated maximums. Time away from work on parental leave shall be deducted from the amount permitted for medical leave, and time away from work on medical leave shall be deducted from the amount permitted for parental leave.
PROCEDURE:
Parental Leave
There are two types of parental leave described in this regulation. The first kind of parental leave is a one-year parental leave policy provided by the City of Berkeley's personnel rules and regulations. Not all City employees will qualify for this benefit. The second kind of parental leave is a twelve-week parental leave required by state and federal law which respectively are called the California Family Rights Act and the Family and Medical Leave Act of 1993. Some employees who do not qualify for the City's one-year parental leave policy may qualify under state and federal law for the twelve-week parental leave.
A. City of Berkeley Personnel Rules
1. Any employee with one (1) or more years of benefited employment with the City of Berkeley shall be entitled to up to one (1) year of parental leave as provided in the City's personnel rules as follows:
a. The birth of a child of the employee, or the adoption of a child who is five (5) years of age or younger by the employee
b. Leave for the birth or adoption of a child must commence no later than thirteen (13) months from the date of birth or adoption and must conclude no later than twenty-five (25) months from the date of birth or adoption. Leave may begin before the date of birth or adoption upon presentation of medical certification of pregnancy, or the presentation of legal evidence of adoption. Leave may be taken intermittently upon mutual agreement between the employee and the department director.
c. Employees exercising their rights under this provision must provide the department director at least thirty (30) calendar days written notice prior to the anticipated commencement date of parental leave.
d. At the employee's option, the employee may be placed on authorized leave without pay or may be compensated during parental leave with his / her accumulated sick leave (up to a maximum of two hundred (200) days), and all other accrued leaves. Such accrued leave balances will be paid in the same manner as if the employee were absent due to illness or on vacation during the leave. Upon exhausting all employee designated leave balances, the employee will be on unpaid status for the remainder of the leave.
e. During approved parental leave, after all accrued leaves are exhausted, the City will maintain life and health insurance coverage for the duration of the parental leave subject to any regular participation requirement of the employee.
f. In the event both parents are employed by the City of Berkeley, both employees may take parental leave simultaneously if eligible.
g. Approved parental leave shall not be deducted from the employee's seniority service date.
B. State and Federal Law
1. Employees who are not eligible for the one-year parental leave benefit under the City of Berkeley's personnel rules may still qualify for up to twelve (12) weeks of parental leave in a twelve-month period under state and federal law. In addition, while the City of Berkeley's one-year parental leave policy does not cover placement of a child with the employee for foster care, the state and federal law does provide leave for foster care. In order to qualify for parental leave under federal and state law, employees must have at least one (1) year of continuous service with the City and also have worked at least 1,250 hours in the twelve (12) months preceding the leave. This includes non-career hourly employees. Eligible employees may be entitled to a leave of absence of up to a maximum of twelve (12) weeks in a twelve-month period as follows:
a. Upon the birth of the employee's child, the adoption of a child by the employee or placement of a child with the employee for foster care;
b. Leave may begin before the date of birth, adoption or foster care upon presentation of medical certification of pregnancy, the presentation of legal evidence of adoption, or presentation of documentation requiring state action for foster care. Leave may be taken intermittently upon mutual agreement between the employee and the department director, but under no condition may intermittent leave extend the period of parental leave beyond the one (1) year period in which the maximum twelve (12) weeks of leave is permitted to be taken under state and federal law.
c. Employees exercising their rights to parental leave under state and federal law must provide the department director at least thirty (30) calendar days written notice prior to the anticipated commencement date of parental leave. If the need is such that 30 days' notice cannot be provided, the request must be made as soon as possible.
d. All parental leaves of absence under federal and state law are unpaid unless an employee has accrued leave. All accrued sick leave, vacation leave, compensatory leave, and/or administrative leave must be used before being placed on leave without pay.
e. During an approved parental leave under federal and state law, the City will maintain life and health insurance coverage for the duration of the twelve-week parental leave subject to any regular participation requirement of the employee.
f. In the event both parents are employed by the City of Berkeley, both employees may take parental leave simultaneously if eligible.
g. Approved parental leave shall not be deducted from the employee's seniority service date.
Medical Leave
1. Eligible employees shall be granted medical leave as follows:
a. Up to twelve (12) weeks of leave in a twelve-month period to care for a family member with a serious health condition, or to care for the employee's own serious health condition that prevents the employee from performing his / her job.
b. For the purposes of this provision, a family member is defined as a biological child, adopted or foster child, stepchild, legal ward of an employee, biological parent, step-parent, adoptive parent, legal guardian, grandchild or grandparent in families where no parents are present, spouse or domestic partner. A serious health condition is defined as an illness, injury, impairment, or physical or mental condition requiring either inpatient treatment at a hospital, hospice, or residential care facility or continuing treatment by a health care provider that prevents the employee from performing his / her job.
c. Employees exercising their rights under this provision must provide the department director at least thirty (30) calendar days written notice prior to the anticipated commencement date of medical leave. If the leave is unforeseen, the employee shall provide the department director written notice of leave as soon as is practicable. When medically necessary, leave may be taken intermittently or on a reduced work week schedule, however the employee must schedule the leave so as not to unduly disrupt the department director operations. The City may transfer an employee to another position which would better accommodate the requirements of the City's operations.
d. At the commencement of medical leave, the employee must first use accrued sick leave, and then must use all other accrued leaves. Employees may not use greater than twelve (12) days of their sick leave to care for a family member. Such accrued leave balances will be paid in the same manner as if the employee were absent due to illness or on vacation during the leave. Upon exhausting all leave balances, the employee will be on unpaid status for the remainder of the leave.
e. During approved medical leave, after all applicable leaves are exhausted, the City will maintain life and health insurance coverage for the duration of the leave subject to any regular participation requirement of the employee.
f. The foregoing leave shall be granted upon medical certification that the employee has a serious health condition, or the employee is needed to care for a family member suffering from a serious health condition. Additional medical opinions may be required (at the City's expense) and a fitness for duty report to return to work.
g. Approved medical leave shall not be deducted from the employee's seniority service date.
1. Non-career hourly employees shall be eligible for up to twelve (12) weeks of medical leave if they have a minimum of one (1) year of service and have worked at least 1,250 hours during the previous twelve (12) months.
Implementation of Family Care Leave
1. Employees requesting family care leave must submit completed Request For Family Care Leave form (designating either parental or medical leave), or if leave is unforeseen, call their supervisor to obtain the form.
a. If parental leave is requested, employee must provide medical certification of pregnancy, legal evidence of adoption, or evidence of State authorized foster care.
b. If medical leave is requested to care for the employee's own serious health condition, the department shall require the employee to submit the City of Berkeley Medical Certification form completed by the employee's personal physician.
c. If medical leave is requested to care for a family member, the employee must submit City of Berkeley Medical Certification form indicating that the employee is needed to provide care for family member.
3. Employees may only be granted intermittent parental leave upon mutual agreement between the employee and the Department / City.
4. Intermittent leave must be granted for medical leave to care for the employee's own serious health condition provided the employee schedules leave so as not to unduly disrupt the department's operational needs.
5. Upon receiving documented leave requests, the departmental payroll clerk will conduct an audit of the employee's file and time cards for previous 12 months to confirm that the employee is eligible for family care leave, and to determine amount of leave employee can use.
6. Upon verification of employee eligibility, DCM/Department Director will approve family care leave for a specific time period and forward the leave application to Director of Human Resources and City Manager for authorization.
7. The department will prepare the necessary payroll forms and employee transaction form to document the family care leave, and to ensure that the employee receives compensation, if applicable, and that all paid leaves are exhausted, as appropriate, prior to placing the employee on leave without pay.
RESPONSIBLE PARTY:
TO BE REVISED:
Approved by:
__________________________________________
Department Director
__________________________________________
Deputy City Manager
__________________________________________
City Manager
REQUEST FOR PARENTAL LEAVE
There are two types of Parental Leaves provided in A.R. 2.31. The first is a one-year Parental Leave policy provided by the City of Berkeley's Personnel Rules and Regulations. The second type of Parental Leave is a 12-week parental leave required by state and federal law. Some employees who do not qualify for the City's one-year Parental Leave policy may qualify under state and federal law for the 12-week Parental Leave.
I. City of Berkeley Personnel Rules: Any employee with one (1) or more years of benefited employment with the City of Berkeley shall be entitled to up to one (1) year of Parental Leave for the birth of a child of the employee or the adoption of a child who is five (5) years of age or younger by the employee. Leave must commence no later than thirteen (13) months from the date of birth or adoption and must conclude no later than twenty-five (25) months from the date of birth or adoption.
II. State and Federal Law: Employees who are not eligible for the one-year parental leave under the City of Berkeley's Personnel Rules may still qualify for up to 12-weeks of Parental Leave in a 12-month period under State and Federal law if an employee has at least one (1) year of continuous service with the City and has worked at least 1,250 hours in the 12-months preceding the leave. This includes non-career hourly employees. Leave may be taken for the birth of a child of the employee, the adoption of a child by the employee, or placement of a child with the employee for foster care. Leave may not extend the period of parental leave beyond the one (1) year period in which the maximum 12-weeks of leave is permitted.
|
PART A (To be completed by employee and submitted to immediate supervisor) |
||
|
Employee Name_______________________________________________________ Phone Ext._________________________ Department/Division____________________________________________Class Title___________________________________ REQUEST FOR: (check one) □ Parental Leave under the City's Personnel Rules and Regulations At your option, you may be placed on authorized leave without pay or be compensated during an approved Parental Leave by using accrued sick leave (to a maximum of 200 days) and other leave balances. (Must be accompanied by medical certification of pregnancy or legal evidence of adoption.) □ Parental Leave under State and Federal Law (Must be accompanied by medical certification of pregnancy, legal evidence of adoption, or foster care.) Request for leave from____________________________ to ___________________________. Conditions of Parental Leave: After all designated accrued leaves have been exhausted, the City will maintain medical, dental, and life insurance coverage for the duration of the approved leave subject to any regular participation requirements. You must provide a 30-calendar day written notice prior to the leave and present medical certification of pregnancy, legal evidence of adoption, or documentation requiring state action for foster care. Leave may begin prior to the birth or adoption of a child and may be scheduled intermittently upon mutual agreement between you and your department director. Parental Leave shall not be deducted from your seniority service date. I understand that I will have voluntarily resigned if I accept other employment during my leave and that I will be subject to disciplinary action if I fail to return at the expiration of my approved parental leave. Leaves cannot be approved unless the City of Berkeley has received requested documentation. If the leave is unforeseen, conditional approval will be made pending submission of medical documentation. I understand that it is my responsibility to apply for State Disability Insurance if I am eligible for such benefits. __________________________________________________ _________________
|
|
PART B (to be completed by employee's supervisor and Department Director |
||||||||
|
Based upon the employee's eligibility and proof of medical documentation, Parental Leave is: □ Denied If approved, leave is from ___________________ to ___________________ □ Approved If approved, will the employee be replaced during absence? □ Yes □ No If replacement is necessary, please indicate method: □ Temporarily promote existing staff □ Hire from existing eligible list □ Use Temporary Agency □ We have consulted with the Human Resources Department to request recruitment for a replacement. Replacement will be available by__________________. Based upon employee's eligibility, leave is approved from ____________________________to ___________________________. Authorization of Parental Leave: ______________________________________________ _______________________________________________________
______________________________________________ _______________________________________________________
If leave is approved by Deputy City Manager/Department Director, forward to Human Resources Department with copy of medical certification and Employee Transaction Form. If leave is denied due to ineligibility, notify employee in writing. cc: Human Resources Department Medical File White Copy Employee Supervisor Canary Copy Employee Pink Copy |
REQUEST FOR MEDICAL LEAVE
FEDERAL FAMILY MEDICAL LEAVE ACT (FMLA) BENEFITS: A.R. 2.31 provides for medical leave of up to 12-weeks in a 12-month period to care for your own serious health condition that prevents you from performing the functions of your job classification, or to provide care when medically necessary for a family member with a serious health condition. You may be eligible for medical leave if you have one (1) or more years of benefited employment with the City or have at least one (1) year of continuous service with the City and have worked at least 1,250 hours in the 12-months preceding the leave. A FMLA qualifying medical leave may be taken intermittently provided you schedule your leave so as not to unduly disrupt the City's operations. At the beginning of the medical leave you must use accrued sick leave, vacation leave, compensatory time, and administrative leave prior to being placed on unpaid status. You may not use greater than 15-days of your sick leave when medical leave is for the purpose of providing care for a family member. Use of such leave balances cannot be used to extend medical leave beyond the 12-week maximum in a 12-month period.
|
PART A. (To be completed by employee and submitted to immediate supervisor) |
||
|
Employee Name______________________________________________________ Phone Ext._________________________ Department/Division___________________________________________ Class Title___________________________________ Request for: (check one) □ FMLA Medical leave (care for myself) □ FMLA Medical leave (care for family member) □ Medical Leave (Non-FMLA qualifying) □ Extension to current Medical leave Note: All Medical Leaves must be accompanied by City Medical Certification Form Request for leave from____________________________ to ___________________________. Conditions of FMLA Qualifying Medical Leave: During approved FMLA medical leave, after all applicable accrued leaves (sick, vacation compensatory time, administrative leave) have been exhausted you will be placed on unpaid status and the City will maintain medical, dental, and life insurance coverage for the duration of the leave, subject to any regular participation requirements. You must provide a 30-calendar day written notice prior to the leave and submit a completed copy the City's Medical Certification of Physician form. Absence covered by the FMLA Medical Leave shall not be deducted form your seniority service date. I understand that I will have voluntarily resigned if I accept other employment during my leave and that I will be subject to disciplinary action if I fail to return at the expiration of my approved family care leave. Leaves cannot be approved unless the City of Berkeley has received requested documentation. If the leave is unforeseen, conditional approval will be made pending submission of medical documentation. I understand that it is my responsibility to apply for State Disability Insurance if I am eligible for such benefits. __________________________________________________ _________________
|
|
PART B (to be completed by employee's supervisor and Department) |
||||||||
|
Based upon the employee's eligibility and proof of medical documentation, □ FMLA / □ Non-FMLA Medical Leave is: □ APPROVED from ____________________ to ____________________. If leave is approved by Department Director, Department must forward to Human Resources Department with Medical Certification AND EMPLOYEE TRANSACTION FORM. □ DENIED If leave is denied by the Department due to ineligibility or inadequate medical documentation, Department must notify employee in writing and forward a copy to the Director of Human Resources. No Director of Human Resources or City Manager signature is necessary. If approved, will the employee be replaced during absence? □ Yes □ No If replacement is necessary, please indicate method: □ Temporarily promote existing staff □ Hire from existing eligible list □ Use Temporary Agency □ We have consulted with the Human Resources Department to request recruitment for a replacement. Replacement will be available by__________________. Based upon employee's eligibility, leave is approved from ____________________________to ___________________________. Authorization of Parental Leave: ______________________________________________ _______________________________________________________
______________________________________________ _______________________________________________________
If leave is approved by Deputy City Manager/Department Director, forward to Human Resources Department with copy of medical certification and Employee Transaction Form. If leave is denied due to ineligibility, notify employee in writing. cc: Human Resources Department Medical File White Copy Employee Supervisor Canary Copy Employee Pink Copy |
MEDICAL CERTIFICATION OF PHYSICIAN
(Medical Leave)
|
PART A - COMPLETED BY PHYSICIAN |
|
Employee Name__________________________________________ Job Title______________________________ Patient's Name (if other than employee)______________________________________________________________ Has been under my care since______________________ For the purposes of compliance with Federal and State law, a serious health condition shall be defined as an illness, injury, impairment, or physical or mental condition requiring either inpatient treatment at a hospital, hospice, or residential care facility or continuing treatment by a health care provider for such condition. The health condition must require absence from work, school, or other related activity for a minimum of three calendar days, or continuing treatment for chronic or a long-term condition. Is the employee or patient suffering from a serious health condition as defined above? ? □ Yes □ No If the employee is suffering from a serious health condition as defined above, is it the result of an industrial injury or illness? □ Yes □ No Date condition commenced____________________ Probable duration of the condition____________________________ Regimen of treatment to be prescribed. (Indicate number of visits, general nature and duration of treatment, including referral of health services. Include schedule of visits or treatment if it is medically necessary for the employee to be off work on an intermittent basis or to work less than the employee's normal work schedule. _____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ______________________________________________________________________________________________________ |
|
PART B - EMPLOYEE'S OWN SERIOUS HEALTH CONDITION If this certification relates to care for the employee's seriously ill family member, skip Part B and proceed to Part C |
||||
|
Check Yes or No in the boxes below: □ Yes □ No Is employee able to perform work of any kind? □ Yes □ No Is employee able to perform the functions of employee's job classification? (refer to attached job classification description) _____________________________ _____________________________ _____________________________ ___________
|
|
PART C - EMPLOYEE'S FAMILY MEMBER WITH A SERIOUS HEALTH CONDITION |
||||
|
Check Yes or No in the boxes below: □ Yes □ No Does (or will) the patient require assistance for basic medical, hygiene, nutritional needs, safety or transportation? □ Yes □ No After reviewing employee's signed statement below, is the employee's presence necessary or beneficial for the care of the patient? (This may include psychological comfort.) Estimate the period of time care is needed or the employee's presence would be beneficial______________________________ _____________________________ _____________________________ _____________________________ ___________
|
|
PART D - TO BE COMPLETED BY THE EMPLOYEE REQUESTING FAMILY MEDICAL LEAVE |
||
|
When medical leave is needed to care for a seriously-ill family member, the employee shall state the care he or she will provide and an estimate of the time period during which this care will be provided, including a schedule if leave is to be taken intermittently or on a reduced work schedule: ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ ______________________________________________________________________________________________________ _______________________________________________________ ______________
|