Qualifying Reasons for COVID-19 Supplemental Paid Sick Leave. An employer must provide COVID-19 supplemental paid sick leave to each covered employee if that covered employee is unable to work or telework due to any of the following reasons:
Please check qualifying box above. Attach documentation justifying qualifying reason (i.e., immunization record, doctor letter or school schedule).
BY SUBMITTING FORM, I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I FURTHER UNDERSTAND THAT ANY FALSE STATEMENT MAY RESULT IN DISCIPLINARY ACTION, INCLUDING TERMINATION OF EMPLOYMENT.