Leave Election Form Templates
Injured employees use these forms to specify whether they want to use personal leave during the seven-day benefit waiting period.
Injured employees are not eligible for weekly workers’ compensation income benefits until their absence exceeds seven calendar days. These forms, available in English and Spanish, allow injured employees to indicate whether they want to use paid leave during the seven-day waiting period. Employers should check their leave policy to verify whether they have an offsetting policy.
You'll need to log in to keep reading.
This information is exclusively for Fund members with Workers' Compensation coverage.
Log inOther Resources You May Also Like...
Bona Fide Offer of Employment Template
When the doctor clears your injured employee to return to work, use this template to issue a bona fide offer of employment that meets state requirements.
Employee Acknowledgement of Alliance Direct Contracting Program
Employees must sign this form acknowledging they understand how to receive health care in the Political Subdivision Workers’ Compensation Alliance. Available in English and Spanish.
Employee Incident Investigation Worksheet
Uncover and correct the root causes of workplace accidents to reduce the risk of them happening again.