Form |
Description |
Campus |
|---|---|---|
| Catastrophic Leave - Application |
UC Davis Health employees should use this form to apply for catastrophic leave.
Submit to: Department Manager or Chief Administrative Officer. |
UC Davis Health |
| Catastrophic Leave - Worksheet |
Managers and Chief Administrative Officers complete this form when considering an employee’s request for catastrophic leave.
Submit to: ELR for review and determination. |
UC Davis Health |
| Catastrophic Leave - Medical Information Release (Exhibit A) |
In the event that an employee has donated their leave to a colleague, this form allows the university to release a general medical description to support the employee's catastrophic leave request.
Submit to: Department Supervisor |
UC Davis |
| Catastrophic Leave - Request for Donations (Exhibition B) |
Form through which employees can donate leave time to fellow employees who have exhausted their personal leave options.
Submit to: Department Employees |
UC Davis |
| Catastrophic Leave - Donation Form (Exhibit C) | Form through which employees who wish to donate their accrued vacation leave to colleague who have exhausted their own leave options. Submit to: Department Supervisor |
UC Davis |
| Exceed Maximum Vacation Accrual Limit Request | Managers and employees can use this form to when the employee exceeds the vacation accrual threshold. Submit to: Department Head, then ELR |
UC Davis |
| FML Declaration of Relationship | Employees are eligible for family medical leave for certain life events that impact relatives. This form helps ensure the relationship is FML eligible. Submit to: Department personnel |
UC Davis / UC Davis Health |
| FML Employee Checklist | Helps employees work through the process of requesting family medical leave for certain life events. Submit to: For employee use only. |
UC Davis |
| FML Request, Department Checklist | Helps departments who aren't under a Shared Services Center to manage employee leave requests. Submit to: For department use only. |
UC Davis |
| FML Return to Work Certification | Employee completes with health care provider and returns completed form to their department, allowing employee to return to work after FML. Submit to: Employee completes with health care provider and returns completed form to their department. |
UC Davis / UC Davis Health |
| FML/PDL Intermittent Tracking Form | Assists departments in tracking intermittent usages of family medical leave (FML) or pregnancy disability leave (PDL). Submit to: For department use only |
UC Davis / UC Davis Health |
| FMLA Certification of Health Care Provider for Employee's Own Condition | For employees requesting FML or CFRA for themselves, this form documents their qualifying condition. Submit to: After completion by employee, family member, and family member's health care provider; then submit to department personnel |
UC Davis / UC Davis Health |
| FMLA Certification of Health Care Provider for Family Member |
For employees requesting FML or CFRA to care for a family member, this form documents the family member's qualifying condition.
Submit to: After completion by employee, family member, and family member's health care provider; then submit to department personnel |
UC Davis / UC Davis Health |
| FMLA Certification for Leave Arising out of Active Duty |
For employees requesting FML for a covered military member being called to active duty.
Submit to: Department |
UC Davis / UC Davis Health |
| FMLA Military Caregiver Leave Certification | Employees are Eligible for protected leave to care for the serious injury or illness of a covered service member. Submit to: Department personnel |
UC Davis / UC Davis Health |
| FMLA, CFRA, Pregnancy Disability Leave Designation Notice |
Allows departments to document if an employee's FML, CFRA, or PDL request has been approved.
Submit to: Department completes form and submits to employee. |
UC Davis |
| Leave of Absence Request | Form that UC Davis Health employees can use to request an extended leave of absence for certain life events. Submit to: Manager and/or department personnel liaison. |
UC Davis Health |
| Non-Financial Leave Hours Adjustment Form | For Department personnel liaisons and payroll to submit form to adjust an employee’s leave hours. Submit to: Payroll |
UC Davis |
| Pay Status During Leave | UC Davis Health employees should use this form to indicate their pay status during leave. Submit to: LOA Services Department/UCDH | UC Davis Health |
| PDL Certification of Health Care Provider | This form provides the medical certification to support your request for PDL due to pregnancy, childbirth, or related medical condition.
Submit to: After completion by employee and health care provider; then submit to department personnel. |
UC Davis / UC Davis Health |
| Staff Leave Request |
Staff may use form to request leave using vacation, sick, comp time, leave without pay, supplemental family medical leave, or personal leave.
Submit to: Department Manager |
UC Davis |
| Supplement to Military Pay |
Active duty military personnel can receive supplemental compensation.
Submit to: UC Davis - If leave is managed by a Shared Services team, please send to the appropriate office otherwise, please provide to your supervisor. UC Davis Health - Submit to: hs-hrrecords@ucdavis.edu
|
UC Davis / UC Davis Health |
