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Paid Sick of Safe Leave Request
Paid Sick or Safe Leave Accrued Time
Under New York City’s Earned Safe and Sick Time Act (Paid Sick Leave Law), you are permitted to use earned sick leave for absence from scheduled work in NYC when (1) you have a mental or physical illness, injury, or health condition; you need a medical diagnosis, care, or treatment of your mental or physical illness, injury, or health condition; you need preventive medical care; (2) you must care for a family member who needs medical diagnosis, care, treatment of a mental or physical illness, injury, or health condition, or who needs preventive medical care; (3) your place of business closes due to a public health emergency or you need care for a child whose school or childcare provider closed due to a public health emergency; or (4) you or a family member has been the victim of a family offense matter (certain domestic violence offenses), sexual offense, stalkng, or human trafficking and you need to take actions to restore the physical, psychological, or economic health or safety of you or your family member or to protect those who associate or work with you ("safe time"). You may be disciplined, including dismissal from employment, if you use earned sick leave for a purpose other than those authorized by the Paid Sick Leave Law.
If your need for sick leave is foreseeable, you must provide us with seven (7) days' advance notice, in writing, of your intention to use sick leave by completing this form. If your need for sick leave is unforeseeable, you must give us notice as soon as practicable by calling our office and also submitting this form.
Accrued sick leave must be used in increments of not less than four (4) hours, except in the event you have accrued less than four (4) hours of sick leave.
: If you use more than 3 consecutive workdays as sick leave, we may request documentation signed by a licensed health care provider attesting to the need for the amount of sick leave that was taken and that the sick leave was used for an authorized purpose under the Paid Sick Leave Law. If you wish to use more than 3 consecutive days for safe time” purposes, we may request reasonable documentation that the use of safe time was for an authorized purpose. Such documentation need not explain the nature of the illness, injury or condition or the details of the family offense matter, sexual offense, stalking, or human trafficking, and you need not provide such information
FINDING A REPLACEMENT:
You will not be required to find a replacement employee for the hours you are scheduled to work and plan to use sick leave.
We will not take any negative action against you for requesting sick leave, using sick leave, or attemping to exercise any other rights under the Paid Sick Leave Law. If you believe an unlawful retaliatory action has been taken against you, notify us immediately. Alternatively, you may file a complaint with the New York City Department of Consumer Affairs online at nyc.gov/consumers or by calling 311.
New York, NY
Hours: M-F: 8:00am - 5:00pm
Hours: M-F: 8:00am - 5:00pm
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