Sick Leave Note Submission Form

This medical documentation must be the original, and include:

• For sick leave taken for the employee:
  1. the employee’s name;
  2. the date the employee was seen by the physician or other healthcare provider; and
  3. the date the employee is able to return to work.
• For sick leave or family sick leave taken for an immediate family member:
  1. the immediate family member’s name; and
  2. the date(s) the immediate family member was under the care of the physician or other healthcare provider.

View the Medical Documentation Memo for additional details.

Note: If a BC needs to be added to the drop-down list of BCs above, please submit a TSR (category: Web-Based Forms).