Fillable CORONAVIRUS LEAVE FORM

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CORONAVIRUS LEAVE FORM

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R2/4/2021
CORONAVIRUS LEAVE FORM
When a team member experiences any of the following four situations, this form should be completed
by the manager as soon as possible:
1. The team member has been exposed to coronavirus
o “Exposure” is defined by the CDC as having had close contact (less than 6 feet) for more
than 15 minutes with:
A person with COVID-19 symptoms
A person who has tested positive for COVID-19
Or the team member has experienced possible COVID-19 exposure in the
community
2. The team member has received a positive test result for COVID-19
3. The team member has been diagnosed by a medical professional as “presumptive positive,”
meaning that the medical professional is treating the team member with the belief that they
have COVID-19
4. The team member is experiencing COVID-19 symptoms (i.e., fever, cough, headache, sore
throat, loss of taste and/or smell, etc.)
Please note: one form should be completed for each individual team member who is affected.
Please enter all requested information in full – incomplete forms
will be returned to the initiator to be completed.
Name and job title of the person completing this form
Your email address
Today’s date
NOTE - You must download and save this form to your computer.
Once saved, you can complete the form and then upload to the leave
system by clicking the link on page 4.
Is this work location located in Alameda
County, California? Yes or No
Yes
No
Victoria Brown
victoria.brown@greystar.com
01/03/2022
✔
R2/4/2021
S
ECTION 1: AFFECTED TEAM MEMBER’S INFORMATION
Team member’s first and last name
Team member’s ID Number (can be found on the team member’s Job Details page in Workday)
Team
member’s personal email address (preferably not their Greystar email address)
Is this pers
on an Onsite or a Corporate team member?
Community Manager’s first and last name (if applicable)
RPM’s first and last name (if applicable)
Work location or
property name
Work state
Team member’s immediate manager’s first and last name
Is team memb
er currently working?
Victoria Brown
brownavictoria@gmail.com
Onsite
Angela Isaacs
Alice House, 47Hundred
CA
Angela Isaacs
No
R2/4/2021
If working, please enter where they are working (Property, corporate office, or remote)
If not working, first day out due to COVID
What is the situation? (Exposed to COVID-19, sick/has symptoms, received a positive test result)
Date
of positive test (if applicable)
Date of first symptom (if known)
Any additional details
S
ECTION 2: SAFE PROTOCOL PRACTICES
Please respond yes/no if the team member is working in a Greystar location
or n/a if the team member is working remotely
1. Does the individual, his/her manager, and the team
consistently wear facial covering when around other
team members, residents, or vendors?
2. Do they consistently wear gloves, if needed and
applicable?
3. Do they consistently keep at least 6 feet social
distancing between themselves and others?
4. If not keeping the minimum 6 feet distance, are they
ever closer than 6 feet to others for more than 15
minutes?
01/04/2022
Received positive test result
01/03/2022
12/31/2021
n/a
Yes
No
Yes
R2/4/2021
Please note: if you answered “no” to Questions 1 and/or 3 above, please complete a separate
Coronavirus Leave Form for any additional team members who have potentially been exposed and/or
have stated that they would like to be tested for COVID-19.
NEXT STEPS
After the completed form is downloaded to your computer, please upload to the Greystar MyLeave system:
•
Click here and log into MyLeave with your Greystar personal email address (firstname.lastname@greystar.com)
• Once you have logged into MyLeave (our self-service leave portal), please click on the affected team
member’s name.
• Once you are in the team member’s record, click on “Upload Documents” and follow the directions to
upload the completed form (see screenshot below)
• Under “File Title” and “File Notes” – please state that the uploaded form is for a COVID leave
• A Talent Management specialist will follow up asap via email to assist with next steps
If you have any questions about this form, please contact your Employee Relations Director.
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CORONAVIRUS LEAVE FORM

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Completed 7 January 2022

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