Fillable Form 8106: FAMILIES FIRST CORONAVIRUS RESPONSE ACT (Cuesta College)

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Form 8106: FAMILIES FIRST CORONAVIRUS RESPONSE ACT (Cuesta College)

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Human Resources
P.O. Box 8106
San Luis Obispo, CA 93403
-
8106
hr@cuesta.edu
(805) 546
-
3129
SAN LUIS OBISPO COUNTY
COMMUNITY COLLEGE DISTRICT
FAMILIES FIRST
CORONAVIRUS RESPONSE ACT
EMPLOYEE PAID LEAVE RIGHTS
Due to the passage of the Families First Corona Virus Response Act (HR 6201) you may be entitled to one or more of the emergency
leave benets listed below. These provisions will be eective from April 1, 2020 through December 31, 2020. Below is a summary
of the new leave benets but please refer to the DOL Notice for more detailed information. If you have questions regarding your
eligibility or benets, please contact Human Resources Department at hr@cuesta.edu.
EFFECTIVE APRIL 1, 2020
PUBLIC HEALTH EMERGENCY PAID FAMILY LEAVE (leave for childcare purposes for minor children related
to school or daycare closures)
• Employee has been employed for at least 30 days to be eligible
• Employee needs to care for a minor child due to a school or childcare closure caused by public health emergency and is unable
to work or telework.
What does this mean for you?
Up to 12 weeks of leave. First two weeks unpaid, unless other leave is utilized, then 10 weeks at 2/3 pay up to a maximum of
$200/day and $10,000 total.
EMERGENCY PAID SICK LEAVE
1) EMERGENCY PAID SICK LEAVE (SELF)
(i) Employee is unable to work due to government issued quarantine or isolation order related to COVID-19.
(ii) Employee has been advised to self-quarantine by a healthcare provider related to COVID
-
19 and is unable to work.
(iii) Employee is experiencing symptoms of COVID
-
19, is seeking diagnosis and is unable to work.
(iv) Employee is experiencing “a substantially similar condition” to COVID
-
19 as specied by certain federal agencies and
is unable to work.
What does this mean for you?
Up to 2 weeks leave at full pay, up to a maximum of $511 per day and $5110 total for reasons (i-iii). Up to 2 weeks leave at
2
⁄
3
pay,
up to a maximum of $200 per day and $2000 total for reason (iv).
2) EMERGENCY PAID SICK LEAVE (CARE OF OTHERS)
• Employee is caring for an individual subject to government issued quarantine or isolation order related to COVID
-
19 or who is car-
ing for an individual who has been advised to self-quarantine by a healthcare provider related to COVID
-
19 and is unable to work.
• Employee is caring for a son or daughter whose school or childcare is closed or unavailable “due to COVID
-
19 precautions” and is
unable to work.
What does this mean for you?
Up to 2 weeks leave at
2
⁄
3
pay, up to a maximum of $200 per day and $2000 total. May be used to provide pay during the rst
2 weeks of unpaid Public Health Emergency Leave.
IMPORTANT NOTES:
• Emergency Paid Sick leave (self) and Emergency Paid Sick Leave (others) combined may not exceed 2 weeks total.
• The 12 weeks of Public Health Emergency Paid Family Leave is subject to the FMLA limits of 12 workweeks annually. These laws do
not entitle you to an additional 12 workweeks of leave if you have already exhausted your leave for this year. Similarly, if you utilize
this leave now, it will reduce your available leave for the next 12 months. However, even if you have exhausted your FMLA leave,
you will be entitled to utilize Emergency Paid Sick Leave for qualifying reasons.
• These emergency benets will be applied before the employee’s regular accruals are used.
CUESTA COLLEGE CORONAVIRUS RESPONSE ACT cuesta.edu
Human Resources
P.O. Box 8106
San Luis Obispo, CA 93403
-
8106
hr@cuesta.edu
(805) 546
-
3129
SAN LUIS OBISPO COUNTY
COMMUNITY COLLEGE DISTRICT
FAMILIES FIRST CORONAVIRUS RESPONSE ACT LEAVE REQUEST
Employee Name Job Title/Work Location
Type of Request: Select all that apply.
F Public Health Emergency Paid Family Leave Dates of leave: _______________ to _______________
• Employee has been employed for at least 30 days
• Leave is required to care for a minor child due to a school or childcare closure caused by public health emergency
and employee is unable to work.
F Emergency Paid Sick Leave (self) Dates of leave: _______________ to _______________
• Employee is unable to work due to government issued quarantine or isolation order.
• Employee has been advised to self-quarantine by a healthcare provider and is unable to work.
• Employee is experiencing symptoms of COVID-19, seeking diagnosis and unable to work.
• Employee is experiencing “a substantially similar condition” as specied by certain federal agencies and is unable to work.
F Emergency Paid Sick Leave (care of others) Dates of leave: _______________ to _______________
• Employee is caring for someone subject to government issued quarantine, isolation order or is caring for an individual who has
been advised by a health care provider to self-quarantine related to COVID-19 and is unable to work.
• Employee is caring for a son or daughter whose school or childcare is closed or unavailable “due to COVID-19 precautions” and
is unable to work.
My signature below assures that I meet the criteria listed above and qualify for Emergency Paid Leave as I am unable to work, either
at an assigned work site or in a remote assignment oered by the District. Misuse of this leave is grounds for disciplinary action and
the District may require repayment of leave benets.
Signature Date
FOR HR USE ONLY BELOW THIS LINE
Eligibility veried by Date
Qualies for ________ hours days at
2
⁄
3
pay
Qualies for ________ hours days at full pay
Qualies for ________ days at $200 per day.
Qualies for ________ days at $511 per day.
F Does not qualify. Reason:
Completed copy to Employee and Payroll.
CUESTA COLLEGE CORONAVIRUS RESPONSE ACT cuesta.edu
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Form 8106: FAMILIES FIRST CORONAVIRUS RESPONSE ACT (Cuesta College)

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Completed 4 September 2020

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