COVID-19

Our hearts go out to all affected by the COVID-19 crisis. We plan to weather this storm standing together in unity. Below are documents relevant to your employment and COVID-19.

Emergency Paid Sick Leave Act (EPSLA)

The Emergency Paid Sick Leave Act (EPSLA) is a temporary paid leave policy in effect from April 1, 2020
through December 31, 2020. EPSLA provides partial and full paid leave, subject to maximum limits, to
employees who are unable to work or telework due to one of the approved reasons.

Emergency Family Medical Leave Expansion Act (EFMLA)

In accordance with the Families First Coronavirus Response Act, employees who are unable to work or
telework are eligible effective April 1, 2020 for paid EFMLA leave due to one of the approved reasons.

COVID-19 safety policy

This policy is to ensure the safety of our employees, customers and community in these difficult times related to the COVID-19 pandemic. Beginning April 1, 2020, and until further notice, we urge all our employees to follow the specific COVID-19 policy our customer has posted in addition to the Imperial Design Service policy.

Emergency Preparedness Plan

COVID-19 Preparedness and Response Plan

COVID-19 Leave Request Form

Legitimate reasons for COVID-19 leave can be found below:

Personal

The employee is subject to a Federal, State, or local quarantine or isolation order related to COVID–19.
The employee has been advised by a health care provider to self-quarantine due to concerns related to COVID–19.
The employee is experiencing symptoms of COVID–19 and seeking a medical diagnosis.

Care of Others

The employee is caring for an individual who is subject to an order as described in reason (1) or has been advised as described in reason (2).
The employee is caring for a son or daughter of such employee if the school or place of care of the son or daughter
The employee is experiencing any other substantially similar condition specified by the Secretary of Health and Human Services in consultation with the Secretary of the Treasury and the Secretary of Labor.

Name
First Last
Email*
Phone*
Date(s) of requested time off*
(Please include how many hours per date you plan to use – EPSLA may not be used in less than 1-hour increments)
Check the boxes below for which type of leave you are requesting:*
- Personal
- Care of Others
Select Personal Reasons:
- Reason #1
- Reason #2
- Reason #3
Select Care of Others Reasons:
- Reason #4
- Reason #5
- Reason #6 (please explain)
Please explain Reason #6:
Option to Use Paid Vacation Time
- Paid Vacation Time – Please select this box if you want to use available paid vacation time if COVID-19 related paid leave (EFMLA or EPSLA) is not available for dates of requested leave.
Employee Online Signature:*
I agree and understand that I have accurately reflected the reason for my COVID-19 related absence. I understand that any misrepresentation of my reason for my absence may result in discipline, up to and including termination.
Date of Signature:*
Comments
This field is for validation purposes and should be left unchanged.