Temporary Employee Paid Sick Leave Timecard

NOTE: THE BELOW DOCUMENT refers to Los Angeles specific laws; modify as needed but this is a great starting place.

Worker Full Name: Worker Email:

Client / Assignment Supervisor Name
Supervisor Email Phone # Optional Fax #:

Employee: Please enter the date(s) and hours of any used accrued sick leave for the pay period. To determine your accrued sick leave balance, review your most recent paystub, or visit https://ipay.adp.com. Contact our office if you have questions or concern regarding your balance. Submit this form by clicking Sign & Send below along with your time card, or email it with the corresponding work dates to: YOUR COMPANY CONTACT HERE

Sick Hours:
Sick Hours:
Sick Hours:
Sick Hours:
Sick Hours:
Sick Hours:
Sick Hours:

TOTAL Sick Hours: 0

*Sick Leave Qualifying Events: Sick Leave is not intended for personal time off, vacation or holiday pay. See Policy below for full details.

I hereby attest that the time and hours recorded on this sick leave record accurately and fully identify all time used as sick leave that I have used during the designated time period. I declare that the foregoing is true and correct under penalty of perjury. YOUR COMPANY NAME HERE reserves the right to modify, supplement, curtail or eliminate any feature of a benefit plan, or the entire benefit program, if the Company determines, in its sole discretion, that such action is warranted.

YOUR COMPANY NAME HERE Sick Leave Policy Revised as of May 17, 2018:

Accrual Amount:
An employee will earn one (1) hour of paid sick leave for every thirty (30) hours worked on an assignment.

Maximum Balance - Cap:
Employees will NOT accrue more than seventy two (72) hours of sick leave at any given time. Therefore, once an employee has accrued seventy two (72) hours of sick leave, he or she will cease accruing sick leave time until he or she, through use of sick leave, has drawn down his or her sick leave balance (bank of sick leave) to less than seventy two (72) hours. Once the sick leave balance (or bank) has fallen below seventy two (72) hours, the employee will resume accruing sick leave at the rate of one (1) hour of paid sick leave for every thirty (30) hours worked. Accrued sick leave shall carry over to the following calendar year, but is subject to a maximum balance - cap of seventy two (72) hours.

Limit on Amount of Paid Sick Leave that Can Be taken Each Year:
Los Angeles Employees may not use more than forty eight (48) hours and Santa Monica Employees not more than seventy two (72) hours of sick leave in a year.
For purposes of this section, a "year" is determined as follows:

  • (i) First year of employment: The "year" begins on the date of hire and ends on December 31st of the year of hire.
  • (ii) All subsequent years of employment: The "year" begins on January 1st and ends on December 31st.

*Sick Leave Qualifying Events: An employee can take accrued sick leave for scheduled work hours for him or herself, or a family member, for diagnosis, care (including preventative care) or treatment of an existing health condition or for specified purposes if he or she are a victim of domestic violence, sexual assault or stalking. Family members include the employee's parent, child, spouse, registered domestic partner, grandparent, grandchild, and sibling. For Los Angeles Employees, family members also include any individuals related by blood or affinity whose close association with the employee is the equivalent of a family relationship. Preventive care includes annual physicals or flu shots. Sick Leave is not intended for personal time off, vacation or holiday pay.

Notice of Sick Leave Use: Employee are permitted to use his or her accrued paid sick leave upon an oral or written request. An employee is NOT required to find a replacement as a condition for using leave. If the need is foreseeable the employee must give reasonable advance notice, but where the need is unforeseeable the employee need only give notice as soon as practicable. Employees should promptly called their recruiter at YOUR COMPANY NAME HERE upon determining the need to use accrued sick leave. This will allow the Company to contact the assignment and notify the supervisor of the absence. Los Angeles Employees may be required to provide reasonable documentation to support any sick leave taken in excess of twenty four (24) hours a year.

Increments of Use: An employee may use accrued sick leave in increments of 2 hours (partial days), but otherwise the determination of how much time is needed is left to the employee and his or her earned sick leave bank balance. An employee will not be permitted sick leave advances. Therefore, if an employee's balance is zero, he or she cannot be paid sick leave hours in advance of accrued sick leave.

Waiting Period: There is no waiting period for an employee to use accrued sick leave.

Payout upon Termination: Accrued sick leave is NOT paid to an employee upon termination or retirement for any reason. If an employee leaves the Company and is rehired within 12 months, an employee can reclaim what, if any, accrued sick leave was left in his or her leave bank at the time of termination.

Documentation of Available Sick Leave: An employee's weekly pay stub will reflect available sick leave.

If you have any questions regarding our Sick Leave Benefit Program, please contact our office for further information.

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