County of Santa Clara Employee Services Agency Employee Benefits Department 400 Race Street, Suite 201 San Jose, California 95126 Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Susan Ellenberg, S. Joseph Simitian County Executive: Jeffrey V. Smith DATE: April 28, 2020 TO: Agency/Department Heads Executive Leadership Group Departmental Human Resources Liaisons Departmental Timekeepers FROM: John P. Mills, Director, Employee Services Agency SUBJECT: EXPANDED FAMILY AND MEDICAL LEAVE ACT (EFMLA) GUIDELINES AND PROCEDURES FOR EMPLOYEE SERVICE CENTERS, DEPARTMENTAL HR LIAISONS, AND TIMEKEEPERS The Expanded Paid Family & Medical Leave Act (EFMLA)—one of the new paid leaves under the federal Families First Corona Virus Response Act (FFCRA)—adds a new qualifying reason for related FMLA leave: the need to care for a child under age 18 because of school and daycare closures due to COVID-19. Eligible employees may access 12 weeks of paid leave, which includes (i.e., runs concurrently with) the Emergency Paid Sick Leave, or use of other accrued balances, for the first two weeks. For the remaining 10 weeks of eligibility, per the provisions of amended EFMLA, the employee will receive two-thirds of their rate of pay for their regular schedule. The FFCRA regulations allow an employer to cap EFMLA compensation at a maximum of $200 per day and $10,000 total. The County has made a policy decision not to apply these caps to employee compensation received under EFMLA. This means that, if an employee’s daily compensation under EFMLA exceeds the $200 cap, they will receive the full calculated value of two-thirds of their rate of pay and their daily compensation will not be capped at $200. In addition, the County will implement this two-thirds paid leave and will allow integration of leave to achieve full pay. The benefits under the amended EFMLA expire on December 31, 2020. Who is not eligible for benefits under the EFMLA? Healthcare Providers and Emergency Responders are exempt from the EFMLA. Please note, however, that any employee may be eligible for regular FMLA (which is not paid unless the employee’s standard paid leave banks are used) if they are sick with COVID-19 or are caring for a qualified family member who is sick with COVID-19, since symptomatic COVID-19 may be a “serious health condition.” Employees are only eligible to receive a total of 12
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County of Santa Clara Employee Services Agency Employee Benefits Department 400 Race Street, Suite 201
San Jose, California 95126
Board of Supervisors: Mike Wasserman, Cindy Chavez, Dave Cortese, Susan Ellenberg, S. Joseph Simitian
County Executive: Jeffrey V. Smith
DATE: April 28, 2020
TO: Agency/Department Heads
Executive Leadership Group
Departmental Human Resources Liaisons
Departmental Timekeepers
FROM: John P. Mills, Director, Employee Services Agency
SUBJECT: EXPANDED FAMILY AND MEDICAL LEAVE ACT (EFMLA)
GUIDELINES AND PROCEDURES FOR EMPLOYEE SERVICE
CENTERS, DEPARTMENTAL HR LIAISONS, AND TIMEKEEPERS
The Expanded Paid Family & Medical Leave Act (EFMLA)—one of the new paid leaves under the federal Families First Corona Virus Response Act (FFCRA)—adds a new qualifying reason for related FMLA leave: the need to care for a child under age 18 because of school
and daycare closures due to COVID-19. Eligible employees may access 12 weeks of paid
leave, which includes (i.e., runs concurrently with) the Emergency Paid Sick Leave, or use of
other accrued balances, for the first two weeks. For the remaining 10 weeks of eligibility, per
the provisions of amended EFMLA, the employee will receive two-thirds of their rate of pay
for their regular schedule.
The FFCRA regulations allow an employer to cap EFMLA compensation at a maximum of
$200 per day and $10,000 total. The County has made a policy decision not to apply these
caps to employee compensation received under EFMLA. This means that, if an employee’s
daily compensation under EFMLA exceeds the $200 cap, they will receive the full calculated
value of two-thirds of their rate of pay and their daily compensation will not be capped at
$200.
In addition, the County will implement this two-thirds paid leave and will allow integration of
leave to achieve full pay. The benefits under the amended EFMLA expire on December 31,
2020.
Who is not eligible for benefits under the EFMLA?
Healthcare Providers and Emergency Responders are exempt from the EFMLA. Please note,
however, that any employee may be eligible for regular FMLA (which is not paid unless the
employee’s standard paid leave banks are used) if they are sick with COVID-19 or are caring
for a qualified family member who is sick with COVID-19, since symptomatic COVID-19
may be a “serious health condition.” Employees are only eligible to receive a total of 12
Expanded Family and Medical Leave Act (EFMLA) Guidelines and Procedures
for Employee Service Centers, Departmental HR Liaisons, and Timekeepers
Page 2
weeks of FMLA, regardless of the qualifying reason for leave. The EFMLA does not provide
for an additional 12 weeks of leave.
Who is a Healthcare Provider?
For the purposes of employees who are exempt from expanded family and medical leave, a
healthcare provider is anyone employed at any doctor’s office, hospital, healthcare center,
clinic, post-secondary educational institution offering healthcare instruction, medical school,
local health department or agency, nursing facility, retirement facility, nursing home, home
healthcare provider, any facility that performs laboratory or medical testing, pharmacy, or any
similar institution, employer, or entity. This includes not only medical professionals, but other
workers who are needed to keep hospitals and similar health facilities well supplied and
operational. This also includes any permanent or temporary institution, facility, location, or
site where medical services are provided that are similar to those provided at hospitals and
other such health facilities. This definition includes any individual employed by an entity that
contracts with any of the above institutions, employers, or entities to provide services or to
maintain the operation of the facility. This also includes anyone employed by any entity that
provides medical services, produces medical products, or is otherwise involved in the making
of COVID-19-related medical equipment, tests, drugs, vaccines, diagnostic vehicles, or
treatments. This also includes any individual that the highest official of a state or territory,
including the District of Columbia, determines is a health care provider necessary for that
state’s or territory’s or the District of Columbia’s response to COVID-19.
Who is an Emergency Responder?
For the purposes of employees who are exempt from expanded family and medical leave, an
emergency responder is an employee who is necessary for the provision of transport, care,
health care, comfort, and nutrition of such patients, or whose services are otherwise needed to
limit the spread of COVID-19. This includes, but is not limited to, military or national guard,
law enforcement officers, correctional institution personnel, fire fighters, emergency medical
services personnel, physicians, nurses, public health personnel, emergency medical
technicians, paramedics, emergency management personnel, 911 operators, public works
personnel, and persons with skills or training in operating specialized equipment or other
skills needed to provide aid in a declared emergency, as well as individuals who work for such
facilities employing these individuals and whose work is necessary to maintain the operation
of the facility. This also includes any individual that the highest official of a state or territory,
including the District of Columbia, determines is an emergency responder necessary for that
state’s or territory’s or the District of Columbia’s response to COVID-19.
How does the County determine who is a health care provider or emergency responder?
Please see the attached list of classifications that are exempt from the expanded family and
medical leave provisions, updated as of April 24, 2020. This list is not comprehensive.
Classifications/positions not included on this list will be reviewed on a case-by-case basis.
If you are contacted by a supervisor/manager who believes an employee meets the
definition for exemption from EFMLA, or you identify a class or position you believe
Expanded Family and Medical Leave Act (EFMLA) Guidelines and Procedures
for Employee Service Centers, Departmental HR Liaisons, and Timekeepers
Page 3
should be exempt, but is not on the exemption list, please contact Gina Donnelly at
[email protected] or 408.209.7322 to discuss exempting a class or position(s)
within a class.
If an otherwise eligible employee already used 12 weeks of FMLA in the last 12
months, are they eligible for benefits under expanded FMLA?
No, employees who have exhausted 12 weeks of FMLA leave in the last 12 months are
not eligible for EFMLA.
If an otherwise eligible employee used a portion of the 12 weeks of FMLA in the last 12
months, are they eligible for benefits under EFMLA?
Yes, otherwise eligible employees who have exhausted only a portion of the 12 weeks of
FMLA leave in the last 12 months are eligible, but only for the remaining hours/the balance
of the 12 weeks remaining for this benefit. Similarly, going forward, use of EFMLA or
FMLA leave now (for any qualifying reason) limits future eligibility for EFMLA or FMLA
leave depending on how many hours the employee has used of the 12-week benefit.
Can the EFMLA be used intermittently?
The County has approved intermittent use of EFMLA benefits but only for a regularly
occurring weekly schedule mutually agreed upon between the employee and the
manager/supervisor that meets the needs of the employee and the operational needs of the
Department. Intermittent schedules may not be approved in increments less than one full
workday. For example, an employee who normally works Monday through Friday, eight
hours per day, may request to use EFMLA leave on Mondays, Wednesdays, and Fridays, and
continue working eight hours on Tuesdays and Thursdays. However, they may not elect to
work four hours per day and take four hours of EFMLA leave.
The Department has discretion to approve use of intermittent leave, but must do so fairly and
equitably, and must not treat similarly situated employees differently. For example, if a
Department has two workers in the same job classification working remotely, the Department
should not grant one person use of part-time intermittent leave and deny another person’s
request for the same intermittent leave, absent a legitimate, non-discriminatory reason for
doing so. A Department should agree with the employee on a schedule of intermittent leave
(i.e., particular days) for use it approves.
How do employees apply for the new benefits under the EFMLA?
EFMLA leave is subject to approval by the Service Center Manager in their assigned
Employee Service Center. Employees requesting approval should complete the EFMLA
application and should consult with their manager/supervisor for schedule approval and
their department’s Employee Service Center for questions regarding EFMLA benefits and
eligibility. However, employees who attest to the notice requirements for leave, even
orally, must be conditionally approved and their leave initiated.
Verification of school closure or daycare closure/unavailability is required.
Expanded Family and Medical Leave Act (EFMLA) Guidelines and Procedures
for Employee Service Centers, Departmental HR Liaisons, and Timekeepers
Page 4
What options are available for employees who are not eligible for EFMLA leave—like health care providers or emergency responders—but cannot work due to closure of schools or daycare facilities?
Paid childcare is being offered by the County for employees who are continuing to provide essential services on site to the community.
EFMLA Procedures:
Responsible Party Description/Event
Employee
Notify your supervisor/manager that you are requesting EFMLA
leave and believe you are eligible. You will need to provide
sufficient information to allow the County to conditionally approve
the leave. As soon as practicable, complete the EFMLA form and
submit it to your supervisor/manager (if requesting intermittent use, it
is recommended that you consult with your supervisor to discuss your
request prior to submission for approval of your requested schedule.)
Intermittent use is subject to supervisorial approval and may only be
taken in full day increments.
Supervisor/Manager
Review and approve/deny any intermittent schedule request.
If schedule is approved, forward form to Service Center for
determination of eligibility and final approval of EFMLA leave.
If denied, return the County’s EFMLA form to the employee and
inform the employee of the reason for denial. Employee may
supplement their information, but if they are not eligible, discuss
other options, if any, for intermittent use.
Service Center
Manager
Review exclusion list and determine eligibility. If approved, inform
timekeeper of approval and instructions for coding timecards.
Timekeeper/HR
Liaison
Complete timecard entries as per instructions from Service Center
Managers. For questions, please contact the approving Service
Expanded Family and Medical Leave Act (EFMLA) Guidelines and Procedures
for Employee Service Centers, Departmental HR Liaisons, and Timekeepers
Page 5
Regular Daily Scheduled
Hours EFMLA Daily Entry
LWOP/Integration of
Accrued Leave Daily Entry
10 6.6 3.4
9 5.9 3.1
8 5.3 2.7
7 4.6 2.4
6 4 2
5 3.3 1.7
4 2.6 1.4
Attachments: Healthcare Provider and Emergency Responder Classifications Exempted from
Expanded Paid Family and Medical Leave
EFMLA Form
Job Code Job Title UnionT14 PARK RANGER I Park Rangers AssociationT09 PARK RANGER II Park Rangers AssociationT08 SR PARK RANGER Park Rangers AssociationT29 PARK RANGER SUPERVISOR CEMAB6K MGR PARK RANGER OPERATIONS CEMAS75 CLINICAL NURSE III RNPAT84 SHERIFF'S CORRECTIONAL DEPUTY CPOAP41 PHYSICIAN-VMC Valley Physician GroupD2E HEALTH SERVICES REP 521 ClericalS76 CLINICAL NURSE II RNPAU64 DEPUTY SHERIFF DSAS93 HOSPITAL SERVICES ASST II 521 APTS7A CLINICAL NURSE III - STEP A RNPAS85 LICENSED VOCATIONAL NURSE 521 APTX50 DEPUTY PROBATION OFFICER III Probation 1587D1E SR HEALTH SERVICES REP 521 ClericalR29 PHARMACY TECHNICIAN 521 APTR27 PHARMACIST 521 APTX27 SR GROUP COUNSELOR Probation 1587H93 MEDICAL ASSISTANT 521 APTD02 MEDICAL UNIT CLERK 521 ClericalR74 MEDICAL LABORATORY ASST II 521 APTS57 PSYCHIATRIC NURSE II RNPAS89 CLINICAL NURSE I RNPAS7B CLINICAL NURSE III - STEP B RNPAD48 PATIENT BUSINESS SERV CLERK 521 ClericalR1S RESPIRATORY CARE PRAC II 521 APTP96 MARRIAGE & FAMILY THERAPIST II 521 APTY41 PSYCHIATRIC SOCIAL WORKER II 521 APTU61 SHERIFF'S SERGEANT DSAS7C CLINICAL NURSE III - STEP C RNPAV76 CRIMINAL INVESTIGATOR II DAIAR1F CLINICAL LAB SCIENTIST II IFPTE Local 20 ESCS11 ASSISTANT NURSE MANAGER RNPAS9S MENTAL HEALTH WORKER 521 APTS9T PATIENT TRANSPORTER 521 APTG74 CUSTODY SUPPORT ASSISTANT 521 Blue CollarS48 PUBLIC HEALTH NURSE II 521 PHNS59 NURSE PRACTITIONER RNPAD42 LAW ENFORCEMENT RECORDS TECH 521 ClericalR11 PHYSICAL THERAPIST II 521 APTY03 MEDICAL SOCIAL WORKER II 521 SSUX22 PROBATION COUNSELOR II 521 PCSUP55 PSYCHIATRIST UAPDT74 SHERIFF'S CORRECTIONAL SERG CPOAP39 POST GRADUATE YEAR I CIR
Healthcare Provider and Emergency Responder Classifications Exempted from Expanded Paid Family and Medical Leave
S06 STERILE PROCESS TECH II 521 APTS39 NURSE COORDINATOR RNPAX52 DEPUTY PROBATION OFFICER II Probation 1587X48 SUPV PROBATION OFFICER Probation 1587D2J MENTAL HEALTH PEER SUPPORT WRK 521 APTR1A OCCUPATIONAL THERAPIST II 521 APTS12 UTILIZATION REVIEW COORDINATOR CEMAU84 CORRECTIONAL OFFICER CPOAS6D INPATIENT CASE MANAGER CEMAH66 FOOD SERVICE WORKER II 521 Blue CollarU66 DEPUTY SHERIFF CADET - U Cadets (DSA and CPOA)S23 SURGICAL TECHNICIAN 521 APTC83 HEALTH CARE PROGRAM MGR II CEMAX53 DEPUTY PROBATION OFFICER I Probation 1587R8C DIAG IMAGING TECH I-FLUORSCOPY 521 APTD76 MEDICAL ADMIN ASSISTANT II 521 ClericalY42 PSYCHIATRIC SOCIAL WORKER I 521 APTS91 EMERGENCY ROOM TECH 521 APTW71 SR HEALTH CARE PROG ANALYST CEMAH67 FOOD SERVICE WORKER I 521 Blue CollarX29 GROUP COUNSELOR I Probation 1587R2L CLINICAL DIETITIAN II 521 APTP76 REGISTERED DENTAL ASSISTANT 521 APTR1P PHYSICAL THERAPIST I 521 APTH68 FOOD SERVICE WORKER-CORR 521 Blue CollarZ17 JANITOR - U 521 Blue CollarC87 Q I COORD-SCVMC CEMAD50 MEDICAL TRANSLATOR 521 APTE32 PUBLIC HEALTH ASSISTANT 521 APTP37 POST GRADUATE YEAR II CIRU63 SHERIFF'S CORR DEPUTY CADET-U Cadets (DSA and CPOA)H59 COOK II 521 Blue CollarS2A ASSISTANT NURSE MANAGER STEP A RNPAJ67 HEALTH INFORMATION CLERK III 521 ClericalR71 DIALYSIS TECHNICIAN 521 APTP40 PHARMACIST SPECIALIST 521 APTP36 POST GRADUATE YEAR III CIRG93 COMMUNICATIONS DISPATCHER II 521 APTS08 PUBLIC HEALTH NUTRITION ASSOC 521 APTG73 SHERIFF'S TECHNICIAN 521 APTS46 PHYSICIAN ASST - PRIMARY CARE 521 APTP82 SURGICAL AIDE 521 APTR62 CLINICAL LAB SCIENTIST I IFPTE Local 20 ESCG9A COMMUNICATIONS DISPATCHER III 521 APTS9D ULTRASONOGRAPHER II - D 521 APTJ77 HEALTH INFORMATION TECH II 521 ClericalJ68 HEALTH INFORMATION CLERK II 521 Clerical
Healthcare Provider and Emergency Responder Classifications Exempted from Expanded Paid Family and Medical Leave
H60 COOK I 521 Blue CollarD45 SR PATIENT BUSINESS SVCS CLK 521 ClericalS87 PSYCHIATRIC TECHNICIAN II 521 APTD4M VHP CLAIMS EXAMINER 521 ClericalP14 MENTAL HEALTH PROG SPEC II CEMAX28 GROUP COUNSELOR II Probation 1587S38 STAFF DEVELOPER RNPAP97 MARRIAGE & FAMILY THERAPIST I 521 APTP9E PSYCHOLOGIST 521 APTD25 VHP MEMBER SERVICES REP 521 ClericalQ98 DENTIST - U Valley Physician GroupS3M MONITOR TECHNICIAN 521 APTR8D DIAG IMAGING TECH I -MAMMO 521 APTS51 COMMUNICABLE DISEASE INVEST 521 APTH64 DIETETIC ASSISTANT 521 Blue CollarR38 SPEECH LANGUAGE PATH II 521 APTR48 THERAPY TECHNICIAN 521 APTG52 HOSPITAL COMMUNICATIONS OPR 521 ClericalE19 PROBATION COMMUNITY WORKER 521 APTX25 SUPV GROUP COUNSELOR Probation 1587D44 SUPV PATIENT BUSINESS SV CLK CEMAB5X HEALTH CARE PROGRAM ANALYST II CEMAP84 OBSTETRIC TECHNICIAN 521 APTS19 UTILIZATION REVIEW COORD-VHP CEMAE33 MENTAL HEALTH COMMUNITY WORKER 521 APTS2C ASSISTANT NURSE MANAGER STEP C RNPAU58 SHERIFF'S LIEUTENANT DSA SupervisorsR7F MEDICAL LABORATORY ASST III 521 APTR56 SUPV PHARMACIST CEMAW67 GRADUATE INTERN PHARMACIST - U 521 APTG94 COMMUNICATIONS DISPATCHER I 521 APTT58 SHERIFF'S CORRECTIONAL LIEUT CPOAS6G REHABILITATION CASE MANAGER CEMAR8B DIAG IMAGING TECH II-CT 521 APTR1T OCCUPATIONAL THERAPIST I 521 APTD63 LAW ENFORCEMENT RECORDS SPEC 521 ClericalR10 PHYSICAL THERAPIST III 521 APTS2D SURGERY SCHEDULER 521 ClericalJ05 CODER II 521 APTR8E DIAG IMAGING TECH I-CT 521 APTP13 SR MENTAL HEALTH PROG SPEC CEMAE2A PSYCHIATRIC NURSE II - STEP A RNPAR1G SUPV CLINICAL LAB SCIENTIST IFPTE Local 20 ESCD08 SUPV HEALTH SERVICES REP II CEMAB9F SR HEALTH CARE FIN ANALYST CEMAR64 PHYSICAL THERAPIST ASST II 521 APTR88 DIAGNOSTIC IMAGING TECH II 521 APT
Healthcare Provider and Emergency Responder Classifications Exempted from Expanded Paid Family and Medical Leave
R1E SR CLINICAL LAB SCIENTIST IFPTE Local 20 ESCX54 PROBATION ASSISTANT II 521 PCSUY0A NURSE PRACTITIONER - STEP A RNPAH30 HEALTH CENTER MANAGER CEMAS34 EKG TECHNICIAN 521 APTR24 PUBLIC HEALTH NUTRITIONIST 521 APTR6A MRI TECHNOLOGIST - ANGIO 521 APTB9E HEALTH CARE FIN ANALYST II CEMAJ04 CODER III - INPATIENT 521 APTB5Y HEALTH CARE PROGRAM ANALYST I CEMAR2I PHARMACY ASSISTANT 521 ClericalC70 PUBLIC HEALTH NURSE MGR I CEMAU55 CAPTAIN Executive LeadershipX91 REHABILITATION OFFICER II 521 APTX44 PROBATION DIVISION MANAGER CEMAX23 PROBATION COUNSELOR I 521 PCSUS1R BEHAVIORAL HEALTH DIV DIR CEMAS09 EMERGENCY MEDICAL SERV SPCLST CEMAJ78 HEALTH INFORMATION TECH I 521 ClericalN96 HOSPITAL STATIONARY ENGINEER 521 Blue CollarR15 RESPIRATORY CARE PRAC I 521 APTD79 MEDICAL ADMIN ASSISTANT I 521 ClericalS63 NRS MGR MEDICAL SURGICAL NRSIN CEMAY04 MEDICAL SOCIAL WORKER I 521 SSUU1H HOSPITAL SERVICES ASST II - U 521 APTC24 PREVENTION PROGRAM ANALYST I CEMAD1F HEALTH SERVICES OFFICE SUPV CEMAS2B ASSISTANT NURSE MANAGER STEP B RNPAS3A NURSE COORDINATOR - STEP A RNPAR59 CLINICAL LAB SCIENTIST MGR IFPTE Local 20 ESCD29 HOUSE STAFF COORD 521 ClericalP71 OPERATING ROOM CLERK 521 ClericalB9S PROFESSIONAL CODING ANALYST CEMAP35 POST GRADUATE YEAR IV CIRR1L SPEECH LANGUAGE PATHOLOGIST I 521 APTB01 HEALTH PLANNING SPEC III CEMAX20 SUPV PROBATION COUNSELOR CEMAC97 Q I COORDINATOR - MHS 521 APTS50 PUBLIC HEALTH NURSE I 521 PHNS47 PUBLIC HEALTH NURSE III 521 PHNR12 OCCUPATIONAL THERAPIST III 521 APTG84 CENTRAL SUPPLY DISTRIBTN SUPV CEMAK03 BIOMEDICAL EQUIPMENT TECH II 521 Blue CollarH84 LAUNDRY WORKER II 521 Blue CollarZ1B ACCOUNTING MANAGER-SCVHHS CEMAH86 LAUNDRY WORKER I 521 Blue CollarG66 OPERATING ROOM STOREKEEPER 521 Blue Collar
Healthcare Provider and Emergency Responder Classifications Exempted from Expanded Paid Family and Medical Leave
H56 FOOD SERVICE SUPERVISOR CEMAG92 SR COMMUNICATIONS DISPATCHER 521 APTD41 LAW ENFORCEMENT RECORDS SUPV CEMAD35 VALLEY HEALTH PLAN ASSISTANT 521 ClericalJ31 PROVIDER RELATIONS SPECIALIST CEMAC06 Q I COORDINATOR II A&D SV 521 APTV75 SUPERVISING CRIM INVESTIGATOR DAIAR78 ANESTHESIA TECHNICIAN 521 APTD3A RESOURCES SCHEDULING REP 521 ClericalR31 THERAPY SERVICES PROGRAM MGR CEMAS01 Q I MGR - HOSPITAL CEMAB54 MGR PATIENT ACCOUNTING SCVHHS CEMAR32 RADIATION THERAPIST 521 APTP9H HOSPITAL CLIN PSYCH - NEURO 521 APTR65 SR HISTOLOGIC TECHNICIAN IFPTE Local 20 ESCR13 PSYCHOSOCIAL OCC THERAPIST 521 APTR95 NUCLEAR MEDICINE TECHNOLOGIST IFPTE Local 20 ESCP34 POST GRADUATE YEAR V CIRZ64 FOOD SERVICE WORKER II - U 521 Blue CollarL37 COMMUNICATIONS SYSTEMS TECH 521 Blue CollarQ1D COMMUNICATIONS DISPATCHER I-U 521 APTS1V CERT REG NRS ANESTHETIST RNPAS3B NURSE COORDINATOR - STEP B RNPAS3C NURSE COORDINATOR - STEP C RNPAP28 SR STAFF PHYSICIAN II UAPDC59 AMBULATORY SERVICE MGR CEMAR83 SUPV DIAGNOSTIC IMAG TECH CEMAR1R RECREATION THERAPIST I 521 APTR1D RECREATION THERAPIST II 521 APTC48 REVENUE CONTROL ANALYST CEMAL35 TELECOMMUNICATIONS TECHNICIAN 521 Blue CollarS95 HOSPITAL SERVICES ASST I 521 APTP47 OPTOMETRIST 521 APTS68 STERILE PROCESSING TECH I 521 APTB9R HEALTH CARE COMPLIANCE ANALYST CEMAR17 SUPV RESPIRATORY CARE PRACTNR CEMAS6B ULTRASONOGRAPHER I - B 521 APTB9C HEALTH CARE FIN ANALYST ASSOC CEMAB5Z HEALTH CARE PROG ANALYST ASSOC CEMAC84 HEALTH CARE PROGRAM MGR I CEMAJ07 CLINICAL DOCUMENTATION SPEC CEMAP9F PSYCHOLOGIST - NEURO SERVICES 521 APTG91 SUPV COMMUNICATIONS DISPATCHER CEMAJ25 EPIDEMIOLOGIST II 521 APTT54 SHERIFF'S CORRECTIONAL CAPTAIN Executive LeadershipX92 REHABILITATION OFFICER I 521 APTP46 ASST MEDICAL EXAMINER-CORONER UAPD
Healthcare Provider and Emergency Responder Classifications Exempted from Expanded Paid Family and Medical Leave
V77 CRIMINAL INVESTIGATOR I DAIAS04 INFECTION CONTROL NURSE RNPAS5C STAFF DEVELOPER - STEP C RNPAR90 ORTHOPEDIC TECHNICIAN 521 APTH39 ASST DIR FOOD SERVICES CEMAD87 MEDICAL TRANSCRIPTIONIST 521 ClericalR26 ASST DIR OF PHARMACY SERVICES CEMAU9D SUPV PROTECTIVE SVCS OFFICER CEMAB9Q HEALTH CARE FINANCIAL MANAGER CEMAK06 BIOMEDICAL EQUIPMENT TECH I 521 Blue CollarC13 HEALTHCARE SERV BSNS DEV ANAL CEMAR7E MEDICAL LABORATORY ASST II-U 521 APTR02 SUPERVISING CCS THERAPIST CEMAF5E VITAL RECORDS SPECIALIST II 521 ClericalC23 PREVENTION PROGRAM ANALYST II CEMAR46 PUBLIC HEALTH MICROBIOLOGIST IFPTE Local 20 ESCA82 DEPUTY CHIEF PROBATION OFFICER Executive LeadershipX55 PROBATION ASSISTANT I 521 PCSUS31 NRS MGR CLD SHLT CSTDY HLTH CEMAJ30 CREDENTIALS SPECIALIST CEMAS35 CLINICAL NURSE SPECIALIST RNPAY0B NURSE PRACTITIONER - STEP B RNPAP4D PHYSICIAN-VMC - RAD ONCOLOGY Valley Physician GroupS5B STAFF DEVELOPER - STEP B RNPAS42 NRS MGR CRITICAL CARE CEMAD75 MEDICAL OFFICE SPECIALIST 521 ClericalS9P PATIENT TRANSPORT COORDINATOR 521 APTR8G DIAG IMAGING TECH I-CLIN INSTR 521 APTN95 SR HOSPITAL STATIONARY ENGINR 521 Blue CollarS3D DIR NRSG CRT CR & ADMIN SVCS Executive LeadershipH6A REGISTERED DIETETIC TECHNICIAN 521 APTR30 DIAGNOSTIC IMAGING INFO SYS MG CEMAK19 MEDICAL EQUIPMENT REPAIRER 521 Blue CollarS9B ULTRASONOGRAPHER II - B 521 APTB3C CLINICAL ADMIN SUPPT OFFCR III CEMAS65 NRS MGR LABR DEL PERNL EVL PRD CEMAB3A CLINICAL ADMIN SUPPT OFFCR I CEMAY09 GENETIC COUNSELOR II 521 APTD4P SPIRITUAL SERVICES COORDINATOR 521 APTC2D CLINICAL RESEARCH ASSOCIATE 521 APTS56 INFECTION CONTROL NURSE MGR CEMAQ8S LICENSED VOCATIONAL NURSE - U 521 APTR43 SR PUBLIC HLTH MICROBIOLOGIST IFPTE Local 20 ESCG70 SUPV CUSTODY SUPPORT ASSISTANT CEMAE49 DAY CARE CENTER AIDE 521 Blue CollarY0C NURSE PRACTITIONER - STEP C RNPAS5A STAFF DEVELOPER - STEP A RNPA
Healthcare Provider and Emergency Responder Classifications Exempted from Expanded Paid Family and Medical Leave
A1D PATIENT QUAL & SAFETY MED DIR Executive LeadershipR54 RESPIRATORY THERAPY SVCS SPCL 521 APTR66 HISTOLOGIC TECHNICIAN IFPTE Local 20 ESCY02 MANAGER OF MEDICAL SOCIAL SVCS CEMAR7G MEDICAL LABORATORY TECHNICIAN IFPTE Local 20 ESCJ70 MEDICAL LIBRARIAN CEMAC41 COMPLIANCE OFFICER CEMAB3B CLINICAL ADMIN SUPPT OFFCR II CEMAB9D HEALTH CARE FIN ANALYST I CEMAC2G ENTERPRISE FUND BUDGET MGR CEMAG50 INFO SYSTEMS TECH II 521 APTS9C ULTRASONOGRAPHER II - C 521 APTS54 CHIEF RADIATION THERAPIST CEMAS62 NRS MGR REHABILITATION CEMAB5B MANAGER, CARE MANAGEMENT CEMAD56 SUPV, HLTH INFO MGMT SVCS CEMAS72 Q I MGR - ACUTE PSYCH SVCS CEMAR2N CLINICAL NUTRITION SVCS MGR CEMAR58 SR CYTOTECHNOLOGIST IFPTE Local 20 ESCB2Q ASST ADMIN DIRECTOR LAB CEMAR1M CLIN LAB SCIENTIST SYS SPEC IFPTE Local 20 ESCR37 SPEECH LANGUAG PATH III 521 APTJ33 STERILE PROCESSING MANAGER CEMAP48 OPHTHALMIC TECHNICIAN 521 APTB85 DIR BUS DEVT & MNGED CARE CONT Executive LeadershipA5F DIRECTOR, ANALYTICS & REPORTG Executive LeadershipP9C CHIEF PSYCHOLOGIST CEMAR06 DIR, NUTRITION & FOOD SERVICES CEMAC2E CLINICAL RESEARCH ASST II 521 APTR9A CLINICAL NEUROPHYSIOLG TECH I 521 APTS6A ULTRASONOGRAPHER I - A 521 APTD2G HEALTH SERVICES REP - U 521 ClericalA4G SCVMC-CHIEF OPERATING OFFICER Executive LeadershipS9A ULTRASONOGRAPHER II - A 521 APTQ10 ACCOUNT CLERK II-U 521 ClericalW1P MANAGEMENT ANALYST - U CEMAB5E HEALTH CARE SERVICE LINE DIR CEMAU48 PATIENT BUSINESS SERV CLERK-U 521 ClericalG87 CHIEF COMMUNICATIONS DISP CEMAK02 COMMUNICATIONS ENGINEERING MGR CEMAK20 SR COMMUNICATION SYSTEMS TECH 521 Blue CollarJ23 SR EPIDEMIOLOGIST 521 APTB6H HEALTH PLANNING SPEC II 521 APTP04 ASST PUBLIC HEALTH OFFICER Executive LeadershipA2Z ASSISTANT SHERIFF Executive LeadershipH63 BAKER 521 Blue CollarP9D SENIOR PSYCHOLOGIST 521 APT
Healthcare Provider and Emergency Responder Classifications Exempted from Expanded Paid Family and Medical Leave
V10 ASSISTANT CLAIMS MANAGER CEMAS10 UTILIZATION REVIEW SUPV CEMAR2S PHARMACY DATA SPECIALIST VHP 521 APTP30 CLINICAL STANDARDS COORD CEMAA5Q BHS DEPT, DEPUTY DIRECTOR Executive LeadershipY1A CERT REG NRS ANESTHETIST STP A RNPAD0A CLINICAL NURSE II - STEP A RNPAS4A CLINICAL NURSE SPECIALIST ST A RNPAU57 CORR SERGEANT CPOAE2B PSYCHIATRIC NURSE II - STEP B RNPAS45 PUBLIC HEALTH NURSE SPECLST 521 PHNS53 NRS MGR EMERGENCY DEPARTMENT CEMAS33 DIR INPATIENT ACUTE CARE Executive LeadershipS71 TRAUMA PROGRAM COORD CEMAA4U SCVMC-DIR OF QUALITY & SAFETY Executive LeadershipA3C DIR, GVT, PR & SPEC PROJECTS Executive LeadershipR68 MGR TECH OPR-ARTFCL KIDNY UNIT CEMAA14 CHIEF NURSING OFFICER Executive LeadershipY01 DIR OF MEDICAL SOCIAL SERVICES CEMAA4E CHIEF DENTIST Executive LeadershipR8F DIAG IMAGING TECH I-CT & MAMMO 521 APTK18 SR TELECOMMUNICATIONS TECH 521 APTR63 UROLOGY CLINICAL COORD 521 APTP9A HOSPITAL CLINICAL PSYCH 521 APTB5C DIR OF PATIENT BUSINESS SRVC CEMAB7P PUBLIC COMMUNICATIONS PRG MGR CEMAR18 CHIEF RESPIRATORY CARE PRACTNR CEMAR33 DIR OF THERAPY SERVICES CEMAA5G DIR AMBULATORY CARE SUPP SVCS Executive LeadershipR3P SR PSYCHOSOCIAL OCC THERAPIST 521 APTA36 DIR AMBULATORY COMM HLTH SRV Executive LeadershipC01 MEDICAL TRANSLATOR COORD CEMAC0A SCVHHS ASSISTANT CONTROLLER Executive LeadershipE2D TELECOMM/FACILITIES MGR-SCVHHS CEMAS64 NRS MGR MOTHER INFANT CR CTR CEMAA5K DIRECTOR OF SYSTEM INTEGRATION Executive LeadershipA4B SCVMC - CHIEF MEDICAL OFFICER Executive LeadershipE20 TELECOMMUNICATIONS SRV SPC 521 ClericalA5L PRIMARY CARE MEDICAL DIRECTOR Executive LeadershipD10 SUPV HEALTH SERVICES REP I CEMAR2C OCCUPATIONAL THERAPY ASST II 521 APTD52 MEDICAL TRANSLATOR TRAINEE 521 APTK09 BIOMEDICAL EQUIPMENT SUP CEMAA5C DIR, CLINICAL & SUPPORT SVCS Executive LeadershipG1B VALLEY CONNECTION SVC CNT MGR CEMAR1C RECREATION THERAPIST III 521 APTA5V WHOLE PERSON CARE MEDICAL DIR Executive Leadership
Healthcare Provider and Emergency Responder Classifications Exempted from Expanded Paid Family and Medical Leave
A9M DIRECTOR OF MATERIALS MGMT Executive LeadershipR25 DIR OF PHARMACY SVCS SCVHHS CEMAR94 SR NUCLEAR MEDICINE TECH IFPTE Local 20 ESCK01 SR BIOMEDICAL EQUIPMENT TECH 521 Blue CollarR8A DIAG IMAGING TECH II- MAMMO 521 APTN9A INSTIT REV BOARD ADMINISTRATOR CEMAA4M PERIOPERATIVE SERVICES MED DIR Executive LeadershipS67 NRS MGR PEDIATRICS-ICU CEMAC2C CLINICAL SUPPORT PROGRAM CRD 521 APTJ75 ASST DIR, HLTH INFO MGMT SVCS CEMAS84 NRS MGR MENTAL HEALTH NURSING CEMAE60 MOBILE OUTREACH DRIVER 521 APTZ1D SCVHHS REIMBMNT MGR/ASST CTRL CEMAS43 NRS MGR BURN CENTER CEMAR81 DIR OF DIAGNOSTIC IMAGING CEMAV1G SCVHHS ENV SVCS ASST DIRECTOR CEMAP9G SENIOR PSYCH - NEURO SERVICES 521 APTC5C DIR CARE, CONT, PERF, AN & SPT CEMAA2G DIRECTOR, CONTRACTS - SCVHHS Executive LeadershipH55 DIR Q&U AMB & COMM HLTH/MNG CR CEMAR84 DIAGNOSTIC IMAGING ASST DIR CEMAS66 NRS MGR ARTIFICIAL KIDNEY UNIT CEMAS90 DIR NURSING ACUTE PSYCH SVCS CEMAJ06 CODER I 521 APTA1U DIRECTOR of PRIMARY CARE OPER Executive LeadershipT47 ENV HLTH & SFTY COM SPL-SCVHHS IFPTE Local 21 Engineers & ArchitectsS07 Q I MGR-AMBULATORY CHS CEMAJ1T MEANINGFUL USE PROGRAM MANAGER CEMAA1E SCVMC-CHIEF EXEC OFFICER Executive LeadershipA4A SCVHHS - CHIEF MEDICAL OFFICER Executive LeadershipN54 DIR OF NURSING PROF PRACTICE CEMAA4F DIR, FIN PLANNING AND PERFORM Executive LeadershipN56 DIR VALLEY SPECIALITY CENTER CEMAC94 MGR OF VOLUNTEER SERVICES CEMAJ10 DIR, CODING DOC & HIMS CEMAS55 NRS MGR OPERATING ROOM SERVS CEMAC05 DIR GENERAL FUND FINANCIAL SRV Executive LeadershipA4K CHIEF IMP AND INNOVATION OFFCR Executive LeadershipJ09 DEP DIR, CODING & CLIN DOC IMP CEMAS81 NRS MGR NEONATAL ICU CEMAA15 CHIEF FINANCIAL OFC-SCVH & HS Executive LeadershipB56 CLINICAL RISK PRV PROG MGR CEMAA4P MEDICINE RESIDENCY PROG DIR Executive LeadershipN5A DIRECTOR OF CARE MANAGEMENT CEMAS69 Q I MGR - INPATIENT NURSING CEMAA4L DIRECTOR, ADVANCED PRACTICE Executive LeadershipB9T HOSPITAL EM PREPAREDNESS MGR CEMA
Healthcare Provider and Emergency Responder Classifications Exempted from Expanded Paid Family and Medical Leave
A88 DIRECTOR OF MARKETING SCVMC CEMAC04 SCVHHS CONTROLLER Executive LeadershipF68 ENTERPRISE ITPS MANAGER CEMAC2A CLINICAL RESEARCH PROG DIR CEMAR3D DOSIMETRIST 521 APTA4Q SPECIALTY CARE MEDICAL DIR Executive LeadershipR51 CLINICAL MICROBIOLOGIST CEMAA1Y CHIEF MEDICAL INFO OFFICER Executive LeadershipR1B CHILD LIFE SPECIALIST 521 APTR52 CLINICAL BIOCHEMIST CEMAS9E SCVHHS ENVIR SVCS DIRECTOR CEMAR21 CLINICAL DIETITIAN I 521 APTQ9A MEDICAL ASSISTANT - U 521 APTB3G DIR PATIENT ACCESS CEMAH1E JANITOR SUPERVISOR - U CEMAQ9T PATIENT TRANSPORTER - U 521 APTV31 OFFICE SPECIALIST III - U 521 ClericalB2H ADMIN DIRECTOR, LAB CEMAQ6Q DIETETIC ASSISTANT - U 521 Blue CollarR44 GASTROENTEROLOGY TECHNICIAN 521 APTG8C STOREKEEPER- U 521 Blue CollarQ4H THERAPY TECHNICIAN - U 521 APTQ2L SURGERY SCHEDULER - U 521 ClericalB4A CLINICAL ADMIN SERVICES MGR CEMAP85 CLINICAL AUDIOLOGIST 521 APTD1L CHIEF MEDICAL PHYSICIST CEMAC2B CLINICAL RESEARCH PROG MGR CEMAU10 REHABILITATION THERAPY SPEC-U 521 APTC10 REVENUE CYCLE DIRECTOR Executive LeadershipJ32 STERILE PROCESS EDUCATION CORD CEMAK05 COMMUNICATIONS ENGINEER CEMAB36 DIV DIR, COMM ENG & TECH SVCS CEMAR01 CHIEF CCS THERAPIST CEMAS4D DIR PUB HEALTH-NURSING SVC Executive LeadershipB7T PUBLIC HEALTH PREPAREDNESS MGR CEMAP06 PUBLIC HEALTH OFFICER Executive LeadershipA5H DEPUTY DIR, PH OPERATIONS Executive LeadershipB8G ASSIST DIR, PUB HEALTH LAB CEMAJ69 HEALTH INFORMATION CLERK I 521 ClericalC69 PUBLIC HEALTH NURSE MGR II CEMAR2U SUP PUBLIC HEALTH NUTRITIONIST CEMAE06 CHIEF REGISTRAR OF VITAL STAT CEMAP05 DEPUTY PUBLIC HEALTH OFFICER Executive LeadershipC9A PH COMMUNICATIONS OFFICER CEMAA58 BRANCH DIR HEALTHY COMMUNITIES Executive LeadershipF5F VITAL RECORDS SPECIALIST I 521 ClericalA65 SHERIFF - U Executive Leadership
Healthcare Provider and Emergency Responder Classifications Exempted from Expanded Paid Family and Medical Leave
G33 DATA ENTRY OPERATOR 521 ClericalA1S DIR OF SHERIFF'S ADMIN SRV Executive LeadershipZ56 UNDERSHERIFF - U Executive LeadershipT10 RANGEMASTER II 521 APTV90 FINGERPRINT IDENTIFICATION DIR CEMAV4S LATENT FINGERPRINT EXAM SUPV CEMAV43 LATENT FINGERPRINT EXAM II 521 APTU6E SHERIFF'S HELICOPTER PILOT 521 APTM03 CORR SUPPORT SERVICES MGR CEMAA6G ASST SHERIFF-CORRECTION OPR Executive LeadershipN94 INSTITUTIONAL MAINTENANCE ENGR 521 Blue CollarX9E INMATE REHABILITATION MANAGER CEMAS32 CORRECTIONAL FOOD SERVICES DIR CEMAF3A JUVENILE PROBATION RECORDS SUP CEMAM48 GENERAL MAINT MECHANIC I 521 Blue CollarG9E ASSOCIATE DATA ENGINEER CEMAS9F DEPUTY DIR OF PROBATION ADMIN Executive LeadershipA80 CHIEF PROBATION OFFICER-U Executive LeadershipB6P ADMIN SERVICES MGR-PROBATION Executive LeadershipB6F MGR ADULT CUSTODY M H CEMAS86 DIR. CUSTODY HEALTH SERVICES Executive LeadershipD2P VHP PHARMACY SERVICES DIV DIR CEMAB7M DIR OF HEALTH EDUCATION CEMAD2R VHP Member Services Manager CEMAF8C SR BUSINESS CONF ANALYST CEMAA4J VHP - CHIEF FINANCIAL OFFICER Executive LeadershipA4V VHP-CHIEF OPERATIONS OFFICER Executive LeadershipA4Y VHP-CHIEF BUS DEV OFFICER Executive LeadershipA4H VHP - CHIEF EXECUTIVE OFFICER Executive LeadershipA4I VALLEY HLTH PLAN - MED DIRECTR Executive LeadershipY5C VHP MARKETING & COMM REP CEMAW1W MGMT AIDE - U CEMAA9G VHP CHIEF MEDICAL OFFICER Executive LeadershipB89 VHP-ASST DIR MANAGED CARE PROG Executive LeadershipR85 CHEST X-RAY TECHNICIAN 521 APTC8A EMPLOYEE ASSISTANCE PROG MGR CEMAC49 DIR ALCOHOL DRUG ACCESS SRVCS Executive LeadershipA9H BEHAVIORAL HEALTH MEDICAL DIR Executive LeadershipB2X ASSOC TRNG & STAFF DEV SPEC I CEMAA5E DIR, BEHAVIORAL HEALTH SVCS Executive LeadershipP15 MENTAL HEALTH PROGRAM SPC I 521 APTA5U BEHVRL HLTH SVCS DEPT QUAL DIR Executive LeadershipB20 EMERGENCY MED SVCS ADMIN Executive LeadershipA9F EMS MEDICAL DIRECTOR Executive LeadershipB10 EMERGENCY PLANNING COORD CEMA
Healthcare Provider and Emergency Responder Classifications Exempted from Expanded Paid Family and Medical Leave
COUNTY OF SANTA CLARA EMERGENCY EXPANSION
FAMILY AND MEDICAL LEAVE REQUEST FORM
Applications for leave under the Emergency Family and Medical Leave Expansion Act (EFMLEA) should be made in advance whenever possible. To request leave under the EFMLEA, complete this form and return it to your Department Employee Service Center. You may request EFMLEA for up to twelve work weeks if you need to care for a child under age 18 because of school/daycare closures or childcare provider is unavailable related to COVID-19. The Department of Labor’s notice about EFMLEA is attached with this Request Form. EFMLEA is not available to healthcare providers and emergency responders as noted in the “Updated COVID-19 Guidance for Leaves and Timekeeping” memo provided along with this form.
Employee ID: _________________ Name (First and Last): _____________________________________
Leave Begin Date: _____________ Expected Leave End Date (if known): __________________
Are you requesting this leave be intermittent? � Yes � No If yes, requested schedule will be: ______________________________________________________ Approved by: ___________________________ ______________________________ ___________ Supervisor Name Supervisor Signature Date
Are you unable to work because of the need to take care of a child/children under fourteen because the school or place of childcare is closed, or whose childcare provider is unavailable, due to COVID-19?
� Yes � No
Name of childcare provider (school, daycare, or individual)? ______________________________________ Name and age of the child(ren) you are caring for? ______________________________________________ ________________________________________________________________________________________ Is there another suitable person besides you who can care for the child(ren)?
� Yes � No Have you worked for the County for at least 30 days?
� Yes � No Have you used FMLA during the past 12 months?
� Yes � No
Please mark your preference for leave usage during the first 10 days of leave:
� I elect to use Emergency Sick Leave for the first 10 days � I elect to use my own leave balances for the first 10 days � I elect to go uncompensated for the first 10 days
Do you want to integrate your leave balances with the 2/3 County pay after the first 10 days to receive full pay? The 2/3 County pay has a daily maximum of $200 and an aggregate maximum of $10,000.
� Yes
� No
I hereby certify under penalty of perjury that to the best of my knowledge the information that I have provided for this leave is accurate. I understand that it is my responsibility to inform my supervisor immediately of any change in circumstance related to the reason for my leave of absence. I understand that, after the first 10 work days of unpaid leave, the County will pay 2/3 of my regular pay up to a daily maximum of $200 and aggregate $10,000 maximum for my eligible FMLA period. I understand that I may elect to integrate my leave balances to receive full pay. Employee Signature: ____________________________________ Date: __________________
