Families First Coronavirus Response Act: Employer Paid Leave Tracking Sheet

Hours
Docum
Allowed
Hrs of Employee entatin Eligibility
Rec'd Designat
Service Start Anticipate received a Was there a from Approval Letter/Tim RTW FML
Status First Last Dept. DOH 12 Month Actual Reason For HYBRID? For 12 weeks: Health ion Duration Payroll Supervisor Notes:
(1250 hours Request d positive/negative building Day by HR ekeeper Cert Hours
Start Date Return Leave 24 hr shift = 672 hrs Care Letter Notification Notification
requirement Date Return /N/A COVID-19 exposure? Yes/No Care Director? Notificatio Rec'd? Used
12 hr shift = 504 hrs Cert? Sent On
) Test Result Provide n Sent On
10 hr shift = ???
r
8 hr shift = 480 hrs
Ongoing A - Birth or adoption of child 12 weeks Yes Yes Continuous Yes
B - EE's own serious condition 12 weeks No No Intermittent No
C - To care for spouse, child or parent 12 weeks Pending
D - Military Exigency 12 weeks
E - To care for a Servicemember 26 weeks
P&R 7/2/2007 Y 4/7/2019 4/6/2020 6/22/2020 6/30 last day of5-Child
480 hours
Care 480 N/A No N/A Yes Y email 4/9/20 Continuous 4/9/2020 4/9/2020 N/A
Landfill 6/24/2019 N/A 4/7/2020 4/22/2020 2 quarantine and 3 seeking
Y treatment
80 He used 16 hours of code 97 for Negative
reason 3 No need a letter from donaldYes
for the file rcvd
email 4/13/2020 Continuous 4/13/2020 4/13/2020 4/3 and 4/7 were not approved because he was officially not seeking care. Although [Redacted] said that he called his pc and was told that he was too old to see covid patients and refused the visit. 4/15 Shannon approved th and Monday
Open P&R 4/18/2005 Yes 4/13/2020 4/10/2020 Intermittent 5-Child Care 80 ER sick leave then an extra 199N/A for a total of 279 FMLA No N/A Yes Yes email 4/14/20 Intermittent 4/14/2020 4/14/2020 N/A he used FMLA in the past 12 months. Pay attention to hours used.
Sheriff Yes 4/14/2020 4/13/2020 6/30/20 Intermittent 5-Child Care 80 hours N/A No N/A Yes Yes 4/20/20 4/20/2020 Intermittent 4/20/2020 4/20/2020 N/A He is only eligible for 80 because he is a deputy
Sheriff 9/13/2016 3/16/2020 3/26/2020 3/27/2020 2-advised by Health care provider to quarantine Negative No Yes N/A Yes 4/23/2020 N/A Continuous 4/23/2020 4/23/2020
Sheriff 1/11/2016 4/1/2020 4/9/2020 56 hours 1-Dept Quarantine-exposure on job N/A No Dept Q emailN/A Yes 4/27/2020 Continuous 4/27/2020 4/27/2020 N/A
Utilities 9/18/2017 3/30/2020 4/8/2020 2-advised by Health care provider to quarantine Negative No Yes N/A Yes 4/24/2020 4/24/2020 Continuous 4/24/2020 4/24/2020 [Redacted] was sick and received a test. It was negative.
F&R 10/24/2005 4/22/2020 5/10/2020 12 hour periods5-Child
per dayCare 12 hour shifts N/A No N/A N/A Yes 4/24/2020 4/24/2020 Intermittent 4/24/2020 4/24/2020
Bldg Maint 11/17/2014 4/27/2020 4/30/2020 waiting for test2-advised
results by Health care provider to quarantine Negative No yes N/A Yes 5/4/2020 Continuous 5/4/2020 5/4/2020 sick, tested, told to quarantine by doc.
Sheriff 10/14/2013 3/19/2020 3/29/2020 2-advised by Health care provider to quarantine N/A No yes N/A Yes 5/21/2020 Continuous 5/21/2020 5/21/2020 N/A
Open Sheriff 6/13/2016 5/18/2020 12/31/2020 or until situation changes
5-Child Care 480 total with 80 hours of FFCRA sick
N/A No N/A Yes Yes 5/21/20 5/28/2020 Intermittent 5/28/2020 5/28/2020 N/A
Utilities 4/6/2020 5/26/2020 6/2/2020 2-advised by Health care provider to quarantine N/A No Yes N/A yes 5/28/2020 Continuous 5/28/2020 5/28/2020 tested negative
Utilities 6/16/2020 6/18/2020 tested negative2-advised
on 6/1/20by Health care provider to quarantine Negative No YEs N/A 6/24/2020 Continuous 6/24/2020 6/24/2020 tested negative
Sheriff 9/19/2019 PT M-T 7hr/day 6/29/2020 7/6/2020 7/6 tested negative still has symptoms 5 days at 7 hrs/day=35 hours totalNegative No Yes N/A Yes 7/8/2020 Continuous 7/8/2020 7/8/2020 N/A
Sheriff 2/6/2012 7/6/2020 7/14/2020 tested on 7/7 waiting
3- 7/6-7/7,2-7/8-7/13No
for results 7/6-7/7 code 97 16 hrs. 7/8 and 7/13N/Acode 98 16 hours No Yes N/A yes 7/23/2020 Continuous 7/23/2020 7/23/2020 N/A
Sheriff 8/3/2018 7/6/2020 7/7/2020 7/8/2020 3-seeking med diagnosis 7/6-7/7/20 code 97 Negative No Yes N/A Yes 7/23/2020 Continuous 7/23/2020 7/23/2020 N/A
#2 Landfill 6/24/2019 7/8/2020 7/22/1980 4-caring for an individual subject to7/8/20-7/22/20
quarantine code 97. He used N/A 16 hours in claim #1, so he No
has 64 hours left of the 80 hrs
Yes N/A Yes 7/23/2020 Continuous 7/23/2020 7/23/2020 N/A
Sheriff 7/24/2020 7/27/2020 7/27/2020 1-Dept Quarantine based on exposure 8 hours
on the job N/A No negative test Yes 7/28/2020 7/28/2020 7/28/2020 N/A
Sheriff 7/24/2020 7/27/2020 7/27/2020 1-Dept Quarantine based on exposure 8 hours
on the job N/A No negative test Yes 7/28/2020 7/28/2020 7/28/2020 N/A
Sheriff 7/24/2020 7/27/2020 7/27/2020 1-Dept Quarantine based on exposure he worked
on the 2.5
jobhrs of an 11.5 shift.N/A
9 hrs of FFCRA leave No negative test Yes 8/10/2020 8/10/2020 8/10/2020 N/A
Sheriff 7/24/2020 7/27/2020 7/27/2020 1-Dept Quarantine based on exposure 8 hours
on the job N/A No negative test Yes 7/28/2020 7/28/2020 7/28/2020 N/A
Sheriff 7/24/2020 7/27/2020 7/27/2020 1-Dept Quarantine based on exposure 8 hours
on the job N/A No negative test Yes 7/28/2020 7/28/2020 7/28/2020 N/A
#2 Public Works-Utilities 7/13/2020 7/20/2020 7/20/2020 2-advised by doctor to quarantine 35.5 exposure
hoursto positive covid Negative No negative test Yes 7/29/2020 Continuous 7/29/2020 7/29/2020 N/A
Sheriff 7/9/2018 7/23/2020 2-sick and advised to quarantine Approved for all 80 hours Negative No 1st test negative Yes 8/7/2020 Continuous 8/7/2020 8/7/2020 N/A

Sheriff 7/11/2016 7/30/2020 8/5/2020 1-exposure on the job. Dept quarantine

total 3 11.5 hour days N/A No N/A Yes 7/31/2020 7/31/2020 7/31/2020
4-taking care of dad N/A No
PRCF PT 7/20/2020 8/6/2020 2-advised to quarantine 72 hours Positive COVID Test Positive No Yes Yes 8/7/2020 Continuous 8/7/2020 8/7/2020
Utilities 6/26/2017 8/3/2020 8/6/2020 8/7/2020 3-sick/seeking med diagnosis 32 hours Negative No Yes 8/12/2020
DSS 7/29/2020 2-advised to quarantine tested Positive 7/29/20 Positive No Yes sent 8/10
Sheriff
COR 8/10/2020 tested positive Positive Yes
waiting on FFCRA LRF 8/12/2020 waiting on test results 2-exposed and told by doc to quarantine Yes
Sheriff

24-Apr
Fire and Rescue They are approved to possibly receive more than 80 hours of leave if quarantined because of exposure on the job.
F&R 6/17/2019 summary done 4/20/2020 5/1/2020 1-Dept Quarantine-exposure on job N/A No N/A N/A Yes 4/23/2020 N/A Continuous 4/23/2020 4/23/2020 COVID exposure on a call
F&R 6/17/2019 summary done 3/31/2020 4/11/2020 1-Dept Quarantine-exposure on job N/A No Dept Q N/A Yes 4/23/2020 N/A Continuous 4/23/2020 4/23/2020 COVID exposure on a call
F&R 8/26/1991 summary done 4/14/2020 4/15/2020 48 hours 2-Sick advised by doctor to quarantine Negative No Doc Note N/A Yes 4/23/2020 N/A Continuous 4/23/2020 4/23/2020 he is sick and waiting for test results
F&R 8/13/2007 summary done 4/3/2020 4/9/2020 48 hours 2-sick advised by doctor to quarantine N/A No Doc Note N/A Yes 4/23/2020 4/23/2020 Continuous 4/23/2020 4/23/2020
F&R 12/4/2006 summary done 1st quarantine 4/2/2020 4/11/2020 1-Dept Quarantine-exposure on job N/A No Dept Q emailN/A Yes 4/23/2020 4/23/2020 Continuous 4/23/2020 4/23/2020 COVID exposure on a call
F&R 12/4/2006 summary done 2nd quarantine 4/15/2020 5/1/2020 4-caring for an ind with COVID symptoms N/A No Dept Q emailN/A Yes 4/23/2020 4/23/2020 Continuous 4/23/2020 4/23/2020 Wife was sick and quarantined. Granger wanted him home.
F&R 8/13/2007 summary done 1-Dept Quarantine-exposure on job N/A No Dept Q N/A Yes 4/23/2020 N/A Continuous 4/23/2020 4/23/2020 COVID exposure on a call
F&R 8/10/2009 summary done 1-Dept Quarantine-exposure on job N/A No Dept Q emailN/A Yes 4/23/2020 N/A Continuous 4/23/2020 4/23/2020 COVID exposure on a call
F&R 11/3/2003 summary done 3/31/2020 4/9/2020 1-Dept Quarantine-exposure on job N/A No Dept Q emailN/A Yes 4/23/2020 N/A Continuous 4/23/2020 4/23/2020 COVID exposure on a call
F&R 1/9/2017 summary done 4/3/2020 4/12/2020 1-Dept Quarantine-exposure on job N/A No Dept Q emailN/A Yes 4/23/2020 N/A Continuous 4/23/2020 4/23/2020 COVID exposure on a call
F&R 1/9/2017 summary done 3/26/2020 4/19/2020 2-sick advised by doctor to quarantine tested Negative No multiple dr notes
N/A Yes 4/23/2020 N/A Continuous 4/23/2020 4/23/2020 Sick w/fever and smptoms. Roommate quarantined. Tested negative. Ret to light duty 4/20/20
F&R 1/9/2017 summary done 4/5/2020 4/14/2020 52 hours 2-sick advised by doctor to quarantine tested-negative Negative No Yes Yes 5/4/2020 N/A Continuous 5/4/2020 5/4/2020 sick tested quarantined, tested negative, came back
F&R 6/17/2019 summary done 4/6/2020 4/15/2020 1-Dept Quarantine-exposure on job N/A No Dept Q email Yes 5/1/2020 N/A Continuous 5/1/2020 5/1/2020
F&R 6/17/2019 summary done 4/24/2020 4/29/2020 8 hours 1-Dept Quarantine-exposure on job N/A No Dept Q emailN/A Yes 5/5/2020 N/A Continuous 5/5/2020 5/5/2020
F&R 1/9/2017 summary done 4/24/2020 4/27/2020 8 hours 1-Dept Quarantine-exposure on job N/A No Dept Q emailN/A Yes 5/11/2020 Continuous 5/11/2020 5/11/2020
F&R 8/24/2009 summary done 5/2/2020 5/4/2020 24 hours 5-Dependent Care N/A No N/A No letter from dept. No letter from day care because spouse is care provider. See summary for notes
F&R 6/17/2019 summary done 4/20/2020 4/29/2020 80 hours 1-Dept Quarantine-exposure on job N/A No N/A No Yes 5/11/2020 Continuous 5/11/2020 5/11/2020
F&R 1/9/2017 summary done 4/20/2020 4/29/2020 72 hours 1-Dept Quarantine-exposure on job N/A No N/A No Yes 5/11/2020 Continuous 5/11/2020 5/11/2020
F&R summary done 5/16/2020 5/20/2020 53 hours 3 then 2 Negative No Yes N/A 5/29/2020 Continuous 5/29/2020 5/29/2020
F&R 11/27/2012 summary done 5/30/2020 6/8/2020 80 hours 5-Dependent Care 80 N/A No N/A Yes yes 6/10/2020 6/10/2020 6/10/2020 N/A
F&R 10/14/2013 6/15/2020 6/17/2020 80 hours 5-Dependent Care 80 N/A No N/A Yes 6/16/2020 yes on 7/13/20
7/13/2020 Intermittent 7/13/2020 7/13/2020 N/A
F&R 7/24/2020 8/3/2020 50 hours 5-Dependent Care max 80. This time 50 N/A No Yes 7/23/2020 Intermittent 7/23/2020 7/23/2020 N/A Court papers in file.
F&R work related exposure 7/19/2020 ? 2-sick and told to quarantine On the job exposure. Unlimited hours
Positive No Yes N/A Yes 7/31/2020 Continuous 7/31/2020 7/31/2020 N/A
F&R 7/16/2020 7/25/2020 72 hours 2-sick and told to quarantine
pending lab results
F&R
F&R
F&R 7/23/2020 7/28/2020 24 hours 4-taking care of spouse TH, F, M 8hours each day N/A No N/A
F&R Request Denied-see summary 8/6/2020 4-taking care of daughter N/A No
F&R 7/27/2020 7/28/2020 6 hours 2-sick and told to quarantine 7/27/20 6 hours Negative No Yes sent 8/5/20

F&R 7/27 quarantine 7/24/2020 7/27/2020 13.5 hours 1-Dept quarantine due to exposureSee notes N/A No Yes 8/7/2020 Continuous 8/7/2020 8/7/2020
F&R 7/27 quarantine 7/24/2020 7/27/2020 13 hours 1-Dept quarantine due to exposure N/A No Yes 8/7/2020 Continuous 8/7/2020 8/7/2020
F&R 7/27 quarantine 7/24/2020 7/27/2020 8 hours 1-Dept quarantine due to exposure N/A No Yes 8/7/2020 Continuous 8/7/2020 8/7/2020
F&R 7/27 quarantine 7/24/2020 7/27/2020 13 hours 1-Dept quarantine due to exposure N/A No Yes 8/7/2020 Continuous 8/7/2020 8/7/2020
F&R 7/27 quarantine 7/24/2020 7/27/2020 11 hours 1-Dept quarantine due to exposure N/A No Yes 8/7/2020 Continuous 8/7/2020 8/7/2020
F&R 7/27 quarantine 7/24/2020 7/27/2020 24 hours 1-Dept quarantine due to exposure N/A No Yes 8/7/2020 Continuous 8/7/2020 8/7/2020
F&R 7/27 quarantine 7/24/2020 7/27/2020 13 hours 1-Dept quarantine due to exposure N/A No Yes 8/7/2020 Continuous 8/7/2020 8/7/2020
F&R 7/27 quarantine 7/24/2020 7/27/2020 8 hours 1-Dept quarantine due to exposure N/A No Yes 8/7/2020 Continuous 8/7/2020 8/7/2020
F&R 7/27 quarantine 7/24/2020 7/27/2020 13 hours 1-Dept quarantine due to exposure N/A No Yes 8/7/2020 Continuous 8/7/2020 8/7/2020
F&R 7/27 quarantine 7/24/2020 7/27/2020 11.5 hours 1-Dept quarantine due to exposure N/A No Yes 8/7/2020 Continuous 8/7/2020 8/7/2020
F&R 7/27 quarantine 7/24/2020 7/27/2020 48 hours 1-Dept quarantine due to exposure N/A No Yes 8/7/2020 Continuous 8/7/2020 8/7/2020
F&R 7/27 quarantine 7/24/2020 7/27/2020 72 hours 1-Dept quarantine due to exposure N/A No Yes 8/7/2020 Continuous 8/7/2020 8/7/2020
F&R 7/27 quarantine 7/24/2020 7/27/2020 24 hours 1-Dept quarantine due to exposure N/A No Yes 8/7/2020 Continuous 8/7/2020 8/7/2020
F&R 7/27 quarantine 7/24/2020 7/27/2020 48 hours 1-Dept quarantine due to exposure N/A No Yes 8/7/2020 Continuous 8/7/2020 8/7/2020
F&R 7/27 quarantine 7/24/2020 7/27/2020 24 hours 1-Dept quarantine due to exposure N/A No Yes 8/7/2020 Continuous 8/7/2020 8/7/2020
F&R 7/27 quarantine 7/24/2020 7/27/2020 13 hours 1-Dept quarantine due to exposure N/A No Yes 8/7/2020 Continuous 8/7/2020 8/7/2020

F&R
F&R