400 - EMPLOYEES

400 - EMPLOYEES Jen@iowaschool… Tue, 11/09/2021 - 15:42

400 - Role and Guiding Principles for Employees

400 - Role and Guiding Principles for Employees

This series of the board policy manual is devoted to the board's goals and objectives for employees in the performance of their jobs.  Employees provide a variety of important services for the children of the school district community.  They may be teaching or assisting in the classroom, working in the office, maintaining the facilities, driving or repairing the school buses, or cooking lunches.  Each employee plays a vital role in providing an equal opportunity for a quality education for students commensurate with the students' individual needs.  While the teachers have the most direct impact on the formal instruction of students, all employees have an impact on the school environment by their dedication to their work and their actions.  As role models for the students, employees will promote a cooperative, enthusiastic, and supportive learning environment for the students.

In striving to achieve a quality education program, the board's goal is to obtain and retain qualified and effective employees.  The board will have complete discretion to determine the number, the qualifications, and the duties of the positions and the school district's standards of acceptable performance.  It will be the responsibility of the superintendent to make recommendations to the board in these areas prior to board action.  The board recognizes its duty to bargain collectively with duly certified collective bargaining units.

Board policies in this series relating to general employees will apply to employees regardless of their position as a licensed employee, classified employee, substitute or administrator.  Board policies relating to licensed employees will apply to positions that require a teaching license or administrator's certificate or other professional license, certificate or endorsement, unless administrative positions are specifically excluded from the policy.  Classified employees' policies included in this series will apply to positions that do not fall within the definition of licensed employee.

 

 

Approved:  Feb. 11, 1985, February 18, 2019    
Reviewed:  Aug. 24, 2005, Aug 18, 2014, January 21, 2018
Revised:  Feb. 10, 1997, January 21, 2018

 

dawn.gibson.cm… Mon, 11/29/2021 - 12:59

400.1 - All Employee Handbook

400.1 - All Employee Handbook

The Board values all employees in the district and believes an all-employee handbook provides the governance of rules and procedures for employees.

This handbook is a general source of information and may not include every possible situation that could arise. It is not intended and does not constitute a contract between the school district and employees. It is the employee's responsibility to refer to the district policies and/or administrative procedures for further information. Whenever the provisions of this handbook are in conflict with those of a board-adopted policy, an applicable collective bargaining agreement, or any other formal employment contract, the terms of the policy, collective bargaining agreement, and/or employment contract will govern.

Although every effort will be made to update the handbook on a timely basis, there may be occurrences where the district changes policies, procedures, benefits, and terms of employment.

The Board also recognizes the need for a consistent and orderly system, therefore, if, at all possible, handbook changes will occur on an annual basis. These changes will be shared with the handbook committee prior to board approval.

The handbook committee is comprised of the superintendent, business director, Board HR committee representation, food service director, transportation director, facilities director, representatives from food service, transportation, facilities, teacher associates, secretaries, and three teachers. The committee members will be on a three-year term. If more than one employee represents a group, those committee members will be on rotation. The first year, one member would be appointed to a three year term, one to a two year term, and one to a one-year term. The committee will not be larger than 15 at any time. Each department/group helps select individuals to represent them on this committee.

It is the responsibility of the superintendent, in conjunction with central office staff to set the agenda and meeting dates. The meetings will take place at least quarterly for an hour at a time. Handbook Committee Members will email the superintendent's secretary with subjects/items they would like to see placed on the agenda for possible discussion.

The responsibilities of the committee include bringing forward items from the handbook for discussion at the committee level. Committee work may include best practices, research on the system's organizational health, other district employee handbooks, or current working practices within the district. As a committee, a general consensus of what may work for FCSD will be shared for possible consideration by district management. The final handbook will be taken to the board annually prior to the start of the fiscal year.

The board has the final approval of the handbook.

 

 

Approved:  June 18, 2018
Reviewed:  May 21, 2018
Revised:     May 21, 2018

 

dawn.gibson.cm… Mon, 11/29/2021 - 12:59

401 - Internal Relations

401 - Internal Relations dawn.gibson.cm… Mon, 11/29/2021 - 13:01

401.1 - Equal Employment Opportunity

401.1 - Equal Employment Opportunity

The Fairfield Community School District will provide equal opportunity to employees and applicants for employment in accordance with applicable equal employment opportunity and affirmative action laws, directives and regulations of federal, state and local governing bodies.  Opportunity to all employees and applicants for employment includes hiring, placement, promotion, transfer or demotion, recruitment, advertising or solicitation for employment, treatment during employment, rates of pay or other forms of compensation, and layoff or termination.  The school district will take affirmative action in major job categories where women, men, minorities and persons with disabilities are underrepresented.  Employees will support and comply with the district's established equal employment opportunity and affirmative action policies.  Employees will be given notice of this policy annually.

The board will appoint an equity coordinator.  The affirmative action coordinator will have the responsibility for drafting the affirmative action plan.  The affirmative action plan will be reviewed by the board at least every two years.

Individuals who file an application with the school district will be given consideration for employment if they meet or exceed the qualifications set by the board, administration, and Iowa Department of Education for the position for which they apply.  In employing individuals, the board will consider the qualifications, credentials, and records of the applicants without regard to race, color, creed, sex, national origin, religion, age, sexual orientation, gender identity or disability.  In keeping with the law, the board will consider the veteran status of applicants.

[Prior to a final offer of employment for any teaching position, the school district will perform the background checks required by law.  The district may determine on a case-by-case basis that, based on the duties, other positions within the district will also require background checks.  Based upon the results of the background checks, the school district will determine whether an offer will be extended.  If the candidate is a teacher who has an initial license from the BOEE, then the requirement for a background check is waived.]

Advertisements and notices for vacancies within the district will contain the following statement:  "The Fairfield Community School District is an equal employment opportunity/affirmative action (EEO/AA) employer."  The statement will also appear on application forms.

Inquiries by employees or applicants for employment regarding compliance with equal employment opportunity and affirmative action laws and policies, including but not limited to complaints of discrimination, will be directed to the Affirmative Action Coordinator by writing to the Affirmative Action Coordinator, Fairfield Community School District,  403 South 20th Street, Fairfield, Iowa  52556-4243; or by telephoning 641-472-2655. 

Inquiries by employees or applicants for employment regarding compliance with equal employment opportunity and affirmative action laws and policies, including but not limited to complaints of discrimination, may also be directed in writing to the Director of the Region VII office of Civil Rights, U.S. Department of Education, 310 W. Wisconsin Ave., Ste. 800, Milwaukee,  Wisconsin,  53203-2292,  (414) 291-1111  or  the  Iowa Civil Rights Commission,  400 East 14th Street, Des Moines, Iowa, 50319-1004, (515) 281-4121 or 1-800-457-4416, http://www.state.ia.us/government/crc/index.html.  This inquiry or complaint to the federal office may be done instead of, or in addition to, an inquiry or complaint at the local level.

Further information and copies of the procedures for filing a complaint are available in the school district's central administrative office and the administrative office in each attendance center.

 

 

Legal Reference:  29 U.S.C. §§ 621-634 (2012).
    
                                  42 U.S.C. §§ 12101 et seq. (2012).
    
                                  Iowa Code §§ 19B; 20; 35C; 73; 216; 279.8;
                                     
 281 I.A.C. 12.4; 14.1; 95.                                                                 

Cross Reference:  102 Equal Educational Opportunity
    
                                  104    Bullying/Harassment
    
                                  405.2 Licensed Employee Qualifications, Recruitment, Selection
    
                                  411.2 Classified Employee Qualifications, Recruitment, Selection

Approved:  Feb. 11, 1985, March 19, 2012, December 19, 2017
Reviewed:  July 20, 2007, Oct. 11, 2010, March 19, 2012, November 7, 2017
Revised:  Oct. 8, 1990, Aug. 13, 2007, Nov. 8, 2010, March 19, 2012

 

dawn.gibson.cm… Mon, 11/29/2021 - 13:01

401.2 - Employee Conflict of Interest

401.2 - Employee Conflict of Interest

Employees' use of their position with the school district for financial gain will be considered a conflict of interest with their position as employees and may subject employees to disciplinary action.

Employees have access to information and a captive audience that could award the employee personal or financial gain.  No employee may solicit other employees or students for personal or financial gain to the employee without the approval of the superintendent.  If the approval of the superintendent is given, the employee must conduct the solicitations within the conditions set by the superintendent.  Further, the superintendent may, upon five days notice, require the employee to cease such solicitations as a condition of continued employment.

Employees will not act as an agent or dealer for the sale of textbooks or other school supply companies doing business with the school district.  Employees will not participate for personal financial remuneration in outside activities wherein their position on the staff is used to sell goods or services to students or to parents.  Employees will not engage in outside work or activities where the source of information concerning the customer, client or employer originates from information obtained because of the employee's position in the school district.

It will also be a conflict of interest for an employee to engage in any outside employment or activity, which is in conflict with the employee's official duties and responsibilities.  In determining whether outside employment or activity of an employee creates a conflict of interest, situations in which an unacceptable conflict of interest is deemed to exist will include, but not be limited to, any of the following:

          (1)       The outside employment or activity involves the use of the school district's time, facilities, equipment and supplies or the use of the school district's badge, uniform, business card or other evidences of office to give the employee or the employee's immediate family an advantage or pecuniary benefit that is not available to other similarly situated members or classes of members of the general public.  For purposes of this section, a person is not "similarly situated" merely by being related to an employee who is employed by the school district.

          (2)       The outside employment or activity involves the receipt of, promise of, or acceptance of more or other consideration by the employee or a member of the employee's immediate family from anyone other than the school district for the performance of any act that the employee would be required or expected to perform as part of the employee's regular duties or during the hours during which the employee performs service or work for the school district.

          (3)       The outside employment or activity is subject to the official control, inspection, review, audit, or enforcement authority of the employee during the performance of the employee's duties.

 

If the outside employment or activity is employment or activity in (1) or (2) above, the employee must cease the employment of or activity.  If the activity or employment falls under (3), then the employee must:

  •   Cease the outside employment or activity; or
  •   Publicly disclose the existence of the conflict and refrain from taking any official action or performing any official duty that would detrimentally affect or create a benefit for the outside employment or activity.  Official action or official duty includes, but is not limited to, participating in any vote, taking affirmative action to influence any vote, or providing any other official service or thing that is not available generally to members of the public in order to further the interests of the outside employment or activity.

When procurement is supported by Federal Child Nutrition funds, employees will not participate in the selection, award, or administration of a contract if there is a real or apparent conflict of interest in the contract. Contract, for purposes of this paragraph, includes a contract where the employee, employee’s immediate family, partner, or a non-school district employer of these individuals is a party to the contract.

It is the responsibility of each employee to be aware of and take the necessary action to eliminate a potential conflict of interest should it arise.

 

 

Legal Reference:  7 C.F.R. 3016.36(3)
                                       Iowa Code §§ 20.7; 68B; 279.8; 301.28 (2013).

Cross Reference:  203      Board of Directors' Conflict of Interest
    
                                   402.4   Gifts to Employees
    
                                   402.6   Employee Outside Employment
    
                                   404     Employee Conduct and Appearance

Approved:  Feb. 10, 1997, March 19, 2012, December 19, 2017      
Reviewed:  Aug. 24, 2005, Sep. 14. 2009, March 19, 2012, November 7, 2017   
Revised:   Oct. 12, 2009, March 19, 2012 

 

dawn.gibson.cm… Mon, 11/29/2021 - 13:03

401.3 - Nepotism

401.3 - Nepotism

More than one family member may be an employee of the school district.  It will be within the discretion of the superintendent to allow one family member employed by the school district to supervise another family member employed by the school district [subject to the approval of the board].

The employment by the board of more than one individual in a family will be on the basis of their qualifications, credentials and records.

 

 

Legal Reference:  Iowa Code §§ 20; 71; 277.27; 279.8 (2013).

Cross Reference:  405.2 Licensed Employee Qualifications, Recruitment and Selection
    
                                  411.2 Classified Employee Qualifications, Recruitment and Selection

Approved:  Feb. 10, 1997, March 19, 2012, December 19, 2017           
Reviewed:  Aug. 24, 2005, March 19, 2012, November 7, 2017.
Revised:                           

 

dawn.gibson.cm… Mon, 11/29/2021 - 13:11

401.4 - Employee Complaints

401.4 - Employee Complaints

Complaints of employees against fellow employees should be discussed directly between employees.  If necessary, complaints will be brought directly to the immediate supervisor, principal or superintendent and will be made in a constructive and professional manner.  Complaints will never be made in the presence of other employees, students or outside persons.

 

 

Legal Reference:  Iowa Code §§ 20.7, .9; 279.8

Cross Reference:  307 Communication Channels

Approved:  Feb. 10, 1997, March 19, 2012, December 19, 2017           
Reviewed:  Aug. 24, 2005, March 19, 2012, November 7, 2017
Revised:                           

 

dawn.gibson.cm… Mon, 11/29/2021 - 13:12

401.5 - Employee Records

401.5 - Employee Records

The school district will maintain personnel records on employees.  The records are important for the daily administration of the educational program, for implementing board policy, for budget and financial planning, and for meeting state and federal requirements.

The records will include, but not be limited to, records necessary for the daily administration of the school district, salary records, evaluations, and application for employment, references, and other items needed to carry out board policy.  Employee personnel files are school district records and are considered confidential records and therefore are not generally open to public inspection or accessibility.  Only in certain limited instances, when the employee has given a signed consent, will employee personnel records be accessible to individuals other than the employee or authorized school officials.

Employees may have access to their personnel files, with the exception of letters of reference, and copy items from their personnel files at a time mutually agreed upon between the superintendent and the employee.  The school district may charge a reasonable fee for each copy made except the total amount charged for all copies cannot exceed $5.00.  However, employees will not be allowed access to the employment references written on behalf of the employee.  Board members will generally only have access to an employee's file when it is necessary because of an employee related matter before the board.

It will be the responsibility of the superintendent to keep employees' personnel files current.  The board secretary will be the custodian of employee records.

It will be the responsibility of the superintendent to develop administrative regulations for the implementation of this policy.

 

 

Legal Reference:  Iowa Code chs. 20; 21; 22; 91B (2013).

Cross Reference:  402.1  Release of Credit Information
    
                                   403     Employees' Health and Well-Being
                                       708     Care, Maintenance and Disposal of School District Records

Approved:  Feb. 11, 1985, March 19, 2012 , December 19, 2017          
Reviewed:  Aug. 24, 2005, March 19, 2012, November 07, 2017.    
Revised:  Feb. 10, 1997

 

dawn.gibson.cm… Mon, 11/29/2021 - 13:12

401.6 - Transporting of Students by Employees

401.6 - Transporting of Students by Employees

Generally, transportation of students will be in a motor vehicle owned by the school district and driven by an employee.  In some cases, it may be more economical or efficient for the school district to allow an employee of the school district to transport the students in the employee's motor vehicle.

Employees who transport students for school purposes must have the permission of the administration.

This policy statement applies to transportation of students for school purposes in addition to the regular bus route transporting students to and from their designated attendance center.

 

 

Legal Reference:  Iowa Code chs. 285; 321 (1995).

Cross Reference:  401.7  Employee Travel Compensation
          
                            711     Transportation
          
                            904.1  Transporting of Students in Private Vehicles

Approved:  Feb. 10, 1997, March 19, 2012, December 19, 2017          
Reviewed:  Aug. 24, 2005, March 19, 2012, November 07, 2017
Revised:                           

 

dawn.gibson.cm… Mon, 11/29/2021 - 13:14

401.7 - Employee Travel Compensation

401.7 - Employee Travel Compensation

Employees traveling on behalf of the school district and performing approved school district business will be reimbursed for their actual and necessary expenses up to the limits set by the Board in the teacher handbook.  Actual and necessary travel expenses will include, but not be limited to, transportation and/or mileage costs, lodging expenses, meal expenses and actual registration costs up to the district’s approved limits.

 

Travel outside the School District

Travel outside of the school district must be pre-approved.  Pre-approval will include an evaluation of the necessity of the travel, the reason for the travel and an estimate of the cost of the travel to qualify as approved school district business.  Travel outside the school district by employees, other than the superintendent, will be approved by the superintendent.

Prior to reimbursement of actual and necessary expenses, the employee must provide the school district with an itemized list of expenses incurred in the performance of their duties and a receipt for all expenses incurred, other than a credit card receipt, indicating the date, purpose and nature of the expense for each claim item.  In exceptional circumstances, the superintendent may allow a claim without proper receipt.  Written documentation explaining the exceptional circumstances will be maintained as part of the school district's record of the claim.

Failure to have a detailed receipt will make the expense a personal expense.  Personal expenses, including mileage, in excess of that required for the trip will be reimbursed by the employee to the school district no later than 10 working days following the date of the expense

Pre-approved expenses for transportation within three hundred miles of the school district administrative office will be by automobile.  If a school district vehicle is not available, the employee will be reimbursed at the district rate per mile.

 

Travel within the School District

Employees required to travel in their personal vehicle between school district buildings to carry out the duties of their position will be reimbursed at the district rate per mile.  It will be the responsibility of the superintendent to approve travel within the school district by employees.  It will be the responsibility of the board to review the travel within the school district by the superintendent through the board's audit and approval process.

Employees who are allowed an in-school district travel allowance will have the amount of the allowance actually received during each calendar year included on the employee's W-2 form as taxable income according to the Internal Revenue Code.

The superintendent will be responsible for developing administrative regulations regarding actual and necessary expenses, in-school district travel allowances and assignment of school district vehicles.  The administrative regulations will include the appropriate forms to be filed for reimbursement to the employee by the school district and the procedures for obtaining approval for travel outside of and within the school district.

 

At Request of School District

In unique situations where the district desires to send select personnel to a specific event, the superintendent may preapprove payment or reimbursement of registration, overnight, travel and/or meals at cost.

 

 

Legal Reference:  Iowa Constitution, Art. III, § 31.
    
                                  Iowa Code §§ 70A.9-.11 (2013).
    
                                  1980 Op. Att'y Gen. 512.

Cross Reference:  216.3    Board of Directors' Member Compensation and Expenses
    
                                  401.6    Transporting of Students by Employees
    
                                  401.10  Credit Cards
    
                                  904.1    Transporting Students in Private Vehicles

Approved:  Feb. 10, 1997, March 19, 2012, December 19, 2017, July 20, 2018, August 20, 2018             
Reviewed: Aug. 24, 2005, Nov. 9, 2009, Oct. 11, 2010, March 19, 2012, November 7, 2017, July 20, 2018    
Revised:  Dec. 14, 2009, Nov. 8, 2010, March 19, 2012

 

dawn.gibson.cm… Mon, 11/29/2021 - 13:15

401.7E1 - Employee Travel Compensation

401.7E1 - Employee Travel Compensation

Below are the maximum allowable:

 

 

 

 

 

Item

2018-
2019

2019-
2020

2020-
2021

2021-
2022

2022-
2023

Mileage
(if school car not available)

$0.45

$0.46

$0.47

$0.48

$0.49

Meals

$30.00

$30.00

$30.00

$30.00

$30.00

Hotel

$60.00

$60.00

$60.00

$60.00

$60.00

Registration

$115.00

$115.00

$115.00

$115.00

$115.00

Transportation
(flight, bus, other)

$300.00

$300.00

$300.00

$300.00

$300.00

Meal Tips

Limit of 15%

 

 

 

 

 

 

dawn.gibson.cm… Mon, 11/29/2021 - 13:17

401.8 - Recognition for Service of Employees

401.8 - Recognition for Service of Employees

The board recognizes and appreciates the service of its employees.  Employees who retire or resign may be honored by the board, administration and staff in an appropriate manner.

If the form of honor thought appropriate by the administration and employees involves unusual expense to the school district, the superintendent will seek prior approval from the board.

 

 

Legal Reference:  Iowa Const. Art. III, § 31.
    
                                  Iowa Code § 279.8 (2013).
    
                                  1980 Op. Att'y Gen. 102.

Cross Reference:  407 Licensed Employee Termination of Employment
    
                                  413 Classified Employee Termination of Employment

Approved:  Feb. 10, 1997, March 19, 2012, December 19, 2017           
Reviewed:  Aug. 24, 2005, March 19, 2012, November 07, 2017    
Revised:                               

 

dawn.gibson.cm… Mon, 11/29/2021 - 13:19

401.9 - Employee Political Activity

401.9 - Employee Political Activity

Employees will not engage in political activity upon property under the jurisdiction of the board.  Activities including, but not limited to, posting of political circulars or petitions, the distribution of political circulars or petitions, the collection of or solicitation for campaign funds, solicitation for campaign workers, and the use of students for writing or addressing political materials, or the distribution of such materials to or by students are specifically prohibited.

Violation of this policy may be grounds for disciplinary action.

 

 

Legal Reference:  Iowa Code §§ 55; 279.8 (2013).

Cross Reference:  409.5 Licensed Employee Political Leave
    
                                  414.5 Classified Employee Political Leave

Approved:  Feb. 10, 1997, March 19, 2012, December 19, 2017           
Reviewed:  Aug. 24, 2005, March 19, 2012, November 07, 2017.    
Revised:                               

 

dawn.gibson.cm… Mon, 11/29/2021 - 13:21

401.10 - Credit Cards

401.10 - Credit Cards

Employees may use school district gasoline credit cards for the actual gasoline expenses incurred while traveling in a school vehicle on school business. Actual and necessary expenses incurred in the performance of work-related duties include, but are not limited to, fuel for school district transportation vehicles used for transporting students to and from school and for school-sponsored events, payment of claims related to professional development of the board and employees, and other expenses required by employees and the board in the performance of their duties.

Employees and officers using a school district gasoline credit card must submit a detailed receipt in addition to a credit card receipt indicating the date, purpose and nature of the expense for each claim item.  Failure to provide a proper receipt will make the employee responsible for expenses incurred.  Those expenses will be reimbursed to the school district no later than ten working days following use of the school district's credit card.  In exceptional circumstances, the superintendent or board may allow a claim without proper receipt.  Written documentation explaining the exceptional circumstances will be maintained as part of the school district's record of the claim.

The school district may maintain a school district credit card for actual and necessary expenses incurred by employees and officers in the performance of their duties.  The superintendent may maintain a school district credit card for actual and necessary expenses incurred in the performance of the superintendent’s duties.  The transportation director may maintain a school district credit card for fueling school district transportation vehicles in accordance with board policy.

It will be the responsibility of the superintendent to determine whether the school district credit card use is for appropriate school business.  It will be the responsibility of the board to determine through the audit and approval process of the board whether the school district credit card use by the superintendent and the board is for appropriate school business.

The superintendent is responsible for developing administrative regulations regarding actual and necessary expenses and use of a school district credit card.  The administrative regulations will include the appropriate forms to be filed for obtaining a credit card.

 

 

Legal Reference:  Iowa Constitution, Art. III, § 31.
    
                                  Iowa Code §§ 279.8, .29, .30 (2013).
    
                                  281 I.A.C. 12.3(1).

Cross Reference:  216.3 Board of Directors' Member Compensation and Expenses
    
                                  401.7 Employee Travel Compensation

Approved:  Feb. 10, 1997, March 19, 2012, December 19, 2017           
Reviewed:  Aug. 24, 2005, Apr. 13, 2009, March 19, 2012, November 7, 2017.    
Revised:  May 11, 2009

 

dawn.gibson.cm… Mon, 11/29/2021 - 13:22

401.11 - Employee Orientation

401.11 - Employee Orientation

Employees must know their role and duties.  New employees may be required to participate in an orientation program for new employees.  The employee's immediate supervisor should provide the new employee with a review of the employee's responsibilities and duties.  Payroll procedures and employee benefit programs and accompanying forms will be explained to the employee by the business manager.  Regular employees ineligible for the school district's group health plan will be given information regarding where they can obtain health care or health care insurance.

 

 

Legal Reference:  Iowa Code §§ 20; 279.8 (2013).
    
                                       191 I.A.C. 74.

Cross Reference:  404  Employee Conduct and Appearance
    
                                  406  Licensed Employee Compensation and Benefits
    
                                  412  Classified Employee Compensation and Benefits

Approved:  Feb. 10, 1997, Sep 15, 2014, December 19, 2017           
Reviewed:  Aug. 24, 2005, Aug 18, 2014, November 07, 2017    
Revised:    Aug 18, 2014                   

 

dawn.gibson.cm… Mon, 11/29/2021 - 13:23

401.13 - Staff Technology Use/ Social Networking

401.13 - Staff Technology Use/ Social Networking

Computers are a powerful and valuable education and research tool and, as such, are an important part of the instructional program.  In addition, the school district depends upon computers as an integral part of administering and managing the schools’ resources, including the compilation of data and recordkeeping for personnel, students, finances, supplies and materials.  This policy outlines the board’s expectations in regard to these different aspects of the school district’s computer resources.  Employees must conduct themselves in a manner that does not disrupt from or disrupt the educational process and failure to do so will result in discipline, up to and including, discharge.

 

General Provisions

The Director of Technology will oversee the use of school district computer resources. The TLC Specialist and Curriculum Director in conjunction with the Director of Technology will prepare in-service programs for the training and development of school district staff in computer skills, appropriate use of computers and for the incorporation of computer use in subject areas.

The superintendent, working with appropriate staff, will establish regulations governing the use and security of the school district’s computer resources. The school district will make every reasonable effort to maintain the security of the system.  All users of the school district’s computer resources, including students, staff and volunteers, will comply with this policy and regulation, as well as others impacting the use of school equipment and facilities.  Failure to comply may result in disciplinary action, up to and including discharge, as well as suspension and/or revocation of computer access privileges.        

Usage of the school district’s computer resources is a privilege, not a right, and that use entails responsibility.  All information on the school district’s computer system may be considered a public record.  Whether there is an exception to keep some narrow, specific content within the information confidential is determined on a case by case basis. Therefore, users of the school district’s computer network must not expect, nor does the school district guarantee, privacy for e-mail or use of the school district’s computer network including web sites visited.  The school district reserves the right to access and view any material stored on school district equipment or any material used in conjunction with the school district’s computer network.

The superintendent, working with the appropriate staff, will establish procedures governing management of computer records in order to exercise appropriate control over computer records, including financial, personnel and student information.  The procedures will address: 

  • passwords,
  • system administration,
  • separation of duties,
  • remote access,
  • data back-up (including archiving of e-mail),
  • record retention, and
  • disaster recovery plans.

Social Networking or Other External Web Sites

For purposes of this policy any web site, other than the school district web site or school-school district sanctioned web sites, are considered external web sites.  Employees should not post confidential or proprietary information, including photographic images, about the school district, its employees, students, agents or others on any external web site without consent of the superintendent.  The employee will adhere to all applicable privacy and confidentiality policies adopted by the school district when on external web sites.  Employees will not use the school district logos, images, iconography, etc. on external web sites.  Employees will not use school district time or property on external sites that are not in direct-relation to the employee’s job.  Employees, students and volunteers need to realize that the Internet is not a closed system and anything posted on an external site may be viewed by others, all over the world.  Employees, students and volunteers who don’t want school administrators to know their personal information, should refrain from exposing it on the Internet.  Employees should not connect with students via external web sites without consent of the superintendent.  Employees should be aware of the risks involved in texting individual students directly. It is recommended that employees should text a group of students or include another staff member or the parent in receipt of the text. Employees who would like to start a social media site for school district sanctioned activities should contact the superintendent.

It is the responsibility of the superintendent to develop administrative regulations implementing this policy.

 

 

Legal Reference:  Iowa Code § 279.8 (2013).
    
                                    282 I.A.C. 13.35, .26

Cross Reference:  104         Anti-Bullying/Harassment
                                        306         Administrator Code of Ethics
                                        401.11    Employee Orientation
                                        407         Licensed Employee Termination of Employment
    
                                    413         Classified Employee Termination of Employment
    
                                    605         Instructional Materials

Approved:  December 19, 2017         
Reviewed:  July 11, 2011, November 07, 2017                                                             
Revised:     September 18, 2017 

 

dawn.gibson.cm… Mon, 11/29/2021 - 13:24

401.13R1 - Staff and Student Technology Use Regulation

401.13R1 - Staff and Student Technology Use Regulation

In making decisions regarding access to the school district computers, computer network, the Internet, and other information resources, the Fairfield Community School District considers the educational mission, goals, and objectives of the district.  Electronic and print information research skills are now fundamental to the preparation of citizens and future employees.  Access to the school district computers(including 1:1 student devices), computer network, the Internet, and other information resources allows student access to thousands of materials, libraries, databases, bulletin boards, and other resources while exchanging creative ideas and images with people around the world.  The Fairfield Community School District expects that faculty will blend thoughtful use of the school district computers, computer network, the Internet, and other information resources throughout the curriculum and will provide guidance and instruction to students in their use.

All FCSD students will receive a Google Apps account that includes access to an email account. This account should primarily be used for educational purpose.  As with all interactions on the Internet, students are expected to use these tools in a safe, legal, and ethical manner.  FCSD also provides student network wireless access in all buildings.FCSD will not be responsible for any damage or loss of any student or staff personal device.  These are the expectations for this use of the FCSD network with personal devices. 1. All students will use the district-provided method for wireless access the network. 2. Students or staff who brings their own devices onto FCSD property and use a non-FCSD network to access the Internet is still bound by this policy.  Below is a list on unacceptable and unsafe behaviors for both students and staff.  This list is not intended to be inclusive of all misuses.

  1. Users will not access, review, upload, download, store, print, post, or distribute pornographic, obscene, sexually explicit material or that use language or images that are inappropriate to the education setting or disruptive to the educational process and will not post information or materials that could cause damage or danger or disruption while on school property.
  2. Users will not access, review, upload, download, store, print, post, or distribute materials that use language or images that advocate violence or discrimination toward other people (hate literature) or that may constitute harassment or discrimination while on school property without an approved educational/instructional purpose.
  3. Users will not knowingly or recklessly post false or defamatory information about a person or organization, to harass another person, or to engage in personal attacks, including prejudicial or discriminatory attacks while on school property.
  4. Users will not engage in any illegal act or violate any local, state, or federal statute or law while on school property.
  5. Users will not vandalize, damage, or disable the property of another person or organization, will not make deliberate attempts to degrade or disrupt equipment, software, or system performance by spreading computer viruses, or by any other means will not tamper with, modify, or change the FCSD Network software, hardware, or wiring.
  6. Users will not take any action to violate the FCSD Network’s security, and will not disrupt the use of the system by other users nor gain unauthorized access to information resources or to access another person’s materials, information, or files without the implied or direct consent of that person.
  7. Users will not post private information about another person or to post personal contact information about themselves or other persons including, but not limited to, addresses, telephone numbers, school addresses, work addresses, identification numbers, account numbers, access codes, or passwords and will not repost a message that was sent to the user privately without permission of the person who sent the message.
  8. Users will not violate copyright laws, usage licensing agreements, or another person’s property without the author’s prior approval or proper citation, including, but not limited to the downloading or exchanging of pirated software or copying software to or from any school computer, and will not plagiarize works they find on the Internet or other information resources.
  9. Users will not use the FCSD Network for the conduct of a business, for unauthorized commercial purposes, or for financial gain unrelated to the mission of the school district.  Users will not use the FCSD Network to offer or provide goods, services, or product advertisement.  Users will not use the FCSD Network to purchase goods or services for personal use without authorization from the appropriate school district official.

FCSD will provide ongoing instruction for students on current safety, legal and ethical use best practices as part of our 21st Century Skills curriculum.  Being a public organization, FCSD subject to open records laws for both student and staff email and network accounts.  These accounts carry no expectation of privacy.  Parents have the right at any time to investigate or review the contents of their child’s accounts.  Parents also have the right to request the termination of their child’s individual account at any time.  The school district will cooperate fully with local, state and federal authorities in any investigation concerning or related to any illegal activities and activities not in compliance with school district policies.

The FCSD defines intellectual property rights as a general term that covers copyright, registered designs and trademarks.  Information users need to understand that authors resort to legal action when their works are infringed.

Plagiarism is the presentation of the thoughts, ideas, or words of another without crediting the sources. It is a form of academic dishonesty and may be grounds for academic sanctions.  Students are expected to cite all sources they use.  Copyright is a legal issue governed by federal law. Copyright extends to all forms of intellectual property, including print resources, web pages, database articles, images, and other works found on the Internet.  The ability to legally use another’s work depends on the following justifications: (1) the work is in the public domain; (2) the researcher has received permission from the copyright holder; or (3) the researcher asserts a right for fair use.  Under the fair use doctrine of the U.S. copyright statute, it is permissible to use limited portions of a work including quotes, for purposes such as commentary, criticism, news reporting, and scholarly reports.  Fair use is determined on a case-by-case basis.  Individuals are expected to make educated, good faith decisions in determining whether fair use applies in a given situation.

Students and staff who choose to violate one or more of the unacceptable uses will be subject to disciplinary action. For students these may include structured/non-independent use of technology while on school property, suspension, reparation for damages, expulsion, and/or referral to local law enforcement.

The Fairfield Community School District has a filtering system in place that will monitor and log Internet activity as well as block unacceptable websites as reviewed by faculty, administration. Although the Fairfield Community School District is taking reasonable measures to ensure students do not acquire objectionable material, the Fairfield Community School District cannot guarantee that a student will not be able to access objectionable material on the Internet. If a student accidentally accesses unacceptable materials or an unacceptable Internet site, the student should immediately report the accidental access to an appropriate school district official.

The proper use of the Internet and other information resources, and the educational value to be gained from proper use of the Internet and other information resources, is the combined responsibility of students, parents, and employees of the school district.

The Internet Use Agreement form must be read and signed by all users (student, employee, or other non-FCSD employed users) as well as by the parent or guardian of student users. The form must then be filed at the school office.

 

 

Legal Reference:  Iowa Code. § 279.8 (2003)

Approved:  July 11, 2011
Reviewed:  July 11, 2011    
Revised:    September 18, 2017 

 

dawn.gibson.cm… Mon, 11/29/2021 - 13:29

401.13R2 - Staff Use of Internet Social Networking and Other Forms of Electronic Communications

401.13R2 - Staff Use of Internet Social Networking and Other Forms of Electronic Communications

 

Statement of Philosophy

The District encourages all staff to use 21st Century tools to teach, communicate and bring the real world into the classroom.  It supports uses of current technology in ways that promote, support, and maintain strong, appropriate relationships between staff and students.

School-provided accounts (like Google e-mail accounts, Google docs, etc) that can be monitored are always the safest means for both student and staff to communicate electronically.  To protect all parties, it is important that staff, students and parents understand the boundaries of professional decorum in the use of ever-changing on-line, digital learning possibilities.  Staff must conduct themselves in ways that do not distract from or disrupt the educational process and in ways that protect students and staff members alike from inappropriate use or the appearance of inappropriate use.

The District’s expectation is that staff will use maturity, common sense and sound professional judgment in all interactions with students, parents, and community members.

 

Practical Guidelines

1. Staff members should not list or follow current students (except their own children) as “friends”, “followers”, or equivalent labels on personal networking accounts.

2. Staff members are encouraged to use district-provided accounts to create a classroom presence or site for legitimate educational purposes (separate from personal sites).

3. When a non-school provided tool is used for legitimate educational purposes, the building administrator and district technology director shall upon request be granted full administrative access to the site.

4. All staff electronic contacts (including phone) with students (except their own children) should be through district accounts whenever possible.

5. In the unusual circumstance when use of a personal account is necessary for interaction between staff and students, interactions should be strictly limited in scope, frequency and duration.  Prolonged interactions on personal accounts are discouraged and should be terminated or transitioned to school accounts as quickly as possible.  “Let’s continue this conversation on the school account” is an appropriate transition.

6. All electronic contacts (including phone) by teachers/coaches/sponsors/directors with the class/team or individual class/team members shall be for legitimate education purposes only;

7. Postings that contain content that disrupts the educational program and damages the relationships of trust necessary between students, staff and parents are strictly prohibited. 

Examples include but are not limited to content that:

            a. is sexually provocative or flirtatious in nature;

            b. exhibits or advocates for use of drugs and alcohol;

            c. would be defined by a reasonable person as obscene, racist, or sexist;

            d. promotes illicit, illegal or unethical activity;

            e. violates the district’s affirmative action and/or bullying and harassment policies.

8. Postings that communicate confidential information to persons not authorized to receive that information are prohibited.

9. Postings that cause significant interference with the education program via any electronic means are prohibited.

 

Legitimate Educational Purposes

As used in this policy, legitimate educational purposes include:

            1. Answering academic inquiries regarding homework, other classroom work or assignments;

            2. Scheduling appointments for school-related conferences and/or extra help;

            3. Clarifying classroom expectations and/or assignments;

            4. Notifications related to classroom, club or sports schedules, safety, attendance, events, trips, assignments and/or deadlines.

 

Consequences

Failure to exercise good judgment in on-line conduct can lead to discipline up to and including suspension and dismissal from employment.

When inappropriate use of electronic contacts is suspected, administrators will immediately investigate.  Misconduct that rises to the level of criminal activity will be reported to law enforcement.  Misconduct that violates professional ethics will be reported to the Board of Educational Examiners.

 

Implementation

This policy will be contained in the staff handbook and posted on the District web-site.

 

dawn.gibson.cm… Mon, 11/29/2021 - 13:30

401.14 - Prohibition of Texting and Talking on Hand-held Cell Phones While Driving District Vehicle

401.14 - Prohibition of Texting and Talking on Hand-held Cell Phones While Driving District Vehicle

Fairfield Community School District prohibits the texting or talking on a hand-held phone while operating a district vehicle or while using a school district issued cell phone while operating a personal vehicle.  This includes, but is not limited to:  answering or making phone calls, engaging in phone conversations, reading or responding to e-mails and text messages.

Fairfield Community School District employees are required to: 

  • Turn cell phones off or put on silent, vibrate or connect to a hands free device before beginning the trip.
  • Pull over to a safe place if a call must be made or received while on the road, unless already connected to a hands free device.
  • Consider modifying voice mail greeting to indicate that you are unavailable to answer calls or return messages while driving.
  • Inform clients, associates and business partners of this policy as an explanation of why calls may not be returned immediately.

Vehicles that are operated that require a Commercial Driver’s License (CDL) must follow the restrictions for cell phone usage as required for the CDL.  Applicable state laws which may be more restrictive must be followed where the vehicle is being operated for all operators.

Violations of this policy may lead to disciplinary action and denial of use of school vehicles and district cell phones.

 

 

Approved:  July 11, 2011, February 18, 2019, May 18, 2020   
Reviewed:  July 11, 2011, January 21, 2018, March 16, 2020
Revised:  May 18, 2020

 

dawn.gibson.cm… Mon, 11/29/2021 - 13:32

401.14E - Texting and Talking on Hand-held Cell Phones While Driving Policy Excluding CDL Drivers

401.14E - Texting and Talking on Hand-held Cell Phones While Driving Policy Excluding CDL Drivers

Of increasing concern to the Fairfield Community School District are the dangers of distracted drivingRecent deadly crashes involving drivers distracted by talking and texting while driving highlight a growing danger on our roads.  Numerous studies have demonstrated how the use of hand-held cell phones while driving pose a significant safety risk to motorists, their passengers and others on the road.  In fact, according the National Highway Traffic Safety Administration (NHTSA), in 2008, nearly 6,000 people died in crashes involving a distracted driver.

Therefore, the Fairfield Community School District will no longer tolerate texting or talking on a hand-held phone while operating a district vehicle or while using a school district issued cell phone while operating a personal vehicle. This includes, but is not limited to, answering or making phone calls, engaging in phone conversations, reading or responding to e-mails and text messages.

Fairfield Community School District employees are required to:

  • Turn cell phones off or put on silent, vibrate or connect to a hands free device before beginning the trip.
  • Pull over to a safe place if a call must be made or received while on the road, unless already connected to a hands free device.
  • Consider modifying voice mail greeting to indicate that you are unavailable to answer calls or return messages while driving.
  • Inform clients, associates and business partners of this policy as an explanation of why calls may not be returned immediately.

Fairfield Community School District is concerned about the safety of its employees.  It is our goal that if we lead by example, the practice of no texting or talking on hand-held cell phones while behind the wheel will spread throughout the community.  Violations of this policy may lead to disciplinary action and denial of use of school vehicles and district cell phones.

Below is a Statement of Acknowledgement that says you have read and fully understand this policy. Please sign it and return it to your supervisor.  If you have any questions regarding this policy please contact your supervisor.

I am aware of the policy prohibiting texting and talking on hand-held cell phones while operating a district vehicle.  I fully understand the terms of this policy and agree to abide by them.

 

___________________________________          __________________________________
Employee Signature                                                   Date

 

_____________________________________________________________________
Employee Name (printed)

 

dawn.gibson.cm… Mon, 11/29/2021 - 13:33

401.15 - 2020-2021 Voluntary Early Retirement Plan

401.15 - 2020-2021 Voluntary Early Retirement Plan

The Fairfield Community School District Board of Directors is offering a one-time, supplemental benefit of early retirement for those employees who meet the eligibility and application requirements. The program provides an incentive that will be of mutual benefit to the District and employees. The benefit to the District will be cost savings in the general fund and the benefit to employees will be cash incentive and single health insurance until age 65 to aid in the transition to retirement. Participation in this program is voluntary. This plan is for the year ending June 30, 2021 only. There is no guarantee that this program, or any early retirement program, will be offered in future years.

 

Eligibility Requirements:

The Board of Directors hereby extends an offer of early retirement benefits to all full-time, regular employees who meet all of the following requirements: at least 55 years of age on or before June 30, 2021 and currently have at least 10 years of continuous service with the district.

 

Application Requirements:

An employee who wants to receive early retirement benefits must complete and turn in an application to the A.C.T. office (See Policy 401.15R1). Approval by the Board of Directors of the employee’s application for early retirement benefits constitutes voluntary resignation from all employment with the district provided they finish out their contract and are not scheduled for layoff or have received an official notice of layoff/termination.  

 

 

Resignation Date for Year-Round Employees:

In an effort to ease the transition of certain key support personnel, a 12-month employee may request and qualify for this early retirement incentive with the understanding that his/her retirement date may be delayed to a date mutually beneficial to the District and the retiring employee. However, the final date of separation will be within a six-week period following June 30, 2021. 

 

Benefit Computation:

An employee who participates in this early retirement program will receive 20%-40% of his/her base salary in the final year of employment (See chart below).  The benefit will be calculated on regular contract, base salary only; not including any stipend, TLC contract, extra-curricular, co-curricular, or over-time pay. For purposes of calculating the years of service, employment must be continuous, regular, and based on 30 hours or more per week.  Absence due to reductions in force or due to approved leaves will not constitute a voluntary interruption in service, unless the absence or leave exceeds six (6) consecutive months in length. However, the period of time during which an employee is absent due to a reduction in force or due to an approved leave will not be counted for purposes of determining the minimum length of service required to establish eligibility.

 

Continuous years

 % of

  of internal service

 base salary

 10-14

20%

 15-19

25%

 20-24

30%

 25-29

35%

 >30

40%

 

Benefit Payment

Payment to employees of early retirement funds shall be made in two payments over a two-year period with the first payment made approximately on September 25th of the year of retirement. The second payment will be made one year later. All cash distributions will be made into the District’s Special Pay Deferral Plan. (If a 12-month employee delays the date of retirement, his/her first benefit payment will be made approximately 60 days after his/her final date of employment.)

In the event of the death of the employee prior to the full payment of the designated amount, payment shall be made to a designated beneficiary, or in the event no beneficiary is named, payment will be made to the estate of the employee. In the event of the death of the employee, the entire sum remaining to be paid to the beneficiary or estate will be paid in one lump sum.

 

Program Timeline

Completed applications for early retirement must be received in the office of the Superintendent by Noon, February 01, 2021. Applications will be accepted via email to:  christine.willmon@fairfieldsfuture.org or in person.  Any eligible employee who has not committed their participation in the program by Noon on February 01, 2021, will forever lose their opportunity to participate in this Early Retirement Program. 

 

Benefit Payments Limit

The Board will limit the total early retirement benefits paid under this program to a total of $2,000,000. If it will be necessary to limit the number of approved applications, the Board will use a process based on seniority in Fairfield and the most senior employee(s) will be granted early retirement benefits.

 

Status of Participants

An employee who elects to participate in this early retirement program and whose application for early retirement is approved will become a retired employee and will be entitled to all rights and privileges of an employee under applicable law and policies of the Fairfield Community School District. An employee who elects to participate in this early retirement program and whose application for early retirement is approved shall not be eligible to be rehired in any capacity with the Fairfield Community School District nor shall the District be required to accept an application for employment from an employee who elects to participate in this early retirement program; however, that, at the sole discretion of the Board of Directors, the District may employ an employee who elects to participate in this early retirement program as a temporary substitute employee.

 

Additional Provisions and Conditions:

All eligible employees who elect early retirement will receive single health insurance.  The health insurance coverage available under this plan shall be the group coverage offered to the staff and may be altered from time to time.  All employees who elect early retirement may purchase health insurance by paying the entire premium for family coverage until the maximum age permitted by the policy. In accordance with Iowa Code 509A.13, employees are eligible to participate until age 65. Employees paying for family insurance must arrange a payment schedule with the District’s Business Office one month prior to the start of coverage. Failure to meet the arranged payment schedule shall result in the loss of family insurance coverage.

 

Right to Waive Requirements:

The Board reserves the right to waive any requirement or condition of this policy at its discretion and at any time. Any decision by the Board to waive a requirement or condition which is a part of this policy shall not establish any precedent with regard to any other request for a waiver.

 

Termination:

This plan shall terminate on June 30, 2021. Notwithstanding the termination of this plan, employees who are granted benefits pursuant to this plan will continue to receive such benefits as set forth herein.

 

No Vesting/Right to Amend or Revoke:

The adoption of this Early Retirement Plan shall not vest any right in any employee whether or not the employee is currently eligible for early retirement.  The Board shall have the complete discretion to amend or repeal this plan or any provisions thereof at any time with or without notice and shall not be obligated to provide any benefits to any employee after the date of such amendment or repeal, except to those employees whose early retirement pursuant to this plan has commenced prior to amendment or repeal.

 

Conflict/Severability:

Should any portion of this policy be in conflict with state or federal rules, regulations or laws, that portion of the policy shall be invalid, and all other portions remain in full force and effect. Any decision by the Board to waive a requirement or condition which is part of this policy shall not establish any precedent with regard to future requests for a waiver.

Plan Interpretation:

The Board is the final arbiter of all questions of interpretation under this plan, including but not limited to, questions of eligibility or benefit calculations.

An employee contemplating participation in this early retirement program should seek the advice of a financial planner and/or an attorney.

 

 

Approved: Jan 19, 2015, Dec 21, 2015, Dec. 14, 2020
Reviewed: Dec 22, 2014, Oct 26, 2015, Dec 09, 2020
Revised:  Dec 22, 2014, Dec. 09, 2020
 
 
dawn.gibson.cm… Mon, 11/29/2021 - 13:35

401.15R1 - 2020-2021 Application for Participation in the Voluntary Early Retirement Plan

401.15R1 - 2020-2021 Application for Participation in the Voluntary Early Retirement Plan

Employee Name:                                                             Phone #                                                                               

Address                                                                                                                                                          

 

I am submitting my formal application for participation in the Voluntary Early Retirement Incentive Plan. This action is taken in accordance with all requirements of the Fairfield Voluntary Early Retirement Plan.

My request for approval of release from my continuing contract(s) and/or letter of employment with the district is made with this application. It is my understanding that my application and request for approval of resignation will be acted upon simultaneously by the Board of Directors.

If my application is accepted, I hereby release and discharge the Fairfield Community School District, its representatives, agents, employees, officers, and directors from any and all liability whatsoever including all claims, demands and causes of action which the employee may have or may ever claim to have by reason of my employment with the District, or the termination thereof and specifically waive any rights or claims which I have or may ever claim to have arising under the Age Discrimination in Employment Act of 1967 (29 U.S.C. 621 et. seq.), excluding claims which may arise after the date of the signing of this Agreement.

I have been advised that I have the right to consult with an attorney prior to signing this Agreement. I acknowledge that I was given at least forty-five days to consider this Agreement. Following the date of signing of the Agreement I shall have seven days to revoke the Agreement. This Agreement will not be effective until this seven day period has expired.

 

Employee Signature                                                                                                                                  Date                                                                                                              

 

 

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

This section is to be completed by the District.

Qualification

 

  1. Birth Date                                                                                                        Age                 (as of June 30)

 

  1. Dates of Service                                                                                              to  ___                 

 

  1. Number of years of service                                                                        

 

  1. Base Salary, year ending 06/30/21 $_____________________

 

  1. Benefit Calculation (Line D x 80%) $____________________

 

  1. First benefit payment of $ _______________________on this date _______________________

 

  1. Second benefit payment of $_______________________ on this date _____________________

 

 

 

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

 

 

 

 

Date                                                  

 

Board of Directors Action

 

Approved                                        Not Approved

 

 

                                                                                                                                                                                                                                                                                        

____________________________________   ______________________________________
Business Manager Signature                                                Employee Signature

 

____________________________________   ______________________________________
Superintendent Signature                                                      Board President Signature

 

 

Beneficiary Designation for

Employee Early Retirement

 

Pursuant to the provisions of the Voluntary Early Retirement Plan for the Fairfield Community School District, I hereby designate

 

 

_____________________________________________________________
 
Name – Please Print

 

 

of ___________________________________________________          _____________________________
                                    Street Address                                                                  City

 

_____________________________________________________ , as my beneficiary.
                                         State

 

 

_________________________________________________________________________________________________    '
   Employee Signature                                                                               Date

 

 

 

_________________________________________________________________________________________________    '
   Witness Signature                                                                                  Date                                                                                                    

 

 

Approved: Jan 19, 2014, Dec 22, 2015, Nov 21, 2016, Dec. 14, 2020
Reviewed: Dec 22, 2014, Oct 26, 2015, Nov. 7, 2016, Dec. 09, 2020
Revised:  Dec 22, 2014, Nov 7, 2016, Dec. 09, 2020

 

dawn.gibson.cm… Mon, 11/29/2021 - 13:40

402 - Outside Relations

402 - Outside Relations dawn.gibson.cm… Mon, 11/29/2021 - 14:20

402.1 - Release of Credit Information

402.1 - Release of Credit Information

The following information will be released to an entity with whom an employee has applied for credit or has obtained credit: title of position, income, and number of years employed.  This information will be released without prior written notice to the employee.  Confidential information about the employee will be released to an inquiring creditor with a written authorization from the employee.

It will be the responsibility of the board secretary or superintendent to respond to inquiries from creditors.

 

 

Legal Reference:  Iowa Code §§ 22.7; 279.8 (2013).

Cross Reference:  401.5 Employee Records

Approved:  Feb. 10, 1997, Jan. 15, 2018      
Reviewed:  Aug. 24, 2005, Nov. 1, 2012, Dec. 19, 2017    
Revised:    Nov. 1, 2012, Dec. 19, 2017    

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:20

402.2 - Child Abuse Reporting

402.2 - Child Abuse Reporting

In compliance with state law and to provide protection to victims of child abuse, the board believes incidents of alleged child abuse should be reported to the proper authorities. All licensed school employees, teachers, coaches, and para educators are mandatory reporters as provided by law and are to report alleged incidents of child abuse they become aware of within the scope of their professional duties. 

When a mandatory reporter suspects a student is the victim of child abuse, the mandatory reporter will make an oral report of the suspected child abuse to the Iowa Department of Human Services within 24 hours of becoming aware of the abusive incident and will make a written report to the Iowa Department of Human Services within 48 hours following the oral report. If the mandatory reporter believes the child is in immediate danger, the local law enforcement agency shall also be notified. 

Within six months of their initial employment, mandatory reporters will take a two-hour training course involving the identification and reporting of child abuse or submit evidence that they’ve taken the course within the previous five years.  The course will be re-taken at least every five years.

 

 

Legal Reference:  Iowa Code §§ 232.67-.77; 232A; 235A; 280.17 (2011).
    
                                  441 I.A.C. 9.2; 155; 175.
    
                                  1982 Op. Att'y Gen. 390, 417.
    
                                  1980 Op. Att'y Gen. 275.

Cross Reference:  402.3 Abuse of Students by School District Employees
                                      502.9 Interviews of Students by Outside Agencies
    
                                  507    Student Health and Well-Being

Approved:  Oct. 11, 1993, Dec. 17, 2012, Jan. 15, 2018     
Reviewed:  Aug. 24, 2005, Nov.1, 2012, Dec. 19, 2017   
Revised:     Nov. 9, 2012, Dec. 19, 2017   

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:21

402.3 - Abuse of Students by School District Employees

402.3 - Abuse of Students by School District Employees

Physical or sexual abuse of students, including inappropriate and intentional sexual behavior, by employees will not be tolerated.  The definition of employees for the purpose of this policy includes not only those who work for pay but also those who are volunteers of the school district under the direction and control of the school district.  Employees found in violation of this policy will be subject to disciplinary action up to and including discharge.

The school district will respond promptly to allegations of abuse of students by school district employees by investigating or arranging for the investigation of an allegation.  The processing of a complaint or allegation will be handled confidentially to the maximum extent possible.  Employees are required to assist in the investigation when requested to provide information and to maintain the confidentiality of the reporting and investigation process.

The school district has appointed a Level I investigator and alternate Level I investigator.  The school district has also arranged for a trained, experienced professional to serve as the Level II investigator.  The Level I investigator and alternate will be provided training in the conducting of an investigation at the expense of the school district.  The names of the investigators are listed in the student handbook published annually in the local newspaper and posted in all school facilities.

The superintendent is responsible for drafting administrative regulations to implement this policy.

 

 

Legal Reference:  Iowa Code §§ 232.67, .70, .73, .75; 235A; 272A; 280.17; 709; 728.12(1) (2013)
    
                                   281 I.A.C. 12.3(6), 102; 103.
    
                                   441 I.A.C. 155; 175.
    
                                   1980 Op. Att'y Gen. 275.

Cross Reference:  106      Bullying/Harassment
    
                                  402.2   Child Abuse Reporting
     
                                  503.5    Corporal Punishment

Approved:  Dec. 13, 2010, Dec. 17, 2012, Jan. 15, 2018     
Reviewed:  Nov. 1, 2012, Dec. 19, 2017    
Revised:     Nov. 1, 2012, Dec. 19, 2017     

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:22

402.4 - Gifts To Employees

402.4 - Gifts To Employees

Employees may receive a gift on behalf of the school district.  Employees will not, either directly or indirectly, solicit, accept or receive any gift, series of gifts or an honorarium unless the donor does not meet the definition of "restricted donor" stated below or the gift or honorarium does not meet the definition of gift or honorarium stated below.

A "restricted donor" is defined as a person or other entity which:

  •   Is seeking to be, or is a party to, any one or any combination of sales, purchases, leases or contracts to, from or with the school district;
  •   Will be directly and substantially affected financially by the performance or nonperformance of the employee's official duty in a way that is greater than the effect on the public generally or on a substantial class of persons to which the person belongs as a member of a profession, occupation, industry or region; or
  •   Is a lobbyist or a client of a lobbyist with respect to matters within the school district's jurisdiction.

A "gift" is the giving of anything of value in return for which something of equal or greater value is not given or received.  However, "gift" does not include any of the following:

  •   Contributions to a candidate or a candidate's committee;
  •   Information material relevant to an employee's official function, such as books, pamphlets, reports, documents, periodicals or other information that is recorded in a written, audio or visual format;
  •   Anything received from a person related within the fourth degree by kinship or marriage, unless the donor is acting as an agent or intermediary for another person not so related;
  •   An inheritance;
  •   Anything available or distributed to the general public free of charge without regard to the official status of the employee;
  •   Items received from a charitable, professional, educational or business organization to which the employee belongs as a dues paying member if the items are given to all members of the organization without regard to an individual member's status or positions held outside of the organization and if the dues paid are not inconsequential when compared to the items received;
  •   Actual expenses of an employee for food, beverages, travel and lodging for a meeting, which is given in return for participation in a panel or speaking engagement at the meeting when the expenses relate directly to the day or days on which the employee has participation or presentation responsibilities;
  •   Plaques or items of negligible resale value given as recognition for public service;
  •   Nonmonetary items with a value of less than three dollars that are received from any one donor during one calendar day;
  •   Items or services solicited or given to a state, national or regional organization in which the state of Iowa or a school district is a member for purposes of a business or educational conference, seminar or other meeting or solicited by or given for the same purposes to state, national or regional government organizations whose memberships and officers are primarily composed of state or local government officials or employees for purposes of a business or educational conference, seminar or other meeting;
  •   Items or services received by members or representatives of members as part of a regularly scheduled event that is part of a business or educational conference, seminar or other meeting that is sponsored and directed by any state, national or regional government organization in which the state of Iowa or a political subdivision of the state of Iowa is a member or received at such an event by members or representatives of members of state, national or regional government organizations whose memberships and officers are primarily composed of state or local government officials or employees;
  •   Funeral flowers or memorials to a church or nonprofit organization;
  •   Gifts which are given to an employee for the employee's wedding or twenty-fifth or fiftieth wedding anniversary;
  •   Payment of salary or expenses by the school district for the cost of attending a meeting of a subunit of an agency when the employee whose expenses are being paid serves on a board, commission, committee, council or other subunit of the agency and the employee is not entitled to receive compensation or reimbursement of expenses from the school district for attending the meeting; or
  •   Gifts other than food, beverages, travel and lodging received by an employee which are received from a person who is a citizen of a country other than the United States and is given during a ceremonial presentation or as a result of a custom of the other country and is of personal value only to the employee.
  • Actual registration costs for informational meetings or sessions, which assist a public official or public employee in the performance of the person's official functions.  The costs of food, drink, lodging and travel are not "registration costs" under this paragraph.  Meetings or sessions which a public official or public employee attends for personal or professional licensing purposes are not "informational meetings or sessions which assist a public official or public employee in the performance of the person's official functions" under this paragraph.

An "honorarium" is anything of value that is accepted by, or on behalf of, an employee as consideration for an appearance, speech or article.  An honorarium does not include any of the following:

  •   Actual expenses of an employee for registration, food, beverages, travel or lodging for a meeting, which is given in return for participation in a panel or speaking engagement at a meeting when the expenses relate directly to the day or days on which the employee has participation or presentation responsibilities;
  •   A nonmonetary gift or series of nonmonetary gifts donated within thirty days to a public body, an educational or charitable organization or the Iowa department of general services; or
  •   A payment made to an employee for services rendered as part of a private business, trade or profession in which the employee is engaged if the payment is commensurate with the actual services rendered and is not being made because of the person's status as an employee of the district, but, rather, because of some special expertise or other qualification.

It will be the responsibility of each employee to know when it is appropriate to accept or reject gifts or an honorarium.

 

 

Legal Reference:  Iowa Code ch. 68B (2013).
    
                                   1972 Op. Att'y Gen. 276.
    
                                   1970 Op. Att'y Gen. 319.

Cross Reference:  217    Gifts to Board of Directors
    
                                   401.2  Employee Conflict of Interest
    
                                   704.4  Gifts-Grants-Bequests

Approved:  Oct. 9, 1989, Dec. 17, 2012, Jan. 15, 2018     
Reviewed:  Aug. 24, 2005, Nov. 1, 2012, Dec. 19, 2017     
Revised:  Oct. 10, 1994, Nov. 1, 2012, Dec. 19, 2017    

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:23

402.5 - Public Complaints About Employees

402.5 - Public Complaints About Employees

The board recognizes situations may arise in the operation of the school district, which are of concern to parents and other members of the school district community.  While constructive criticism is welcomed, the board desires to support its employees and their actions to free them from unnecessary, spiteful, or negative criticism and complaints that do not offer advice for improvement or change.

The board firmly believes concerns should be resolved at the lowest organizational level by those individuals closest to the concern.  Whenever a complaint or concern is brought to the attention of the board it will be referred to the administration to be resolved.  Prior to board action however, the following should be completed:

     (a)   Matters concerning an individual student, teacher, or other employee should first be addressed to the teacher or employee.

     (b)   Unsettled matters from (a) above or problems and questions about individual attendance centers should be addressed to the employee's building principal for licensed employees and the superintendent for classified employees.

     (c)   Unsettled matters regarding district employees from (b) above or problems and questions concerning the school district should be directed to the superintendent.

     (d)   If a matter cannot be settled satisfactorily by the superintendent, it may then be brought to the board.  To bring a concern regarding an employee, the individual may notify the board president in writing, who may bring it to the attention of the entire board, or the item may be placed on the board agenda of a regularly scheduled board meeting in accordance with board policy 210.8.

It is within the discretion of the board to address complaints from the members of the school district community, and the board will only do so if they are in writing, signed, and the complainant has complied with this policy.

 

 

Legal Reference:  Iowa Code § 279.8 (2013).

Cross Reference:  210.8 Board Meeting Agenda
                                      213    Public Participation in Board Meetings
 
                                     307 Communication Channels

Approved:  Feb. 10, 1997, Dec. 17, 2012, Jan. 15, 2018     
Reviewed:  Aug. 24, 2005, Nov. 1, 2012, Dec. 19, 2017          
Revised:  Nov. 1, 2012, Dec. 19, 2017    

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:25

402.6 - Employee Outside Employment

402.6 - Employee Outside Employment

The board believes the primary responsibility of employees is to the duties of their position within the school district as outlined in their job description.  The board considers an employee's duties as part of a regular, full-time position as full-time employment.  The board expects such employees to give the responsibilities of their positions in the school district precedence over any other employment.

It is the responsibility of the superintendent to counsel employees, whether full-time or part-time, if, in the judgment of the superintendent and the employee's immediate supervisor, the employee's outside employment interferes with the performance of the employee's duties required in the employee's position within the school district.

The board may request the employee to cease the outside employment as a condition of continued employment with the school district.

 

 

Legal Reference:  Iowa Code §§ 20.7; 279.8 (2013).

Cross Reference:  401.2 Employee Conflict of Interest
    
                                  408.3 Licensed Employee Tutoring

Approved:  Feb. 10, 1997, Dec. 17, 2012, Jan. 15, 2018     
Reviewed:  Aug. 24, 2005, Nov. 1, 2012, Dec. 19, 2017          
Revised:   Nov. 1, 2012, Dec. 19, 2017    

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:26

403 - Employee Health and Well Being

403 - Employee Health and Well Being dawn.gibson.cm… Mon, 11/29/2021 - 14:27

403.1 - Employee Physical Examinations

403.1 - Employee Physical Examinations

Good health is important to job performance. Employment in the following positions is dependent upon a successful physical examination report. All employees identified as having reasonably anticipated contact with blood or infectious materials will receive the Hepatitis B vaccine or sign a written waiver stating that they will not take the vaccine. *Employees whose physical or mental health, in the judgment of the administration, may be in doubt will submit to additional examinations, when requested to do so, at the expense of the school district.

Teacher Associates

The school district will pay for an initial back screening using the District’s designated medical provider. The form indicating the employee is able to perform the duties for which the employee was hired must be returned prior to payment of salary.

 

Custodians and Maintenance Workers

The school district will pay for an initial back screening using the district’s designated medical provider.  The form indicating the employee is able to perform the duties for which the employee was hired must be returned prior to payment of salary.

 

Food Service Workers

The school district will pay for an initial back screening using the district’s designated medical provider.  The form indicating the employee is able to perform the duties for which the employee was hired must be returned prior to payment of salary.

Preschool Employees

Preschool employees (teachers and associates) are required to have a documented health assessment completed before starting work or having contact with children. The health assessment must be updated every two years. The documented health assessment includes: immunizations status; capacities and limitations that may affect job performance and documentation by a licensed health professional of TB skin testing using the Mantoux method and showing the employee to be free from active TB disease.

Preschool employees will have the health assessment administered at the district’s designated medical provider.

 

School Bus Drivers

School bus drivers will present evidence of good health every other year in the form of a Department of Transportation (DOT) physical examination report unless otherwise required by law or medical opinion. School bus drivers will have the DOT physical examination administered at the district’s designated medical provider.

It is the responsibility of the superintendent to ensure an exposure control plan to eliminate or minimize district occupational exposure to blood borne pathogens is in place. The plan for designated employees will include, but not be limited to, scope and application, definitions, exposure control, methods of compliance, Hepatitis B vaccination and post-exposure evaluation and follow-up, communication of hazards to employees, and record keeping.

*The District will designate the facility to be used for all employment-related physicals as:

Jefferson County Health Center 2000B S Main St Fairfield, IA 52556

 

 

Legal Reference:  29 C.F.R. Pt. 1910.1030 (2010).
                                       
Iowa Code §§ 20.9; 279.8, 321,365 (2011).
                                       
281 I.A.C. 12.4(14); 43.15 -.20.

Cross Reference:  403 Employees’ Health and Well-Being

Approved:  Feb. 10, 1997, Dec. 17, 2012, May 20, 2013, May 13, 2015, Sept 26, 2016, May 20, 2019
Reviewed:  Feb. 13, 2006, June 14, 2010, Nov.1, 2012, Apr. 28, 2014, Oct 27, 2014, Mar 16, 2015, Jul 25, 2016, April 15, 2019
Revised:  Oct. 9, 2000, Dec. 15, 2003, Mar. 13, 2006, July 12, 2010, Nov.1, 2012, Apr.28, 2014, Mar 16, 2015, Jul 25, 2016, May 20, 2019

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:27

403.2 - Employee Injury on the Job

403.2 - Employee Injury on the Job

When an employee becomes seriously injured on the job, the building principal shall notify a member of the family, or an individual of close relationship, as soon as the building principal becomes aware of the injury.

If possible, an employee may administer emergency or minor first aid.  In the case of illness, an employee shall be turned over to the care of the employee's family or qualified medical employees as soon as reasonably possible.  The school district is not responsible for medical treatment of non-work-related injury or illness.

If medical treatment is necessary, for work-related injury or illness, the employee will be directed to the District’s designated medical provider.  For a serious injury or illness (or any treatment that should not wait until the next day) seek treatment at the Jefferson County Health Center or the nearest emergency medical facility.

All employees who experience a work related injury will, along with their supervisor, call the EMC “On Call Nurse 24 hour phone line.  The nurse will give directions for further care as well as file the initial employees’ Work Injury Report.

 

 

Legal Reference:  Iowa Code §§ 85; 279.40; 613.17 (2013).
    
                                  1972 Op. Att'y Gen. 177.

Cross Reference:  403    Employees' Health and Well-Being
    
                                  409.2 Licensed Employee Personal Illness Leave
    
                                  414.2 Classified Employee Personal Illness Leave

Approved:  Feb. 10, 1997, March 19, 2012, May 13, 2015, Jan. 15, 2018     
Reviewed:  Aug. 24, 2005, June 14, 2010, March 19, 2012, Apr.28, 2014, Oct 27, 2014, Mar 16, 2015, December 19, 2017    
Revised:  July 12, 2010, March 19, 2012, Apr.28, 2014, December 19, 2017    

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:29

403.3 - Communicable Diseases - Employees

403.3 - Communicable Diseases - Employees

Employees with a communicable disease will be allowed to perform their customary employment duties provided they are able to perform the essential functions of their position and their presence does not create a substantial risk of illness or transmission to students or other employees.  The term "communicable disease" will mean an infectious or contagious disease spread from person to person, or animal to person, or as defined by law.

Prevention and control of communicable diseases is included in the school district's bloodborne pathogens exposure control plan.  The procedures shall include scope and application, definitions, exposure control, methods of compliance, universal precautions, vaccination, post-exposure evaluation, follow-up, communication of hazards to employees and record keeping.  This plan is reviewed annually by the superintendent and school nurse.

The health risk to immunodepressed employees is determined by their personal physician.  The health risk to others in the school district environment from the presence of an employee with a communicable disease is determined on a case-by-case basis by the employee's personal physician, a physician chosen by the school district or public health officials.

An employee who is at work and who has a communicable disease which creates a substantial risk of harm to a student, coworkers, or others at the workplace will report the condition to the superintendent any time the employee is aware that the disease actively creates such risk.

Health data of an employee is confidential and it will not be disclosed to third parties.  Employees’ medical records are kept in a file separate from their personal file.

It is the responsibility of the superintendent, in conjunction with the school nurse, to develop administrative regulations stating the procedures for dealing with employees with a communicable disease.

 

NOTE:  This policy is consistent with current health practices regarding communicable diseases.  The bloodborne pathogen language in the second paragraph and accompanying regulation is in compliance with federal law on control of bloodborne pathogens.

 

 

Legal Reference:  School Board of Nassau County v. Arline, 480 U.S. 273 (1987).
   
                                  29 U.S.C. § 794, 1910 (2012).
    
                                  42 U.S.C. §§ 12101 et seq. (Supp. 2012).|
    
                                  45 C.F.R. Pt. 84.3 (2012).
    
                                  Iowa Code § 139; 141 (2013).
    
                                  641 I.A.C. 1.2-.7.0

Cross Reference:  401.5 Employee Records
    
                                  403.1 Employee Physical Examinations
    
                                  507.3 Communicable Diseases - Students

Approved:  June 13, 1988, Dec. 17, 2012, Jan. 15, 2018, May 18, 2020     
Reviewed:  Sep. 28, 2005, Nov.1, 2012, December 19, 2017, April 9, 2020          
Revised:  Oct. 10, 1994, Oct. 10, 2005, Nov.1, 2012, December 19, 2017, May 18, 2020 

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:30

403.3E1 - Hepatitis B Vaccine Information and Record

403.3E1 - Hepatitis B Vaccine Information and Record

The Disease

Hepatitis B is a viral infection caused by the Hepatitis B virus (HBV) which causes death in 1-2% of those infected.  Most people with HBV recover completely, but approximately 5-10% become chronic carriers of the virus.  Most of these people have no symptoms, but can continue to transmit the disease to others.  Some may develop chronic active hepatitis and cirrhosis.  HBV may be a causative factor in the development of liver cancer.  Immunization against HBV can prevent acute hepatitis and its complications.

 

The Vaccine

The HBV vaccine is produced from yeast cells.  It has been extensively tested for safety and effectiveness in large scale clinical trials.

Approximately 90 percent of healthy people who receive two doses of the vaccine and a third dose as a booster achieve high levels of surface antibody (anti-HBs) and protection against the virus.  The HBV vaccine is recommended for workers with potential for contact with blood or body fluids.  Full immunization requires three doses of the vaccine over a six-month period, although some persons may not develop immunity even after three doses.

There is no evidence that the vaccine has ever caused Hepatitis B.  However, persons who have been infected with HBV prior to receiving the vaccine may go on to develop clinical hepatitis in spite of immunization.

 

Dosage and Administration

The vaccine is given in three intramuscular doses in the deltoid muscle.  Two initial doses are given one month apart and the third dose is given six months after the first.

 

Possible Vaccine Side Effects

The incidence of side effects is very low.  No serious side effects have been reported with the vaccine.  Ten to 20 percent of persons experience tenderness and redness at the site of injection and low grade fever.  Rash, nausea, joint pain, and mild fatigue have also been reported.  The possibility exists that other side effects may be identified with more extensive use.

 

CONSENT FORM OF HEPATITIS B VACCINATION

I have knowledge of Hepatitis B and the Hepatitis B vaccination.  I have had an opportunity to ask questions of a qualified nurse or physician and understand the benefits and risks of Hepatitis B vaccination.  I understand that I must have three doses of the vaccine to obtain immunity.  However, as with all medical treatment, there is no guarantee that I will become immune or that I will not experience side effects from the vaccine.  I give my consent to be vaccinated for Hepatitis B.

 

Signature of Employee (consent for Hepatitis B vaccination)

 

Date

 

 

 

 

 

 

Signature of Witness

 

Date

 

 

 

REFUSAL FORM OF HEPATITIS B VACCINATION

 

I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring the Hepatitis B virus infection.  I have been given the opportunity to be vaccinated with Hepatitis B vaccine at no charge to myself.  However, I decline the Hepatitis B vaccination at this time.  I understand that by declining this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease.  If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with the Hepatitis B vaccine, I can receive the vaccination series at no charge to me.

 

Signature of Employee (refusal for Hepatitis B vaccination)

 

Date

 

 

 

 

 

 

Signature of Witness

 

Date

 

I refuse because I believe I have (check one)

                  started the series                                              completed the series

 

 

 

 

RELEASE FORM FOR HEPATITIS B MEDICAL INFORMATION

 

I hereby authorize                                           (individual or organization holding Hepatitis B records and

address) to release to the Fairfield Community School District, my Hepatitis B vaccination records for required employee records.

I hereby authorize release of my Hepatitis B status to a health care provider, in the event of an exposure incident.

 

Signature of Employee

 

Date

 

 

 

 

 

 

Signature of Witness

 

Date

 

 

CONFIDENTIAL RECORD

 

 

 

 

 

 

Employee Name (last, first, middle)

 

Social Security No.

 

 

 

 

 

Job Title:

 

 

 

 

 

 

 

 

 

 

Hepatitis B Vaccination Date

Lot Number

Site

Administered by

1

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional Hepatitis B status information:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Post-exposure incident: (Date, time, circumstances, route under which exposure occurred)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Identification and documentation of source individual:

 

 

 

 

 

 

 

 

 

 

Source blood testing consent:

 

 

 

 

 

 

 

 

 

 

 

 

 

Description of employee's duties as related to the exposure incident:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Copy of information provided to health care professional evaluating an employee after an exposure incident:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Attach a copy of all results of examinations, medical testing, follow-up procedures, and health care professional's written opinion.

 

 

 

 

 

Training Record: (date, time, instructor, location of training summary)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                         

 

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:32

403.4 - Hazardous Chemical Disclosure

403.4 - Hazardous Chemical Disclosure

The board authorizes the development of a comprehensive hazardous chemical communication program for the school district to disseminate information about hazardous chemicals in the workplace.

Each employee will annually review information about hazardous substances in the workplace.  When a new employee is hired or transferred to a new position or work site, the information and training, if necessary, is included in the employee's orientation.  When an additional hazardous substance enters the workplace, information about it will be distributed to all employees, and training will be conducted for the appropriate employees.  The superintendent or designee will maintain a file indicating when which hazardous substances are present in the workplace and training and information sessions take place.

Employees who will be instructing or otherwise working with students will disseminate information about the hazardous chemicals with which they will be working as part of the instructional program.

It is the responsibility of the superintendent or designee to develop administrative regulations regarding this program.

 

 

Legal Reference:  29 C.F.R. Pt. 1910; 1200 et seq. (2012).
    
                                  Iowa Code chs. 88; 89B (2013).
    
                                  347 I.A.C. 120.

Cross Reference:  403 Employees' Health and Well-Being
    
                                  804 Safety Program

Approved:  Oct. 12, 1987, Dec. 17, 2012, Jan. 15, 2018     
Reviewed:  Aug. 24, 2005, Nov.1, 2012, December 19, 2017         
Revised:  June 12, 1989, Nov.1, 2012, December 19, 2017   

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:34

403.5 - Substance-Free Workplace

403.5 - Substance-Free Workplace

The board expects the school district and its employees to remain substance free.  No employee will unlawfully manufacture, distribute, dispense, possess, use, or be under the influence of, in the workplace any narcotic drug, hallucinogenic drug, amphetamine, barbiturate, marijuana or any other controlled substance alcoholic beverage, or tobacco as defined by federal or state law.  "Workplace" includes school district facilities, school district premises or school district vehicle.  "Workplace" also includes non-school property if the employee is at any school-sponsored, school-approved or school-related activity, event or function, such as field trips or athletic events where students are under the control of the school district or where the employee is engaged in school business.

District employees in possession of controlled substances, alcohol, or tobacco in the workplace are subject to disciplinary actions whether or not they are convicted of a criminal act. If an employee is convicted of a violation of any criminal drug offense committed in the workplace, the employee will notify the employee's supervisor of the conviction within five days of the conviction.

The superintendent will make the determination whether to require the employee to undergo substance abuse treatment or to discipline the employee. An employee who violates the terms of this policy may be subject to discipline up to and including termination.  If the employee fails to successfully participate in a program, the employee may be subject to discipline up to and including termination.

The superintendent is responsible for publication and dissemination of this policy to each employee.  In addition, the superintendent will oversee the establishment of a substance-free awareness program to educate employees about the dangers of substance abuse and notify them of available substance abuse treatment programs.

It is the responsibility of the superintendent to develop administrative regulations to implement this policy.

 

 

Legal Reference:  41 U.S.C. §§ 701-707 (2012).
    
                                  42 U.S.C. §§ 12101 et seq. (2012).
    
                                  29 C.F.R. 1910, 1200 et seq. (2012).
    
                                  Iowa Code §§ 88,89B (2013).
     
                                 347 I.A.C. 120

Cross Reference:  404 Employee Conduct and Appearance

Approved:  Oct. 9, 1989, Dec. 17, 2012, Jan. 15, 2018     
Reviewed:  Aug. 24, 2005, Nov. 1, 2012, Dec. 19, 2017    
Revised:  Feb. 10, 1997, Nov. 1, 2012, Dec. 19, 2017    

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:35

403.6 - Drug and Alcohol Testing Program

403.6 - Drug and Alcohol Testing Program

Employees who operate school vehicles classified as “commercial motor vehicles” by the U.S. Department of Transportation, and are required to possess a commercial driver’s license (CDL) to operate those vehicles, are subject to drug and alcohol testing.

A “commercial motor vehicle” is a vehicle that transports sixteen or more persons including the driver or has a gross vehicle weight rating (GVWR) of 26,001 pounds or more.  For purposes of the Drug and Alcohol Testing Program, the term "employees" includes applicants who have been offered a position to operate a commercial motor vehicle owned by the school.

Employees or employee applicants who will operate a school vehicle as described above are subject to pre-employment drug testing prior to being allowed to perform a safety sensitive function using the school vehicle.  In addition, employees will be subject to random, reasonable suspicion and post-accident drug and alcohol testing.  Employees operating school vehicles will not perform a safety-sensitive function within four hours of using alcohol.  Employees governed by this policy are subject to the drug and alcohol testing program beginning the first day they operate or are offered a position to operate school vehicles and continue to be subject to the Drug and Alcohol Testing Program as long as they may be required to perform a safety-sensitive function as it is defined in the administrative regulations.  Employees with questions about the Drug and Alcohol Testing Program may contact the school district superintendent/and or transportation director at 403 S. 20th Street, Fairfield, Iowa, 52556.

Employees who violate the terms of this policy may be subject to discipline up to and including termination.  Employees who violate this policy bear the personal and financial responsibility, as a condition of continued employment, to successfully participate in a substance abuse evaluation and a substance abuse treatment program recommended by the substance abuse professional.  Employees who fail to or refuse to successfully participate in a substance abuse evaluation or recommended substance abuse treatment program will no longer be allowed to operate a commercial motor vehicle owned by the school and in addition may be subject to discipline up to and including termination. 

It is the responsibility of the superintendent to develop administrative regulations to implement this policy in compliance with the law.  The superintendent/and or transportation director will inform applicants of the requirement for drug and alcohol testing in notices or advertisements for employment.

The superintendent/and or transportation director will also be responsible for publication and dissemination of this policy and its supporting administrative regulations and forms to employees operating school vehicles.  The superintendent/and or director of auxiliary services  will also oversee a substance-free awareness program to educate employees about the dangers of substance abuse and notify them of available substance abuse treatment resources and programs.

 

 

Legal Reference:  American Trucking Association, Inc. v. Federal Highway Administration, 51 Fed. 3rd 405 (4th Cir. 1995).
          
                                  49 U.S.C. §§ 5331 et. Seq. (2012).
    
                                  42 U.S.C. §§ 12101 (2012).
    
                                  41 U.S.C. §§ 701-707 (2012).
    
                                  49 C.F.R. Pt. 40; 382; 391.81-123 (2012).
    
                                  34 C.F.R. Pt. 85  (2012).
    
                                  Local 301, Internat'l Assoc. of Fire Fighters, AFL-CIO, and City of Burlington, PERB No. 3876 (3-26-91).
    
                                  Iowa Code §§ 124; 279.8; 321.375(2); 730.5  (2013).

Cross Reference:  403.6  Substance-Free Workplace
    
                                  409.2  Licensed Employee Personal Illness Leave
    
                                  414.2  Classified Employee Personal Illness Leave

Approved:  Nov. 13, 1995, Dec. 17, 2012, Jan. 15, 2018     
Reviewed:  Aug. 24, 2005, Nov.1, 2012, Dec. 19, 2017
Revised:  Mar. 14, 2005 , Nov.1, 2012 Dec. 19, 2017    

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:35

403.7E1 - Drug and Alcohol Testing Program Notice To Employees

403.7E1 - Drug and Alcohol Testing Program Notice To Employees

EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING PROGRAM POLICY ARE HEREBY NOTIFIED they are subject to the school district’s Drug and Alcohol Testing Program for pre-employment drug testing and in addition are subject to random, reasonable suspicion, post-accident, return-to-duty, and follow-up drug and alcohol testing as outlined in the Drug and Alcohol Testing Program Policy, its supporting documents, regulations and the law.

Employees who operate school vehicles classified as “commercial motor vehicles” by the U.S. Department of Transportation are subject to drug and alcohol testing.  A “commercial motor vehicle” is a vehicle that transports sixteen or more persons including the driver or has a gross vehicle weight rating (GVWR) of 26,001 pounds or more.  For purposes of the Drug and Alcohol Testing Program, “employees” also includes applicants who have been offered a position to operate a commercial motor vehicle owned by the school.  Employees who will operate a school-owned commercial motor vehicle are subject to the Drug and Alcohol Testing Program regulations beginning the first day they are offered a position to operate a school vehicle and continue to be subject to the Drug and Alcohol Testing Program until such time employment is terminated or the employee will no longer operate, at any time, a commercial motor vehicle for the school.

It is the responsibility of the superintendent/and or transportation director to inform employees of the Drug and Alcohol Testing Program requirements.  Employees with questions regarding the drug and alcohol testing requirements will contact a school district contact person.

EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING PROGRAM POLICY ARE FURTHER NOTIFIED that employees violating this policy, its supporting documents or regulations will be subject to discipline up to and including termination.

EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING PROGRAM POLICY ARE FURTHER NOTIFIED it is a condition of their continued employment to comply with the Drug and Alcohol Testing Program Policy, its supporting documents, regulations and the law.  It is a condition of continued employment for employees operating a school vehicle to notify their supervisor of any prescription medication they are using.  Drug and alcohol testing records about a driver are confidential and are released in accordance with this policy, its supporting documents, regulations or the law.

EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING PROGRAM POLICY ARE FURTHER NOTIFIED that employees violating this policy, its supporting documents, regulations or the law will be subject to discipline up to and including termination.  As a condition of continued employment, employees violating this policy, its supporting documents, regulations or the law bear the personal and financial responsibility, as a condition of continued employment, to successfully participate in a substance abuse evaluation and a substance abuse treatment program recommended by the substance abuse professional.  Employees who are required to participate in and who fail to or refuse to successfully participate in a substance abuse evaluation or recommended substance abuse treatment program will be subject to discipline up to and including termination.

 

DRUG AND ALCOHOL TESTING PROGRAM ACKNOWLEDGMENT FORM

 

 

I, (____________________), have received a copy, read and understand the Drug and Alcohol
          Name of Employee

Testing Program Policy and its supporting documents.  I consent to submit to the Drug and Alcohol Testing Program as required by the Drug and Alcohol Testing Program Policy, its supporting documents, regulations and the law.

I understand that if I violate the Drug and Alcohol Testing Program Policy, its supporting document, regulations or the law, I may be subject to discipline up to and including termination or I may be required to successfully participate in a substance abuse evaluation and a substance abuse treatment program, if recommended by the substance abuse professional.  If I am required to and fail to or refuse to successfully participate in a substance abuse evaluation or recommended substance abuse treatment program, I understand I will be subject to discipline up to and including termination.

I further understand that drug and alcohol testing records about me are confidential and may be released in accordance with this policy, its supporting documents, regulations or the law.

 

________________________________________                    ____________________________
                     (Signature of Employee)                                                                (Date)

 

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:37

404 - Employee Conduct and Appearance

404 - Employee Conduct and Appearance

Employees are role models for the students who come in contact with them during and after school hours.  The board recognizes the positive effect employees can have on students in this capacity.  To this end, the board strongly suggests and encourages employees to dress themselves, groom themselves and conduct themselves in a manner appropriate to the educational environment.

Employees will conduct themselves in a professional manner.  Employees will dress in attire appropriate for their position.  Clothing should be neat, clean, and in good taste.  Discretion and common sense call for an avoidance of extremes which would interfere with or have an effect on the educational process.

Licensed employees of the school district will follow the code of ethics for their profession as established by the Iowa Board of Educational Examiners. All employees are sovereigned by the FCSD Employee Handbook.

 

 

Legal Reference:  Iowa Code § 279.8 (2013).
                                      282 I.A.C. 13.

Cross Reference:  104      Anti-Bullying/Harassment
    
                                  305      Administrator Code Of Ethics
                                      403.5  Substance-Free Workplace
    
                                  407     Licensed Employee Termination of Employment
    
                                  413     Classified Employee Termination of Employment
                                      FCSD Employee Handbook

Approved:  Feb. 10, 1997, Dec. 17, 2012, Jan. 15, 2018     
Reviewed:  Aug. 24, 2005 , Nov.1, 2012, Dec. 19, 2017   
Revised:     Nov.1, 2012, Dec. 19, 2017

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:39

405 - Licensed Employees General

405 - Licensed Employees General dawn.gibson.cm… Mon, 11/29/2021 - 14:40

405.1 - Licensed Employee Defined

405.1 - Licensed Employee Defined

Licensed employees, including administrators, are those employees required to hold an appropriate license from the Iowa Department of Education for their position as required by the Board of Educational Examiners or others with professional licenses.  Licenses required for a position will be considered met if the employee meets the requirements established by the Iowa Department of Education.

It is the responsibility of the superintendent to establish job specifications and job descriptions for licensed employees' positions, other than the position of the superintendent.  Job descriptions may be approved by the board.

Licensed employees must present evidence of current license to the board secretary prior to payment of salary each year.

 

 

Legal Reference:  Clay v. Independent School District of Cedar Falls, 187 Iowa 89, 174 N.W. 47 (1919).
    
                                  Iowa Code §§ 256.7(3); 272.6; 272A; 279.8; 294.1 (2013)
    
                                  282 I.A.C. 14.
    
                                  281 I.A.C. 12.4; 41.25.
    
                                  1940 Op. Att'y Gen. 375.

Cross Reference:  405.2  Licensed Employee Qualifications, Recruitment and Selection
    
                                  410.1  Substitute Teachers
    
                                  411.1  Classified Employee Defined

Approved:  Feb. 11, 1985, Dec. 17, 2012, February 19, 2018    
Reviewed:  Aug. 24, 2005, Nov. 9, 2012, 1/15/18    
Revised:  Feb. 10, 1997, Nov. 9, 2012, 1/15/18      

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:40

405.2 - Licensed Employee Qualifications, Recruitment, Selection

405.2 - Licensed Employee Qualifications, Recruitment, Selection

Persons interested in a licensed position, other than administrative positions which will be employed in accordance with board policies in Series 300, "Administration," will have an opportunity to apply and qualify for licensed positions in the school district without regard to age, race, creed, color, sex, national origin, religion, sexual orientation, gender identity or disability.  Job applicants for licensed positions will be considered on the basis of the following:

  •            Training, experience, and skill;
  •             Nature of the occupation;
  •             Demonstrated competence; and
  •             Possession of, or ability to obtain, state license if required for the position.

 

All job openings shall be submitted to the Iowa Department of Education for posting on TeachIowa, the online state job posting system. Additional announcements of the position will be in a manner, which the superintendent believes will inform potential applicants about the position.  The application process will be via the district’s website at http://www.fairfieldsfuture.org. Whenever possible, the preliminary screening of applicants will be conducted by the administrator who will be directly supervising and overseeing the person being hired.

The board will employ licensed employees after receiving a recommendation from the superintendent.

 

 

Legal Reference:  29 U.S.C. §§ 621-634 (2010).
    
                                  42 U.S.C. §§ 2000e, 12101 et seq. (2010).
    
                                  Iowa Code §§ 20; 35C; 216; 294.1(2017).
    
                                  281 I.A.C. 12.
    
                                  282 I.A.C. 14.
    
                                  1980 Op. Att'y Gen. 367.

Cross Reference:  401.1  Equal Employment Opportunity
    
                                  405     Licensed Employees - General
    
                                  410.1  Substitute Teachers

Approved:  Feb. 11, 1985, Dec. 17, 2012, February 19, 2018       
Reviewed:  July 20, 2007, Oct. 11, 2010 , Nov.9, 2012, January 15, 2018  
Revised:  Feb. 10, 1997, Aug. 13, 2007, Nov. 8, 2010, Nov.9, 2012, January 15, 2018   

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:42

405.3 - Licensed Employee Individual Contracts

405.3 - Licensed Employee Individual Contracts

The board will enter into a written contract with licensed employees, other than administrators, employed on a regular basis.  Each contract will be for a period of one year.                                          

It is the responsibility of the superintendent to complete the contracts for licensed employees and present them to the board for approval.  The contracts, after being signed by the board president, are returned to the superintendent.  The superintendent will obtain the employee's signature.  After being signed, the contract is filed with the board secretary.

         

 

Legal Reference:  Harris v. Manning Independent School District of Manning, 245 Iowa 1295, 66 N.W.2d 438 (1954).
    
                                  Shackelford v. District Township of Beaver, Polk County, 203 Iowa 243, 212 N.W. 467 (1927).
    
                                  Burkhead v. Independent School District of Independence, 107 Iowa 29, 77 N.W. 491 (1898).
    
                                  Iowa Code chs. 20; 279 (2017).

Cross Reference:  405.2  Licensed Employee Qualifications, Recruitment, and Selection
    
                                  405.4  Licensed Employee Continuing Contracts
    
                                  407    Licensed Employee Termination of Employment

Approved:  Feb. 11, 1985, Dec. 17, 2012, February 19, 2018         
Reviewed:  Aug. 24, 2005, Nov.9, 2012, January 15, 2018     
Revised:  Feb. 10, 1997, Nov.9, 2012, January 15, 2018    

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:43

405.4 - Licensed Employee Continuing Contracts

405.4 - Licensed Employee Continuing Contracts

Contracts entered into with licensed employees, other than an administrator, will continue from year to year unless the contract states otherwise, is modified by mutual agreement between the board and the employee, or the contract is terminated by the board.

The first three years of a new licensed employee's contract is a probationary period unless the employee has already successfully completed the probationary period in an Iowa school district.  New employees who have successfully completed a probationary period in a previous Iowa school district will serve a one-year probationary period. In the event of termination of the employee’s contract during this period, the board will afford the licensed employee appropriate due process.  The action of the board will be final.

Licensed employees whose contracts will be recommended for termination by the board will receive notice prior to April 30.  The superintendent shall make a recommendation to the board for the termination of the licensed employee's contract.

Licensed employees who wish to resign, to be released from a contract, or to retire must comply with board policies in those areas.

 

 

Legal Reference:  Ar-We-Va Community School District v. Long and Henkenius, 292 N.W.2d 402 (Iowa 1980).
    
                                 Bruton v. Ames Community School District, 291 N.W.2d 351 (Iowa 1980).
    
                                 Hartman v. Merged Area VI Community College, 270 N.W.2d 822 (Iowa 1978).
                                     Keith v. Community School District of Wilton in the Counties of Cedar and Muscatine, 262 N.W.2d 249 (Iowa 1978).
    
                                 Iowa Code §§ 20; 272; 279.12-.19B, .27; 294.1 (2013).

Cross Reference:  405.3  Licensed Employee Individual Contracts
    
                                  405.9  Licensed Employee Probationary Status
    
                                  407    Licensed Employee Termination of Employment

Approved:  Feb. 11, 1985, Dec. 17, 2012, February 19, 2018          
Reviewed:  Aug. 24, 2005, Nov.9, 2012, January 15, 2018    
Revised:  Oct. 9, 2000, Nov.9, 2012, January 15, 2018

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:44

405.5 - Licensed Employee Work Day

405.5 - Licensed Employee Work Day

The workday for licensed employees shall be eight hours as determined by Master Contract and building schedule. "Day" is defined as one workday regardless of full-time or part-time status of an employee.

Licensed employees are to be in their assigned school building during the workday.  Advance approval to be absent from the school building must be obtained from the principal whenever the licensed employees must be absent from the school building during the workday.

The building principal is authorized to make changes within the work day in order to facilitate the education program. These changes are reported to the superintendent.

The workday outlined in this policy is a minimum workday.  Nothing in this policy prohibits licensed employees from working additional hours outside the workday.

The requirements stated in the Employee Handbook regarding workday of such employees will be followed.

 

 

Legal Reference:  Iowa Code §§ 20; 279.8 (2011).

Cross Reference:  200.2 Powers of the Board of Directors

Approved:  Feb. 11, 1985, Dec. 17, 2012, February 19, 2018             
Reviewed:  Aug. 24, 2005, Nov.9, 2012, January 15, 2018  
Revised:  Feb. 10, 1997, Nov.9, 2012, January 15, 2018   

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:46

405.6 - Licensed Employee Assignment

405.6 - Licensed Employee Assignment

Determining the assignment of each licensed employee is the responsibility of and within the sole discretion of the board.  In making such assignments the board will consider the qualifications of each licensed employee and the needs of the school district.

It is the responsibility of the superintendent to make recommendations to the board regarding the assignment of licensed employees.

 

 

Legal Reference:  Iowa Code §§ 20.9; 279.8 (2013).

Cross Reference:  200.2 Powers of the Board of Directors

Approved:  Feb. 11, 1985, Dec. 17, 2012, February 19, 2018               
Reviewed:  Aug. 24, 2005, Nov.9, 2012, January 15, 2018   
Revised:  Feb. 10, 1997, Nov.9, 2012, January 15, 2018   

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:47

405.7 - Licensed Employee Transfers

405.7 - Licensed Employee Transfers

Determining the location where an employee's assignment will be carried out is the responsibility and within the sole discretion of the board.  In making such assignments the board will consider the qualifications of each licensed employee and the needs of the school district.

A transfer may be initiated by the employee or the superintendent.

It is the responsibility of the superintendent to make recommendations to the board regarding the voluntary or involuntary transfer of licensed employees.

 

 

Legal Reference:  Iowa Code §§ 20.9; 216.14; 279.8 (2011).

Cross Reference:  405.2 Licensed Employee Qualifications, Recruitment, Selection
    
                                  405.6 Licensed Employee Assignment

Approved:  Feb. 11, 1985, Dec. 17, 2012, February 19, 2018    
Reviewed:  Aug. 24, 2005, Nov. 9, 2012, January 15, 2018    
Revised:  Feb. 10, 1997, Nov. 9, 2012, January 15, 2018

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:48

405.8 - Licensed Employee Evaluation

405.8 - Licensed Employee Evaluation

Evaluation of licensed employees on their skills, abilities, and competence will be an ongoing process supervised by the building principals and conducted by approved evaluators.  The goal of the formal evaluation of licensed employees, other than administrators, but including extracurricular employees, is to improve the education program, to maintain licensed employees who meet or exceed the board's standards of performance, to clarify the licensed employee's role, to ascertain the areas in need of improvement, to clarify the immediate priorities of the board, and to develop a working relationship between the administrators and other employees.

The formal evaluation criteria is in writing and approved by the board.  The formal evaluation will provide an opportunity for the evaluator and the licensed employee to discuss the past year's performance and the future areas of growth.  The formal evaluation is completed by the evaluator, signed by the licensed employee and filed in the licensed employee's personnel file.  This policy supports, and does not preclude, the ongoing informal evaluation of the licensed employee's skills, abilities and competence.

Licensed employees will be required to:

  • Demonstrate the ability to enhance academic performance and support for and implementation of the school district’s student achievement goals.
  • Demonstrate competency in content knowledge appropriate to the teaching position.
  • Demonstrate competency in planning and preparation for instruction.
  • Use strategies to deliver instruction that meets the multiple learning needs of students.
  • Use a variety of methods to monitor student learning.
  • Demonstrate competence in classroom management.
  • Engage in professional growth.
  • Fulfill professional responsibilities established by the school district.
  • Behave in a professional manner.

It is the responsibility of the superintendent to ensure licensed employees are evaluated.  New and probationary licensed employees are evaluated at least three times each year.

 

 

Legal Reference:  Aplington Community School District v. PERB, 392 N.W.2d 495 (Iowa 1986).
                                      Saydel Education Association v. PERB, 333 N.W.2d 486 (Iowa 1983).
    
                                  Iowa Code §§ 20.9; 279.14, .19, .27 (2013).
    
                                  281 I.A.C. Ch 83; 12.3(4).

Cross Reference:  405.2  Licensed Employee Qualifications, Recruitment and Selection
    
                                  405.9  Licensed Employee Probationary Status

Approved:  Feb. 11, 1985, Dec. 17, 2012, February 19, 2018              
Reviewed:  Aug. 24, 2005, Nov. 9, 2012, January 15, 2018
Revised:  Feb. 10, 1997, Dec. 10, 2010, Nov. 9, 2012, January 15, 2018

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:48

405.8E1 - Tier II - Comprehensive Evaluation - Summative Evaluation Form

405.8E1 - Tier II - Comprehensive Evaluation - Summative Evaluation Form

Teacher:______________________________________           Folder #:__________________________

Evaluator:_____________________________________          Folder #:__________________________

School Name:_____________________________________________________________________

Grade Level:_____________              Subjects:_____________________________________ 

 

Directions:
In the narrative under each standard, the evaluator should incorporate and address each criterion.

1. DEMONSTRATES ABILITY TO ENHANCE ACADEMIC PERFORMANCE AND SUPPORT FOR AND IMPLEMENTATION OF THE SCHOOL DISTRICT'S STUDENT ACHIEVEMENT GOALS. 
The teacher:
a. Provides evidence of student learning to students, families, and staff.
b. Implements strategies supporting student, building, and district goals.
c. Uses student performance data as a guide for decision making.
d. Accepts and demonstrates responsibility for creating a classroom culture that supports the learning of every student.
e. Creates an environment of mutual respect, rapport, and fairness.
f. Participates in and contributes to a school culture that focuses on improved student learning.
g. Communicates with students, families, colleagues, and communities effectively and accurately.

 

Evidence to support attainment of or failure to meet standard:

 

Evidence spaces are in Microsoft Word. Just insert text and box will expand to fit size of text.

Check one:

__ Meets Standard

__  Does not meet Standard

¨ Additional documentation/artifacts applicable to this standard are attached as Appendix A-1.

 

2. DEMONSTRATES COMPETENCE IN CONTENT KNOWLEDGE APPROPRIATE TO THE TEACHING POSITION.
The teacher:
a. Understands and uses key concepts, underlying themes, relationships, and different perspectives related to the content area.
b. Uses knowledge of student development to make learning experiences in the content area meaningful and accessible for every student.
c. Relates ideas and information within and across content areas.
d. Understands and uses instructional strategies that are appropriate to the content area.

 

Evidence to support attainment of or failure to meet standard:

 

Evidence spaces are in Microsoft Word. Just insert text and box will expand to fit size of text.

Check one:

__ Meets Standard

__  Does not meet Standard

¨ Additional documentation/artifacts applicable to this standard are attached as Appendix A-2.

 

3. DEMONSTRATES COMPETENCE IN PLANNING AND PREPARING FOR INSTRUCTION.
The teacher:
a. Uses student achievement data, local standards and the district curriculum in planning for instruction.
b. Sets and communicates high expectations for social, behavioral, and academic success of all students.
c. Uses student developmental needs, background, and interests in planning for instruction.
d. Selects strategies to engage all students in learning.
e. Uses available resources, including technologies, in the development and sequencing of instruction.

 

Evidence to support attainment of or failure to meet standard:

 

Evidence spaces are in Microsoft Word. Just insert text and box will expand to fit size of text.

Check one:

__ Meets Standard

__  Does not meet Standard

                                                                                                                                       Code No.  405.8E1 continued

¨ Additional documentation/artifacts applicable to this standard are attached as Appendix A-3.

 

4. USES STRATEGIES TO DELIVER INSTRUCTION THAT MEETS THE MULTIPLE LEARNING NEEDS OF STUDENTS.
The teacher:
a. Aligns classroom instruction with local standards and district curriculum.
b. Uses research-based instructional strategies that address the full range of cognitive levels.
c. Demonstrates flexibility and responsiveness in adjusting instruction to meet student needs.
d. Engages students in varied experiences that meet diverse needs and promote social, emotional, and academic growth.
e. Connects students' prior knowledge, life experiences, and interests in the instructional process.
f. Uses available resources, including technologies, in the delivery of instruction.

 

Evidence to support attainment of or failure to meet standard:

 

Evidence spaces are in Microsoft Word. Just insert text and box will expand to fit size of text.

Check one:

__ Meets Standard

__  Does not meet Standard

 

¨ Additional documentation/artifacts applicable to this standard are attached as Appendix A-4.

 

5. USES A VARIETY OF METHODS TO MONITOR STUDENT LEARNING.
The teacher:

a. Aligns classroom assessment with instruction.
b. Communicates assessment criteria and standards to all students and parents.
c. Understands and uses the results of multiple assessments to guide planning and instruction.
d. Guides students in goal setting and assessing their own learning.
e. Provides substantive, timely, and constructive feedback to students and parents.
f. Works with other staff and building and district leadership in analysis of student progress.

 

Evidence to support attainment of or failure to meet standard:

 

Evidence spaces are in Microsoft Word. Just insert text and box will expand to fit size of text.

Check one:

__ Meets Standard

__  Does not meet Standard

¨ Additional documentation/artifacts applicable to this standard are attached as Appendix A-5.

 

6. DEMONSTRATES COMPETENCE IN CLASSROOM MANAGEMENT.
The teacher:

a. Creates a learning community that encourages positive social interaction, active engagement, and self-regulation for every student.
b. Establishes, communicates, models and maintains standards of responsible student behavior.
c. Develops and implements classroom procedures and routines that support high expectations for learning.
d. Uses instructional time effectively to maximize student achievement.
e. Creates a safe and purposeful learning environment.

 

Evidence to support attainment of or failure to meet standard:

 

Evidence spaces are in Microsoft Word. Just insert text and box will expand to fit size of text.

Check one:

__ Meets Standard

__  Does not meet Standard

 

¨ Additional documentation/artifacts applicable to this standard are attached as Appendix A-6.

 

7. ENGAGES IN PROFESSIONAL GROWTH.
The teacher:

a. Demonstrates habits and skills of continuous inquiry and learning.
b. Works collaboratively to improve professional practice and student learning.
c. Applies research, knowledge, and skills from professional development opportunities to improve practice.
d. Establishes and implements professional development plans based upon the teacher needs aligned to the Iowa Teaching Standards and district/building student achievement goals.

 

Evidence to support attainment of or failure to meet standard:

 

Evidence spaces are in Microsoft Word. Just insert text and box will expand to fit size of text.

Check one:

__ Meets Standard

__  Does not meet Standard

 

¨ Additional documentation/artifacts applicable to this standard are attached as Appendix A-7.

 

8. FULFILLS PROFESSIONAL RESPONSIBILITIES ESTABLISHED BY THE SCHOOL DISTRICT. The teacher:

a. Adheres to board policies, district procedures, and contractual obligations.
b. Demonstrates professional and ethical conduct as defined by state law and individual district policy.
c. Contributes to efforts to achieve district and building goals.
d. Demonstrates an understanding of and respect for all learners and staff.
e. Collaborates with students, families, colleagues, and communities to enhance student learning.

 

Evidence to support attainment of or failure to meet standard:

 

Evidence spaces are in Microsoft Word. Just insert text and box will expand to fit size of text.

Check one:

__ Meets Standard

__  Does not meet Standard

 

¨ Additional documentation/artifacts applicable to this standard are attached as Appendix A-8.

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:50

405.9 - Licensed Employee Probationary Status

405.9 - Licensed Employee Probationary Status

The first three years of a new licensed employee's contract is a probationary period unless the employee has already successfully completed the probationary period in an Iowa school district.  New employees who have successfully completed a probationary period in a previous Iowa school district will serve a one-year probationary period.  For purposes of this policy, an employee will have met the requirements for successfully completing a probationary period in another Iowa school district if, at the teacher’s most recent performance evaluation, the teacher received at least a satisfactory or better evaluation and the individual has not engaged in conduct which would disqualify the teacher for a continuing contract.

Only the board, in its discretion, may waive the probationary period.  The board may extend the probationary period with the consent of the licensed employee.  The board will make the decision to extend or waive a licensed employee's probationary status based upon the superintendent's recommendation.  During this probationary period the board may terminate the licensed employee's contract at year-end or discharge the employee in concert with corresponding board policies.

Licensed employees may also serve a probationary period based upon their performance.  Such probationary period is determined on a case-by-case basis in light of the circumstances surrounding the employee's performance as documented in the employee's evaluations and personnel file.

 

 

Legal Reference:  Iowa Code §§ 279.12-.19B (2013).

Cross Reference:  405.4  Licensed Employee Continuing Contracts
    
                                  405.8  Licensed Employee Evaluation

Approved:  Feb. 10, 1997, Dec. 17, 2012, February 19, 2018             
Reviewed:  Aug. 24, 2005, Nov. 9, 2012, January 15, 2018    
Revised:  Oct. 9, 2000, Nov. 9, 2012, January 15, 2018    

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:52

406 - Licensed Employees Compensation and Benefits

406 - Licensed Employees Compensation and Benefits dawn.gibson.cm… Mon, 11/29/2021 - 14:53

406.1 - Licensed Employee Base Wage

406.1 - Licensed Employee Base Wage

The board will establish base wage for licensed employees' positions keeping in mind the financial condition of the school district, the education and experience of the licensed employee, the educational philosophy of the school district, and other factors deemed relevant by the board.

It is the responsibility of the superintendent to make a recommendation to the board annually regarding the base wage.  The base wage shall be subject to review and modification through the collective bargaining process.

The requirements stated in the Master Contract between employees in that certified collective bargaining unit and the board regarding base wages of such employees will be followed.

 

 

Legal Reference:  Iowa Code §§ 20.1, .4, .7, .9; 279.8 (2017).

Cross Reference:  405    Licensed Employees - General
    
                                  406.2  Licensed Employee Salary Schedule Advancement

Approved:  Feb. 11, 1985, Dec. 17, 2012, February 19, 2018               
Reviewed:  Aug. 24, 2005, Nov. 9, 2012, January 15, 2018    
Revised:  Feb. 10, 1997, Nov. 9, 2012, January 15, 2018    

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:53

406.2 - Licensed Employee Advancement

406.2 - Licensed Employee Advancement

The board will determine which licensed employees will advance, keeping in mind the financial condition of the school district, the education and experience of the licensed employee, the educational philosophy of the school district, and other considerations as determined by the board.

It is the responsibility of the superintendent to make a recommendation to the board for the advancement of a licensed employee.

 

 

Legal Reference:  Iowa Code §§ 20.1, .4, .7, .9; 279.8 (2011).

Cross Reference:  405  Licensed Employees - General
    
                                  406  Licensed Employee Compensation and Benefits

Approved:  Feb. 11, 1985, Dec. 17, 2012, February 19, 2018               
Reviewed:  Aug. 24, 2005, Nov. 9, 2012, January 15, 2018      
Revised:  Feb. 10, 1997, Nov. 9, 2012, January 15, 2018 

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:54

406.3 - Licensed Employee Continued Education Credit

406.3 - Licensed Employee Continued Education Credit

Continued education on the part of licensed employees may entitle them to advancement.  Licensed employees who have completed additional hours will be considered for advancement. 

Licensed employees who wish to obtain additional education for advancement must complete the online course approval process with the superintendent prior to taking these courses.  For an employee to advance, the employee will file official transcripts for graduate credit from an accredited college or university within their teaching field or graduate level courses related to their teaching skills within their teaching field with the superintendent no later than October 1.

It is the responsibility of the superintendent to make a recommendation to the board for the advancement of a licensed employee.

 

 

Legal Reference:  Iowa Code §§ 20.1, .4, .7, .9; 279.8 (2017).

Cross Reference:  405  Licensed Employees - General
    
                                  406  Licensed Employee Compensation and Benefits

Approved:  Feb. 11, 1985, Dec. 17, 2012, February 19, 2018              
Reviewed:  Aug. 24, 2005, Nov. 9, 2012, January 15, 2018          
Revised:  Feb. 10, 1997, Nov. 9, 2012, January 15, 2018       

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:55

406.4 - Licensed Employee Compensation for Extra Duty

406.4 - Licensed Employee Compensation for Extra Duty

A licensed employee may volunteer or be required to take on extra duty, with the extra duty being secondary to the major responsibility of the licensed employee.  The board will establish a base wage for extra duty licensed employee positions, keeping in mind the financial condition of the school district, the education and experience of the licensed employee, the educational philosophy of the school district, and other considerations as determined by the board.

Vacant extra duty positions will be posted to allow qualified licensed employees to apply for the extra duty. The licensed employee will receive compensation for the extra duty required to be performed.

It is the responsibility of the superintendent to make a recommendation to the board annually as to which licensed employees will have the extra duty, and the base salary schedule for extra duty, for the board's review.

 

 

Legal Reference:  Iowa Code §§ 20.1, .4, .7, .9; 279.8, .13-.15, .19A-B (2017).

Cross Reference:  405  Licensed Employees - General
    
                                  406  Licensed Employee Compensation and Benefits

Approved:  Feb. 11, 1985, Dec. 17, 2012, February 19, 2018              
Reviewed:  Aug. 24, 2005, Nov. 9, 2012, January 15, 2018               
Revised:  Feb. 10, 1997, Nov. 9, 2012, January 15, 2018   

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:55

406.5 - Licensed Employee Group Insurance Benefits

406.5 - Licensed Employee Group Insurance Benefits

Licensed employees may be eligible for group benefits as determined by the board and required by law.  The board will select group benefit program(s) and the insurance company or third party administrator which will provide or administer the program.

In accordance with the Patient Protection and Affordable Care Act (ACA), the board will offer licensed employees who work an average of at least thirty (30) hours per week or one hundred thirty (130) hours per month, based on the measurement method adopted by the board, with minimum essential coverage that is both affordable and provides the minimum value.  The board will have the authority and right to change or eliminate group benefit programs, other than the group health plan, for its licensed employees.

Licensed employees who work an average of at least thirty (30) hours per week or one hundred thirty (130) hours per month, based on the measurement method adopted by the board, are eligible to participate in the group health plan.  Licensed employees who work 30 hours per week are eligible to participate in the health and major medical, and long-term disability group insurance plans.  Employers should maintain documents regarding eligible employees' acceptance and rejection of coverage.

Normally health insurance benefits run from September through August depending on the employee's start date.  The effective date of health insurance is the first of the month following the first day of service.  If the employee resigns from his/her position before completing a full year of service, district paid health insurance will be discontinued at the end of the month following the last day of service.  A full year of service is defined as one hundred twenty consecutive days of service.  COBRA rights will become effective following the discontinuation of district paid benefits.

Licensed employees and their spouse and dependents may be allowed to continue coverage of the school district's group health insurance program if they cease employment with the school district by meeting the requirements of the insurer.

 

If an employee is unable to perform his/her duties consider this flowchart:

 
 

 

 

 

Legal Reference:  Iowa Code §§ 20.9; 85; 85B; 279.12, .27; 509; 509A; 509B (2017).
                                       
Internal Revenue Code § 4980H(c)(4); Treas. Reg. § 54.4980H-1(a)(21)(ii).
                                       
Shared Responsibility for Employers Regarding Health Coverage, 26 CFR Parts 1, 54 and 301, 78 Fed. Reg. 217, (Jan 2, 2013).
                                       
Shared Responsibility for Employers Regarding Health Coverage, 26 CFR Parts 1, 54 and 301, 79 Fed. Reg. 8543 (Feb. 12, 2014)

Cross Reference:  405.1    Licensed Employee
                                      706.2     Payroll Deductions

Approved: Feb. 11, 1985, Dec. 17, 2012, May 20, 2013, May 13, 2015, Sep 21, 2015, February 19, 2018, May 20, 2019
Reviewed:  Aug. 24, 2005, Nov. 9, 2012, Apr. 5, 2013, Mar 16, 2015, Jul 27, 2015, January 15, 2018, April 15, 2019
Revised: Feb. 10, 1997, Nov. 9, 2012, Apr. 5, 2013, Mar 16, 2015, Jul 27, 2015, January 15, 2018, May 20, 2019

 

dawn.gibson.cm… Mon, 11/29/2021 - 14:56

406.6 - Licensed Employee Tax Shelter Programs

406.6 - Licensed Employee Tax Shelter Programs

The board authorizes the administration to make a payroll deduction for licensed employees' tax sheltered annuity premiums purchased from a company or program affiliated with the state approved program.

Licensed employees wishing to have payroll deductions for tax sheltered annuities will make a written request to the business manager.

The requirements stated in the Employee Handbook between employees in that certified collective bargaining unit and the board regarding the tax sheltered annuities of such employees will be followed.

 

 

Legal Reference:  Small Business Job Protection Act of 1996, Section 1450(a), repealing portions of IRS REG § 1.403(b)-1(b) (3).
         
                                     Iowa Code §§ 20.9; 260C; 273; 294.16 (2017).
   
                                 1988 Op. Att'y Gen. 38.
    
                                 1976 Op. Att'y Gen. 462, 602.
    
                                 1966 Op. Att'y Gen. 211, 220.

Cross Reference:  706 Payroll Procedures

Approved:  Feb. 11, 1985, Dec. 17, 2012, February 19, 2018               
Reviewed:  Aug. 24, 2005, Sep. 14, 2009, Nov. 9, 2012, January 15, 2018                        
Revised:  Feb. 10, 1997, Oct. 12, 2009, Nov. 9, 2012, January 15, 2018                  

 

dawn.gibson.cm… Mon, 11/29/2021 - 15:11

407 - Licensed Employee Termination of Employment

407 - Licensed Employee Termination of Employment dawn.gibson.cm… Mon, 11/29/2021 - 15:13

407.1 - Licensed Employee Resignation

407.1 - Licensed Employee Resignation

A licensed employee who wishes to resign must notify the superintendent in writing within the time period set by the board for return of the contract.  This applies to regular contracts for the licensed employee's regular duties and for an extracurricular contract for extra duty.  Resignations of this nature will be accepted by the board.

The board may require an individual who has resigned from an extracurricular contract to accept the resigned position for only the subsequent school year when the board has made a good faith effort to find a replacement and the licensed employee is continuing to be employed by the school district.

Employees who leave employment with the District for any reason will be eligible to return to employment following a wait period of twenty-six weeks.

 

 

Legal Reference:  Iowa Code §§ 91A.2, .3, .5; 279.13, .19A (2017).

Cross Reference:  405.3  Licensed Employee Individual Contracts
    
                                  405.4  Licensed Employee Continuing Contracts
    
                                  407     Licensed Employee Termination of Employment

Approved:  Feb. 11, 1985, Dec. 17, 2012, Sept 26, 2016, February 19, 2018               
Reviewed:  Aug. 24, 2005, Nov. 9, 2012, Jul 25, 2016, January 15, 2018                        
Revised:  Nov. 12, 1990, Feb. 10, 1997, Nov. 9, 2012, Jul 25, 2016, January 15, 2018                        

 

dawn.gibson.cm… Mon, 11/29/2021 - 15:14

407.2 - Licensed Employee Contract Release

407.2 - Licensed Employee Contract Release

Licensed employees who wish to be released from an executed contract must give at least twenty-one days notice to the superintendent.  Licensed employees may be released at the discretion of the board.  Only in unusual and extreme circumstances will the board release a licensed employee from a contract.  The board will have sole discretion to determine what constitutes unusual and extreme circumstances.

Release from a contract will be contingent upon finding a suitable replacement.  Licensed employees requesting release from a contract after it has been signed and before it expires may be required to pay the board actual advertising costs incurred to locate and hire a suitable replacement.  Upon written mutual agreement between the employee and the superintendent, the costs will be deducted from the employee's final paycheck.  Payment of these costs is a condition for release from the contract at the discretion of the board.  Failure of the licensed employee to pay these expenses may result in a cause of action being filed in small claims court.

The superintendent is authorized to file a complaint with the Board of Educational Examiners against a licensed employee who leaves without proper release from the board.

 

 

Legal Reference:  Iowa Code §§ 216; 272; 279.13, .19A, .46 (2017).
    
                                  1978 Op. Att'y Gen. 247.
    
                                  1974 Op. Att'y Gen. 11, 322.

Cross Reference:  405.3  Licensed Employee Individual Contracts
    
                                  405.4  Licensed Employee Continuing Contracts
    
                                  407.3  Licensed Employee Retirement

Approved:  Feb. 11, 1985, Dec. 17, 2012, February 19, 2018              
Reviewed:  Sep. 28, 2005, Nov. 9, 2012, January 15, 2018                           
Revised:  Nov. 12, 1990, Feb. 10, 1997, Oct. 10, 2005, Nov. 9, 2012, January 15, 2018   

 

dawn.gibson.cm… Mon, 11/29/2021 - 15:15

407.4 - Licensed Employee Suspension

407.4 - Licensed Employee Suspension

Licensed employees will perform their assigned job, respect and follow board policy and obey the law.  The superintendent is authorized to suspend a licensed employee pending board action on a discharge, for investigation of charges against the employee, and for disciplinary purposes.  It is within the discretion of the superintendent to suspend a licensed employee with or without pay.

In the event of a suspension, appropriate due process will be followed.

 

 

Legal Reference:  Northeast Community Education Association v. Northeast Community School District, 402 N.W.2d 765 (Iowa 1987).
    
                               McFarland v. Board of Education of Norwalk Community School District, 277 N.W.2d 901 (Iowa 1979).
    
                               Iowa Code §§ 20.7, .24; 279.13, .15-.19, .27 (2013).

Cross Reference:  404  Employee Conduct and Appearance
    
                               407  Licensed Employee Termination of Employment

Approved:  Feb. 11, 1985, Dec. 17, 2012, February 19, 2018               
Reviewed:  Aug. 24, 2005, Nov. 9, 2012, January 15, 2018                             
Revised:  Feb. 10, 1997, Nov. 9, 2012, January 15, 2018    

 

dawn.gibson.cm… Mon, 11/29/2021 - 15:17

407.5 - Licensed Employee Reduction in Force

407.5 - Licensed Employee Reduction in Force

The board has the exclusive authority to determine the appropriate number of licensed employees.  A reduction of licensed employees may occur as a result of, but not be limited to, changes in the education program, staff realignment, changes in the size or nature of the student population, financial considerations, and other reasons deemed relevant by the board.

The reduction in licensed employees, other than administrators, will be done through normal attrition if possible.  If normal attrition does not meet the necessary reduction in force required, the board may terminate licensed employees.

It is the responsibility of the superintendent to make a recommendation for termination to the board.  The superintendent shall consider the following criteria in making the recommendations:

  • Endorsements and educational preparation within the grade level and subject areas in which the employee is now performing;
  • Relative skills, ability and demonstrated performance;
  • Qualifications for co-curricular programs; and
  • Number of continuous years of service to the school district.  This will be considered only when the foregoing factors are relatively equal between licensed employees.

Due process for terminations due to a reduction in force will be followed.

 

 

Legal Reference:  Iowa Code §§ 20.7, .24; 279.13, .15-.19, .27 (2017).

Cross Reference:  407.4  Licensed Employee Suspension
    
                                  413.5  Classified Employee Reduction in Force
    
                                  703    Budget

Approved:  Feb. 10, 1997, Dec. 17, 2012, February 19, 2018               
Reviewed:  Aug. 24, 2005, Nov. 9, 2012, January 15, 2018                                  
Revised:    Nov, 9, 2012, January 15, 2018   

 

dawn.gibson.cm… Mon, 11/29/2021 - 15:18

408 - Licensed Employees Professional Growth

408 - Licensed Employees Professional Growth dawn.gibson.cm… Mon, 11/29/2021 - 15:19

408.1 - Licensed Employee Professional Development

408.1 - Licensed Employee Professional Development

The board encourages licensed employees to attend and participate in professional development activities to maintain, develop, and extend their skills.  The board will maintain and support an in-service program for licensed employees.

Requests for attendance or participation in a development program, other than those development programs sponsored by the school district, will be made to the superintendent.  Approval of the superintendent must be obtained prior to attendance by a licensed employee in a professional development program when the attendance would result in the licensed employee being excused from their duties or when the school district pays the expenses for the program.

The superintendent will have sole discretion to allow or disallow licensed employees to attend or participate in the requested event.  When making this determination, the superintendent will consider the value of the program for the licensed employee and the school district, the effect of the licensed employee's absence on the education program and school district operations and the school district's financial situation as well as other factors deemed relevant in the judgment of the superintendent. Requests that involve unusual expenses must be approved by the board.

 

 

Legal Reference:  Iowa Code § 279.8; 294 (2011).
    
                                  281 I.A.C. 12.7.

Cross Reference:  414.9 Classified Employee Professional Purposes Leave

Approved:  June 12, 1989, Jan. 21, 2013, February 18, 2019          
Reviewed:  Aug. 24, 2005, Nov.30, 2012, January 21, 2019    
Revised:   Nov. 30, 2012, January 21, 2019  

 

dawn.gibson.cm… Mon, 11/29/2021 - 15:19

408.2 - Licensed Employee Publication or Creation of Materials

408.2 - Licensed Employee Publication or Creation of Materials

Materials created by licensed employees and the financial gain therefrom will be the property of the school district if school materials and time were used in their creation and/or such materials were created in the scope of the licensed employee’s employment.  The licensed employee must seek prior written approval of the superintendent concerning such activities.

 

 

Legal Reference:  Iowa Code § 279.8 (2012).

Cross Reference:  401.2 Employee Conflict of Interest
    
                                  606.4 Student Production of Materials and Services

Approved:  Feb. 10, 1997, Jan. 21, 2013, February 18, 2019   
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, January 21, 2019    
Revised:  Nov. 30, 2012, January 21, 2019

 

dawn.gibson.cm… Mon, 11/29/2021 - 15:20

408.3 - Licensed Employee Tutoring

408.3 - Licensed Employee Tutoring

Every effort will be made by the licensed employees to help students with learning problems before recommending that the parents engage a tutor.  Since there are exceptional cases when tutoring will help students overcome learning deficiencies, tutoring by licensed employees may be approved by the superintendent.

Licensed employees may only tutor students other than those for whom the teacher is currently exercising teaching, administrative or supervisory responsibility unless approved by the superintendent.

Tutoring for a fee may not take place within school facilities or during regular school hours unless approved by the superintendent.

 

 

Legal Reference:  Iowa Code §§ 20.7; 279.8 (2013)

Cross Reference:  401.2 Employee Conflict of Interest
    
                                  402.6 Employee Outside Employment

Approved:  Feb. 11, 1985, Jan. 21, 2013, February 18, 2019       
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, January 21, 2019    
Revised:  Feb. 10, 1997, Nov. 30, 2012, January 21, 2019         

 

dawn.gibson.cm… Mon, 11/29/2021 - 15:21

409 - Licensed Employees Vacation and Leaves of Absence

409 - Licensed Employees Vacation and Leaves of Absence dawn.gibson.cm… Mon, 11/29/2021 - 11:16

409.1 - Employee Vacation - Holidays - Personal Leave

409.1 - Employee Vacation - Holidays - Personal Leave

The board will determine the amount of vacation and holidays, that will be allowed for employees.

It will be the responsibility of the superintendent to make a recommendation to the board annually on vacations, holidays, and personal leave for licensed employees.

 

 

Legal Reference:  Iowa Code §§ 1C.1-.2; 4.1(34); 20.9 (2011).

Cross Reference:  414.1 Classified Employee Vacations - Holidays - Personal Leave
    
                                  601.1 School Calendar

Approved:  Feb. 10, 1997, Jan. 21, 2013, February 18, 2019        
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, January 21, 2018, July 27, 2020    
Revised:   Nov. 30, 2012, January 21, 2018

 

dawn.gibson.cm… Mon, 11/29/2021 - 12:58

409.2 - Licensed Employee Personal Illness Leave

409.2 - Licensed Employee Personal Illness Leave

Licensed employees will granted ten days of sick leave in their first year of employment.  Each year thereafter, one additional day of sick leave will be granted to the licensed employees up to a maximum of fifteen days.  "Day" is defined as one workday regardless of full-time or part-time status of the employee.  A new employee will report for work at least one full workday prior to receiving sick leave benefits.  A returning employee will be granted the appropriate number of days at the beginning of each fiscal year.

Sick leave may be accumulated up to a maximum of 125 days for licensed employees.

Should the personal illness occur after or extend beyond the sick leave accumulated allowance, the employee may apply for disability benefits under the group insurance plan.  If the employee does not qualify for disability benefits, the employee may request a leave of absence without pay.

Evidence may be required regarding the mental or physical health of the employee when the administration has a concern about the employee's health.  Evidence may also be required to confirm the employee's illness, the need for the illness leave, the employee's ability to return to work, and the employee's capability to perform the duties of the employee's position.  It shall be within the discretion of the board or the superintendent to determine the type and amount of evidence necessary.  When an illness leave will be greater than three consecutive days, the employee will comply with the board policy regarding family and medical leave.

The requirements stated in the Master Contract between employees in that certified collective bargaining unit and the board regarding the personal illness leave of such employees will followed.

                                 

 

Legal Reference:  29 U.S.C. §§ 2601 et seq.
                                       29 C.F.R. § 825.
                                       
Iowa Code §§ 2085216279.40.
                                       
Whitney v. Rural Ind. School District, 232 Iowa 61, 4 N.W.2d 394 (1942).

Cross Reference:  403.2 Employee Injury on the Job
                                       
409.3 Licensed Employee Family and Medical Leave
                                       
409.8 Licensed Employee Unpaid Leave

Approved:  Feb. 11, 1985, Jan. 21, 2013, February 18, 2019        
Reviewed:  Aug. 24, 2005, Nov. 9, 2009, Nov. 2012, Jan. 21, 2019  
Revised:  Feb. 10, 1997, Oct. 9, 2000, Dec. 14, 2009, Nov. 30, 2012, Jan. 21, 2019  

 

dawn.gibson.cm… Mon, 11/29/2021 - 12:55

409.3 - Employee Family and Medical Leave

409.3 - Employee Family and Medical Leave

Unpaid family and medical leave will be granted up to 12 weeks per year to assist employees in balancing family and work life.  For purposes of this policy, year is defined as the 12-month period beginning July 1.  Requests for family and medical leave will be made to the superintendent.

Employees may be allowed to substitute paid leave for unpaid family and medical leave by meeting the requirements set out in the family and medical leave administrative rules.  Employees eligible for family and medical leave must comply with the family and medical leave administrative rules prior to starting family and medical leave.  It is the responsibility of the superintendent to develop administrative rules to implement this policy.

 

Note: Boards

 

Links:

https://www.dol.gov/whd/regs/compliance/posters/fmlaen.pdf
WH-380-E Certification of Health Care Provider for Employee's Serious Health Condition (PDF)
WH-380-F Certification of Health Care Provider for Family Member's Serious Health Condition (PDF)
WH-381 Notice of Eligibility and Rights & Responsibilities (PDF)
WH-382 Designation Notice (PDF)
WH-384 Certification of Qualifying Exigency For Military Family Leave (PDF)
WH-385 Certification for Serious Injury or Illness of Covered Service member -- for Military Family Leave (PDF)

Legal Reference:  29 U.S.C. §§ 2601 et seq.
                                       
29 C.F.R. § 825.
                                       
Iowa Code §§ 2085216279.40.
                                       
Whitney v. Rural Ind. School District, 232 Iowa 61, 4 N.W.2d 394 (1942).

Cross Reference:  409.2  Licensed Employee Personal Illness Leave
                                      409.8  Licensed Employee Unpaid Leave
    
                                  414.3  Classified Employee Family and Medical Leave           

Approved:  Mar. 14, 1994, February 18, 2019        
Reviewed:  Aug. 24, 2005, Sep. 14, 2009, Apr. 5, 2013, Jan.21, 2019, July 27, 2020    
Revised:   October 12, 2009, Jan.21, 2019                              

 

dawn.gibson.cm… Mon, 11/29/2021 - 11:29

409.3E1 - Licensed Employee Family and Medical Leave Notice to Employees

409.3E1 - Licensed Employee Family and Medical Leave Notice to Employees

YOUR RIGHTS UNDER THE FAMILY AND MEDICAL LEAVE ACT OF 1993

 

FMLA requires covered employers to provide up to 12 weeks of unpaid, job-protected leave to eligible employees for the following reasons:

  •   For incapacity due to pregnancy, prenatal medical care or child birth;
  •   To care for the employee’s child after birth, or placement for adoption or foster care;
  •   To care for the employee’s spouse, son or daughter, or parent, who has a serious health condition; or
  •   For a serious health condition that makes the employee unable to perform the employee’s job.

 

MILITARY FAMILY LEAVE ENTITLEMENTS

Eligible employees with a spouse, son, daughter, or parent on active duty or call to active duty status in the National Guard or Reserves in support of a contingency operation may use their 12-week leave entitlement to address certain qualifying exigencies.

Qualifying exigencies may include attending certain military events, arranging for alternative childcare, addressing certain financial and legal arrangements, attending certain counseling sessions, and attending post-deployment reintegration briefings.

FMLA also includes a special leave entitlement that permits eligible employees to take up to 26 weeks of leave to care for a covered service member during a single 12-month period.  A covered service member is a current member of the Armed Forces, including a member of the National Guard or Reserves, who has a serious injury or illness incurred in the line of duty on active duty that may render the service member medically unfit to perform his or her duties for which the service member is undergoing medical treatment, recuperation, or therapy; or is in outpatient status; or is on the temporary disability retired list.

 

BENEFITS AND PROTECTION

During FMLA leave, the employer must maintain the employee’s health coverage under any “group health plan” on the same terms as if the employee had continued to work.  Upon return from FMLA leave, most employees must be restored to their original or equivalent positions with equivalent pay, benefits, and other employment terms.

Use of FMLA leave cannot result in the loss of any employment benefit that accrued prior to the start of any employee’s leave.

 

JOB ELIGIBILITY REQUIREMENTS

Employees are eligible if they have worked for a covered employer for at least one year, for 1,250 hours over the previous 12 months, and if at least 50 employees are employed by the employer within 75 miles.

 

DEFINITION OF SERIOUS HEALTH CONDITION

A serious health condition is an illness, injury, impairment, or physical or mental condition that involves either an overnight stay in a medical care facility, or continuing treatment by a health care provider for a condition that either prevents the employee from performing the functions of the employee’s job, or prevents the qualified family member from participating in school or other daily activities.

Subject to certain conditions, the continuing treatment requirement may be met by a period of incapacity of more than three consecutive calendar days combined with at least two visits to a health care provider or one visit and a regimen of continuing treatment, or incapacity due to pregnancy, or incapacity due to a chronic condition.  Other conditions may meet the definition of continuing treatment.

 

USE OF LEAVE

An employee does not need to use this leave entitlement in one block.  Leave can be taken intermittently or on a reduced leave schedule when medically necessary.  Employees must make reasonable efforts to schedule leave for planned medical treatment so as not to unduly disrupt the employer’s operations.  Leave due to qualifying exigencies may also be taken.

 

SUBSTITION OF PAID LEAVE FOR UNPAID LEAVE

Employees may choose or employers may require use of accrued paid leave while taking FMLA leave.  In order to use paid leave for FMLA leave, employees must comply with the employer’s normal paid leave policies.

 

EMPLOYEE RESPONSIBILITIES

Employees must provide 30 days advance notice of the need to take FMLA leave when the need is foreseeable.  When 30 days notice is not possible, the employee must provide notice as soon as practicable and generally must comply with an employer’s normal call-in procedures.

Employees must provide sufficient information for the employer to determine if the leave may qualify for FMLA protection and the anticipated timing and duration of the leave.  Sufficient information may include that the employee is unable to perform job functions, the family member is unable to perform daily activities, the need for hospitalization or continuing treatment by a health care provider, or circumstances supporting the need for military family leave.  Employees also must inform the employer if the requested leave is for a reason for which FMLA leave was previously taken or certified.  Employees also may be required to provide a certification and periodic recertification supporting the need for leave.

 

EMPLOYER REQPONSIBILITIES

Covered employers must inform employees requesting leave whether they are eligible under FMLA.  If they are, the notice must specify any additional information required as well as the employees’ rights and responsibilities.  If they are not eligible, the employer must provide a reason for the ineligibility.

Covered employers must inform employees if leave will be designated as FMLA-protected and the amount of leave counted against the employee’s leave entitlement.  If the employer determines that the leave is not FMLA-protected, the employer must notify the employee.

 

UNLAWFUL ACTS BY EMPLOYERS

FMLA makes it unlawful for any employer to:

  •   Interfere with, restrain, or deny the exercise of any right provided under FMLA;
  • Discharge or discriminate against any person for opposing any practice made unlawful by FMLA or for involvements in any proceeding under or relating to FMLA.

 

ENFORCEMENT

An employee may file a complaint with the U. S. Department of Labor or may bring a private lawsuit against an employer.

FMLA does not affect any Federal or State law prohibiting discrimination, or supersede any State or local law or collective bargaining agreement which provides greater family or medical leave rights.

 

NOTE:  FMLA section 109 (29 U.S.C. § 2619) requires FMLA covered employers to post the text of this notice.  Regulations 29 C.F.R. § 825.300(a) may require additional disclosures.

If you have access to the Internet visit FLMA’s website: http://www.dol.gov/esa/whd/fmla.  

To locate your nearest Wage-Hour Office, phone our toll-free information at 1-866-487-9243 or to the website at:  http://www.wagehour.dol.gov.

For a listing of records that must be kept by employers to comply with FMLA visit the U.S. Dept. of Labor’s website: http://www.dol.gov/dol/allcfr/ESA/Title_29/Part_825/29CFR825.500.htm.

 

 

Approved:  Oct. 12, 2009, February 18,2019    
Reviewed:  Sep. 14, 2009, Apr. 5, 2013, Jan.21, 2019      
Revised:                            

 

dawn.gibson.cm… Mon, 11/29/2021 - 12:52

409.3E2 - Licensed Employee Family and Medical Leave Request Form

409.3E2 - Licensed Employee Family and Medical Leave Request Form

Date:  ___________________

I, _______________________, request family and medical leave for the following reason:

(check all that apply)

          _____         for the birth of my child;

          _____         for the placement of a child for adoption or foster care;

          _____         to care for my child who has a serious health condition;

          _____         to care for my parent who has a serious health condition;

          _____         to care for my spouse who has a serious health condition;

                             or

          _____         because I am seriously ill and unable to perform the essential functions of my position.

          _____         because of a qualifying exigency arising out of the fact that my ___ spouse; ___ son or daughter; ___ parent is on active duty or call to
                             active duty status in support of a contingency operation as a member of the National Guard or Reserves.

          _____         because I am the ___ spouse; ___ son or daughter; ___ parent; ___ next of kin of a covered service member with a serious injury or
                             illness.

I acknowledge my obligation to provide medical certification of my serious health condition or that of a family member in order to be eligible for family and medical leave within 15 days of the request for certification.

I acknowledge receipt of information regarding my obligations under the family and medical leave policy of the school district.

I request that my family and medical leave begin on ___________ and I request leave as follows: (check one)

          _____         continuous

                             I anticipate that I will be able to return to work on __________.

          _____         intermittent leave for the:

                             _____         birth of my child or adoption or foster care placement subject to agreement by the district;

                             _____         serious health condition of ___ myself, ___ parent, ___ spouse, or ___ child when medically necessary;

                             _____         because of a qualifying exigency arising out of the fact that my ___ spouse; ___ son or daughter; ___ parent is on active duty
                                                or call to active duty status in support of a contingency operation as a member of the National Guard or Reserves.

                             _____         because I am the ___ spouse; ___ son or daughter; ___ parent;

                                                ___ next of kin of a covered service member with a serious injury or illness.

 

                             Details of the needed intermittent leave:

                   _______________________________________________________________

                   _______________________________________________________________

                   _______________________________________________________________

 

                             I anticipate returning to work at my regular schedule on _________________.

 

          _____         reduced work schedule for the:

                              _____         birth of my child or adoption or foster care placement subject to agreement by the district;

                             _____         serious health condition of myself, parent, spouse, or child when medically necessary;

                              _____         because of a qualifying exigency arising out of the fact that my ___ spouse; ___ son or daughter; ___ parent is on active
                                                 duty or call to active duty status in support of a contingency operation as a member of the National Guard or Reserves.

                              _____         because I am the ___ spouse; ___ son or daughter; ___ parent;

                                                ___ next of kin of a covered service member with a serious injury or illness.

 

                              Details of needed reduction in work schedule as follows:

                    _______________________________________________________________         

                   _______________________________________________________________

                     _______________________________________________________________

                            

                              I anticipate returning to work at my regular schedule on   _________________.

I realize I may be moved to an alternative position during the period of the family and medical intermittent or reduced work schedule leave.  I also realize that with foreseeable intermittent or reduced work schedule leave, subject to the requirements of my health care provider, I may be required to schedule the leave to minimize interruptions to school district operations.

While on family and medical leave, I agree to pay my regular contributions to employer-sponsored benefit plans.  My contributions will be deducted from monies owed me during the leave period.  If no monies are owed me, I will reimburse the school district by personal check or cash for my contributions.  I understand that I may be dropped from the employer-sponsored benefit plans for failure to pay my contribution.

I agree to reimburse the school district for any payment of my contributions with deductions from future monies owed to me or the school district may seek reimbursement of payments of my contributions in court.

 

I acknowledge that the above information is true to the best of my knowledge.

 

Signed _________________________________________________________________

 

Date     _________________________________________________________________

 

 

Approved:  Oct. 12, 2009, February 18, 2019          
Reviewed:  Sep. 14, 2009, Apr. 5, 2013, Jan.21, 2019      
Revised:                                               

 

dawn.gibson.cm… Mon, 11/29/2021 - 12:43

409.3E3 - Family and Medical Leave Certification

409.3E3 - Family and Medical Leave Certification dawn.gibson.cm… Mon, 11/29/2021 - 12:28

409.3E3A - Certification of Health Care Provider for Employee's Serious Health Condition

409.3E3A - Certification of Health Care Provider for Employee's Serious Health Condition

SECTION I: For Completion by the EMPLOYER

INSTRUCTIONS to the EMPLOYER: The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave due to a serious health condition to submit a medical certification issued by the employee’s health care provider. Please complete Section I before giving this form to your employee. Your response is voluntary. While you are not required to use this form, you may not ask the employee to provide more information than allowed under the FMLA regulations, 29 C.F.R. §§ 825.306-825.308. Employers must generally maintain records and documents relating to medical certifications, recertifications, or medical histories of employees created for FMLA purposes as confidential medical records in separate files/records from the usual personnel files and in accordance with 29 C.F.R. § 1630.14(c)(1), if the Americans with Disabilities Act applies.

 

Employer name and contact: _____________________________________________________________

 

Employee’s job title: _______________________ Regular work schedule: _______________________

 

Employee’s essential job functions: ______________________________________________________

 

Check if job description is attached: _____

 

SECTION II: For Completion by the EMPLOYEE

INSTRUCTIONS to the EMPLOYEE: Please complete Section II before giving this form to your medical provider. The FMLA permits an employer to require that you submit a timely, complete, and sufficient medical certification to support a request for FMLA leave due to your own serious health condition. If requested by your employer, your response is required to obtain or retain the benefit of FMLA protections. 29 U.S.C. §§ 2613, 2614(c)(3). Failure to provide a complete and sufficient medical certification may result in a denial of your FMLA request. 20 C.F.R. § 825.313. Your employer must give you at least 15 calendar days to return this form. 29 C.F.R. § 825.305(b).

Your name: _______________________________________________________________________________
                        First                                         Middle                                      Last

 

SECTION III: For Completion by the HEALTH CARE PROVIDER

INSTRUCTIONS to the HEALTH CARE PROVIDER: Your patient has requested leave under the FMLA. Answer, fully and completely, all applicable parts. Several questions seek a response as to the frequency or duration of a condition, treatment, etc. Your answer should be your best estimate based upon your medical knowledge, experience, and examination of the patient. Be as specific as you can; terms such as “lifetime,” “unknown,” or “indeterminate” may not be sufficient to determine FMLA coverage. Limit your responses to the condition for which the employee is seeking leave. Please be sure to sign the form on the last page.

 

Provider’s name and business address: ____________________________________________________

 

Type of practice / Medical specialty: _____________________________________________________

 

Telephone: (________)____________________________Fax:(_________)_______________________

 

 

PART A: MEDICAL FACTS                                                                                                                                                                                                                                   

1. Approximate date condition commenced: ________________________

 

Probable duration of condition: __________________________________________________________

 

Mark below as applicable:

Was the patient admitted for an overnight stay in a hospital, hospice, or residential medical care facility? ___No ___Yes. If so, dates of admission:

Date(s) you treated the patient for condition:

____________________________________________________________________________________

 

Will the patient need to have treatment visits at least twice per year due to the condition? ___No ___ Yes.

 

Was medication, other than over-the-counter medication, prescribed? ___No ___Yes.

 

Was the patient referred to other health care provider(s) for evaluation or treatment (e.g., physical therapist)? ____No Yes____. If so, state the nature of such treatments and expected duration of treatment:

 

2. Is the medical condition pregnancy? ___No ___Yes. If so, expected delivery date: ________________

 

3. Use the information provided by the employer in Section I to answer this question. If the employer fails        to provide a list of the employee’s essential functions or a job description, answer these questions based upon the employee’s own description of his/her job functions.

 

Is the employee unable to perform any of his/her job functions due to the condition: ____ No ____ Yes.

 

If so, identify the job functions the employee is unable to perform:

 

4. Describe other relevant medical facts, if any, related to the condition for which the employee seeks leave (such medical facts may include symptoms, diagnosis, or any regimen of continuing treatment such as the use of specialized equipment):

____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

 

 

PART B: AMOUNT OF LEAVE NEEDED

5. Will the employee be incapacitated for a single continuous period of time due to his/her medical condition, including any time for treatment and recovery?

____ No ____ Yes.

            If so, estimate the beginning and ending dates for the period of incapacity: __________________

 

6. Will the employee need to attend follow-up treatment appointments or work part-time or on a reduced schedule because of the employee’s medical condition?

___No ___Yes.

 

            If so, are the treatments or the reduced number of hours of work medically necessary?

             ___No ___Yes.

 

            Estimate treatment schedule, if any, including the dates of any scheduled appointments and the time required for each appointment, including any recovery period:

____________________________________________________________________________

            Estimate the part-time or reduced work schedule the employee needs, if any:

            _________hour(s) per day; ________ days per week from ____________through ____________

 

7. Will the condition cause episodic flare-ups periodically preventing the employee from performing his/her job functions? ____ No ____ Yes.

 

            Is it medically necessary for the employee to be absent from work during the flare-ups?   ____ No ____ Yes. If so, explain:

______________________________________________________________________________

______________________________________________________________________________

 

            Based upon the patient’s medical history and your knowledge of the medical condition, estimate        the frequency of flare-ups and the duration of related incapacity that the patient may have over         the next 6 months (e.g., 1 episode every 3 months lasting 1-2 days):

Frequency: _____ times per       _____ week(s) month(s) _____

 

            Duration: _____ hours or ___ day(s) per episode

 

ADDITIONAL INFORMATION: IDENTIFY QUESTION NUMBER WITH YOUR ADDITIONAL ANSWER.

_____________________________________________________________________________________ _____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

 

____________________________________________________________________________________
Signature of Health Care Provider                                                                      Date

 

 

 

 

 

 

PAPERWORK REDUCTION ACT NOTICE AND PUBLIC BURDEN STATEMENT

If submitted, it is mandatory for employers to retain a copy of this disclosure in their records for three years. 29 U.S.C. § 2616; 29 C.F.R. § 825.500.Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. The Department of Labor estimates that it will take an average of 20 minutes for respondents to complete this collection of information, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have any comments regarding this burden estimate or any other aspect of this collection information, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, U.S. Department of Labor, Room S-3502, 200 Constitution Ave., NW, Washington, DC 20210. DO NOT SEND COMPLETED FORM TO THE DEPARTMENT OF LABOR; RETURN TO THE PATIENT.

                                                                                                                               Form WH-380-E Revised January 2009

 

dawn.gibson.cm… Mon, 11/29/2021 - 12:39

409.3E3B - Certification for Serious Injury or Illness Covered Servicemember - for Military Family Leave

409.3E3B - Certification for Serious Injury or Illness Covered Servicemember - for Military Family Leave

Notice to the EMPLOYER INSTRUCTIONS to the EMPLOYER:  The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA leave due to a serious injury or illness of a covered servicemember to submit a certification providing sufficient facts to support the request for leave.  Your response is voluntary.  While you are not required to use this form, you may not ask the employee to provide more information than allowed under the FMLA regulations, 29 C.F.R. § 825.310.  Employers must generally maintain records and documents relating to medical certifications, recertifications, or medical histories of employees or employees’ family members, created for FMLA purposes as confidential medical records in separate files/records from the usual personnel files and in accordance with 29 C.F.R. § 1630.14(c)(1), if the Americans with Disabilities Act applies.

 

SECTION I:  For Completion by the EMPLOYEE and/or the COVERED SERVICEMEMBER for whom the Employee Is Requesting Leave INSTRUCTIONS to the EMPLOYEE or COVERED SERVICEMEMBER:  Please complete Section I before having Section II completed.  The FMLA permits an employer to require that an employee submit a timely, complete, and sufficient certification to support a request for FMLA leave due to a serious injury or illness of a covered servicemember.  If requested by the employer, your response is required to obtain or retain the benefit of FMLA-protected leave.  29 U.S.C. §§ 2613, 2614(c)(3).  Failure to do so may result in a denial of an employee’s FMLA request.  29 C.F.R. § 825.310(f).  The employer must give an employee at least 15 calendar days to return this form to the employer.

 

SECTION II:  For Completion by a UNITED STATES DEPARTMENT OF DEFENSE (“DOD”) HEALTH CARE PROVIDER or a HEALTH CARE PROVIDER who is either:  (1) a United States Department of Veterans Affairs (“VA”) health care provider; (2)  a DOD TRICARE network authorized private health care provider; or (3) a DOD non-network TRICARE authorized private health care provider INSTRUCTIONS to the HEALTH CARE PROVIDER:   The employee listed on Page 2 has requested leave under the FMLA to care for a family member who is a member of the Regular Armed Forces, the National Guard, or the Reserves who is undergoing medical treatment, recuperation, or therapy, is otherwise in outpatient status, or is otherwise on the temporary disability retired list for a serious injury or illness.  For purposes of FMLA leave, a serious injury or illness is one that was incurred in the line of duty on active duty that may render the servicemember medically unfit to perform the duties of his or her office, grade, rank, or rating.

A complete and sufficient certification to support a request for FMLA leave due to a covered servicemember’s serious injury or illness includes written documentation confirming that the covered servicemember’s injury or illness was incurred in the line of duty on active duty and that the covered servicemember is undergoing treatment for such injury or illness by a health care provider listed above.  Answer, fully and completely, all applicable parts.  Several questions seek a response as to the frequency or duration of a condition, treatment, etc.  Your answer should be your best estimate based upon your medical knowledge, experience, and examination of the patient.  Be as specific as you can; terms such as “lifetime,” “unknown,” or “indeterminate” may not be sufficient to determine FMLA coverage.  Limit your responses to the condition for which the employee is seeking leave.

 

SECTION I:  For Completion by the EMPLOYEE and /or the COVERED SERVICE MEMBER for whom the Employee Is Requesting Leave:  (This section must be completed first before any of the below sections can be completed by a health care provider.)

PART A:  EMPLOYEE INFORMATION

Name and Address of Employer (this is the employer of the employee requesting leave to care for covered servicemember):

______________________________________________________________________________

 

Name of Employee Requesting Leave to Care for Covered Servicemember:

______________________________________________________________________________
                      First                                       Middle                                     Last

 

Name of Covered Servicemember (for whom employee is requesting leave to care):

______________________________________________________________________________
                      First                                       Middle                                     Last

 

Relationship of Employee to Covered Servicemember Requesting Leave to Care:

         Spouse        Parent        Son             Daughter       Next of Kin

 

PART B:  COVERED SERVICE MEMBER INFORMATION

 

1.       Is the covered service member a current member of the Regular Armed Forces, the    National Guard or Reserves?      Yes       No

          If “yes,” please provide the covered service member’s military branch, rank and unit currently assigned to:  ______________________________________________________

 

Is the covered service member assigned to a military medical treatment facility as an outpatient or to a  unit established for the purpose of providing command control of members of the Armed Forces receiving medical care as outpatients (such as a medical hold or warrior transition unit)?  _____ Yes  _____ No.  If “yes, please provide the name of the medical treatment facility or unit:  ________________________________________

 

2.       Is the covered service member on the Temporary Disability Retired List (TDRL)?          Yes     No. 

 

PART C:  CARE TO BE PROVIDED TO THE COVERED SERVICE MEMBER

 

Describe the care to be provided to the covered service member and an estimate of the leave needed to provide the care: 

______________________________________________________________________________

______________________________________________________________________________

 

SECTION II:  For Completion by a United States Department of Defense (“DOD”) Health Care Provider or Health Care Provider who is either:  (1) a United States Department of Veterans Affairs (“VA”) health care provider; (2) a DOD TRICARE network authorized private health care provider; or (3) a DOD non-network TRICARE authorized private health care provider. If you are unable to make certain of the military-related determinations contained below in Part B, you are permitted to rely upon determinations from an authorized DOD representative (such as a DOD recovery care coordinator).  (Please ensure that Section I above has been completed before completing this section.)  Please be sure to sign the form on the last page.

 

PART A:  HEALTH CARE PROVIDER INFORMATION

Health Care Provider’s Name and Business Address:  

_________________________________________________________________________________________

 

Type of Practice/Medical Specialty:  ___________________________________________________________

 

Please state whether you are either:  (1) a DOD health care provider; (2) a VA health care provider; (3) a DOD TRICARE network authorized private health care provider; or (4) a DOD non-network TRICARE authorized private health care provider:  __________________________________________________________________

 

Telephone: (     ) ________________   Fax: (     ) ________________   Email: __________________________

 

PART B:  MEDICAL STATUS

 

1.       Covered servicemember’s medical condition is classified as (check one of the appropriate boxes):

 

           (VSI) Very Seriously Ill/Injured – Illness/Injury is of such a severity that life is imminently endangered.  Family members are requested at bedside immediately.  (Please note this is an internal DOD casualty assistance designation used by DOD healthcare providers.)         

           (SI) Seriously Ill/Injured – Illness/injury is of such severity that there is cause for immediate concern, but there is no imminent danger to life.  Family members are requested at bedside.  (Please note this is an internal DOD casualty assistance designation used by DOD healthcare providers.)

           OTHER Ill/Injured – A serious injury or illness that may render the service member medically unfit to perform the duties of the member’s office, grade, rank, or rating.

           NONE OF THE ABOVE (Note to Employee:  If this box is checked, you may still be eligible to take leave to care for a covered family member with a “serious health condition” under § 825.113 of the       FMLA.  If such leave is requested, you may be required to complete DOL FORM WH-380 or an employer-provided form seeking the same information.)

2.       Was the condition for which the covered service member is being treated incurred in line of duty on active duty in the Armed Forces?   Yes    No

 

3.       Approximate date condition commenced:  _______________________________________

                                                                                                                        

4.       Probably duration of condition and/or need for care:  ______________________________                                 

 

 

5.       Is the covered service member undergoing medical treatment, recuperation, or therapy?    

    Yes     No

 

                             If “yes,” please describe medical treatment, recuperation or therapy:          

_________________________________________________________________________

 

PART C:  COVERED SERVICEMEMBER’S NEED FOR CARE BY FAMILY MEMBER

 

1.       Will  the  covered  servicemember need care for a single continuous period  of  time, including any time for treatment and recovery?

    Yes     No

          If “yes,” estimate the beginning and ending dates for this period of time: _________________________

 

2.       Will the covered service member require periodic follow-up treatment appointments? 

 

    Yes     No

            If  “yes.” Estimate the treatment schedule:  _________________________________

 

 

3.       Is there a medical necessity for the covered service member to have periodic care for these follow-up treatment appointments?  

    Yes     No

 

 

 

4.       Is there a medical necessity for the covered servicemember to have periodic care for other than scheduled follow-up treatment appointments (e.g., episodic flare-ups of medical condition)? 

    Yes     No     If “yes,” please estimate the frequency and duration of the periodic care:  __________________________________________________________________________________________

 

__________________________________________________________________________________________

 

 

 

______________________________________     _____________________________________
Signature of Health Care Provider                       Date

 

         

 

 

PAPERWORK REDUCTION ACT NOTICE AND PUBLIC BURDEN STATEMENT

If  submitted,  it  is  mandatory  for  employers  to  retain  a  copy  of  this  disclosure  in  their records for 3 years in accordance with  29 U.S.C.  § 2616; 29 C.F.R. § 825.500.  Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number.  The Department of Labor estimates that it will take an average of 20 minutes for respondents to complete this collection of information, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  If you have any comments regarding this burden estimate or any other aspect of this collection information, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, U.S. Department of Labor, Room S-3502, 200 Constitution Ave., NW, Washington, DC   20210.  DO NOT SEND COMPLETED FORM TO THE DEPARTMENT OF LABOR; RETURN TO THE PATIENT.

 

dawn.gibson.cm… Mon, 11/29/2021 - 12:29

409.3E3C - Certification of Health Care Provider for Family Member's Serious Health Condition

409.3E3C - Certification of Health Care Provider for Family Member's Serious Health Condition

SECTION I: For Completion by the EMPLOYER

INSTRUCTIONS to the EMPLOYER: The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave to care for a covered family member with a serious health condition to submit a medical certification issued by the health care provider of the covered family member. Please complete Section I before giving this form to your employee. Your response is voluntary. While you are not required to use this form, you may not ask the employee to provide more information than allowed under the FMLA regulations, 29 C.F.R. §§ 825.306-825.308. Employers must generally maintain records and documents relating to medical certifications, recertifications, or medical histories of employees’ family members, created for FMLA purposes as confidential medical records in separate files/records from the usual personnel files and in accordance with 29 C.F.R. § 1630.14(c)(1), if the Americans with Disabilities Act applies.

 

 Employer name and contact: _______________________________________________________________________

_______________________________________________________________________________________________

 

SECTION II: For Completion by the EMPLOYEE

INSTRUCTIONS to the EMPLOYEE: Please complete Section II before giving this form to your family member or his/her medical provider. The FMLA permits an employer to require that you submit a timely, complete, and sufficient medical certification to support a request for FMLA leave to care for a covered family member with a serious health condition. If requested by your employer, your response is required to obtain or retain the benefit of FMLA protections. 29 U.S.C. §§ 2613, 2614(c)(3). Failure to provide a complete and sufficient medical certification may result in a denial of your FMLA request. 29 C.F.R. § 825.313. Your employer must give you at least 15 calendar days to return this form to your employer. 29 C.F.R. § 825.305.

 

 Your name: ____________________________________________________________________________________
                        First                                         Middle                                      Last

 

 Name of family member for whom you will provide care:________________________________________________
                                                                                      First                     Middle                      Last

 Relationship of family member to you: ______________________________________________________________

 

 If family member is your son or daughter, date of birth:__________________________________________________

 

 Describe care you will provide to your family member and estimate leave needed to provide care:

­­­­­­­­­­­­­­­­­­­­­­­­­­_______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

 

_____________________________________________                    ________________________________________
 Employee Signature                                                                       Date

 

 

SECTION III: For Completion by the HEALTH CARE PROVIDER INSTRUCTIONS to the HEALTH CARE PROVIDER: The employee listed above has requested leave under the FMLA to care for your patient. Answer, fully and completely, all applicable parts below. Several questions seek a response as to the frequency or duration of a condition, treatment, etc. Your answer should be your best estimate based upon your medical knowledge, experience, and examination of the patient. Be as specific as you can; terms such as “lifetime,” “unknown,” or “indeterminate” may not be sufficient to determine FMLA coverage. Limit your responses to the condition for which the patient needs leave. Page 3 provides space for additional information, should you need it. Please be sure to sign the form on the last page.

 

Provider’s name and business address:________________________________________________________________

 

Type of practice / Medical specialty: _________________________________________________________________

 

Telephone: (________)____________________________ Fax:(_________)__________________________________

 

PART A: MEDICAL FACTS

1. Approximate date condition commenced: ____________________________________________________________ Probable duration of condition: ____________________________________________________________________

Was the patient admitted for an overnight stay in a hospital, hospice, or residential medical care facility?

___No ___Yes. If so, dates of admission: ______________________________________________________________

 

Date(s) you treated the patient for condition: ___________________________________________________________

 

Was medication, other than over-the-counter medication, prescribed? No ______Yes.

 

Will the patient need to have treatment visits at least twice per year due to the condition? ___No ____ Yes.

 

Was the patient referred to other health care provider(s) for evaluation or treatment (e.g., physical therapist)?

____ No ____Yes. If so, state the nature of such treatments and expected duration of treatment:  

_______________________________________________________________________________________________

_______________________________________________________________________________________________

 

2. Is the medical condition pregnancy? ___No ___Yes. If so, expected delivery date: ___________________________

 

3. Describe other relevant medical facts, if any, related to the condition for which the patient needs care (such medical facts may include symptoms, diagnosis, or any regimen of continuing treatment such as the use of specialized equipment):

_______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________

 

 

PART B: AMOUNT OF CARE NEEDED: When answering these questions, keep in mind that your patient’s need for care by the employee seeking leave may include assistance with basic medical, hygienic, nutritional, safety or transportation needs, or the provision of physical or psychological care:

 

4. Will the patient be incapacitated for a single continuous period of time, including any time for treatment and recovery? ___No ___Yes.

 

    Estimate the beginning and ending dates for the period of incapacity: ______________________________________

 

    During this time, will the patient need care? __ No __ Yes.

 

    Explain the care needed by the patient and why such care is medically necessary: _____________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

 

5. Will the patient require follow-up treatments, including any time for recovery? ___No ___Yes.

     Estimate treatment schedule, if any, including the dates of any scheduled appointments and the time required for each appointment, including any recovery period:

 

­­­­­­­­­­­­­­­­­­­­_________________________________________________________________________________________________

 

Explain the care needed by the patient, and why such care is medically necessary: _______________________________

 

_________________________________________________________________________________________________

 

6. Will the patient require care on an intermittent or reduced schedule basis, including any time for recovery?

     __ No __ Yes.

 

     Estimate the hours the patient needs care on an intermittent basis, if any:

 

_________ hour(s) per day; ________ days per week              from _________________ through __________________

 

Explain the care needed by the patient, and why such care is medically necessary: _______________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

 

7. Will the condition cause episodic flare-ups periodically preventing the patient from participating in normal daily     activities? ____No ____Yes.

    

     Based upon the patient’s medical history and your knowledge of the medical condition, estimate the frequency of flare-ups and the duration of related incapacity that the patient may have over the next 6 months (e.g., 1 episode every 3 months lasting 1-2 days):

 

     Frequency: _____ times per _____ week(s) _____ month(s)

 

     Duration: _____ hours or ___ day(s) per episode

 

     Does the patient need care during these flare-ups? ____ No ____ Yes.

 

     Explain the care needed by the patient, and why such care is medically necessary: _____________________________

  _______________________________________________________________________________________________

_______________________________________________________________________________________________

_______________________________________________________________________________________________
_______________________________________________________________________________________________

 

ADDITIONAL INFORMATION: IDENTIFY QUESTION NUMBER WITH YOUR ADDITIONAL ANSWER.  

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

 

_______________________________________________ _____________________________________________

Signature of Health Care Provider                                          Date

 

 

PAPERWORK REDUCTION ACT NOTICE AND PUBLIC BURDEN STATEMENT If submitted, it is mandatory for employers to retain a copy of this disclosure in their records for three years. 29 U.S.C. § 2616; 29 C.F.R. § 825.500. Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. The Department of Labor estimates that it will take an average of 20 minutes for respondents to complete this collection of information, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have any comments regarding this burden estimate or any other aspect of this collection information, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, U.S. Department of Labor, Room S-3502, 200 Constitution Ave., NW, Washington, DC 20210.

DO NOT SEND COMPLETED FORM TO THE DEPARTMENT OF LABOR; RETURN TO THE PATIENT.

 

dawn.gibson.cm… Mon, 11/29/2021 - 12:25

409.3E4 - Designation Notice

409.3E4 - Designation Notice

Leave covered under the Family and Medical Leave Act (FMLA) must be designated as FMLA-protected and the employer must inform the employee of the amount of leave that will be counted against the employee’s FMLA leave entitlement. In order to determine whether leave is covered under the FMLA, the employer may request that the leave be supported by a certification. If the certification is incomplete or insufficient, the employer must state in writing what additional information is necessary to make the certification complete and sufficient. While use of this form by employers is optional, a fully completed Form WH-382 provides an easy method of providing employees with the written information required by 29 C.F.R. §§ 825.300(c), 825.301, and 825.305(c).________

 To:  _____________________________________________

 Date: ____________________________________________

We have reviewed your request for leave under the FMLA and any supporting documentation that you have provided.

We received your most recent information on ______________________________________________ and decided:                     

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 _____ Your FMLA leave request is approved. All leave taken for this reason will be designated as FMLA leave.

 

The FMLA requires that you notify us as soon as practicable if dates of scheduled leave change or are extended, or were initially unknown. Based on the information you have provided to date, we are providing the following information about the amount of time that will be counted against your leave entitlement:

 _____   Provided there is no deviation from your anticipated leave schedule, the following number of hours, days, or weeks will be counted against your leave entitlement: _____________________________________________

 

 _____   Because the leave you will need will be unscheduled, it is not possible to provide the hours, days, or weeks that will be counted against your FMLA entitlement at this time. You have the right to request this information once in a 30-day period (if leave was taken in the 30-day period).

 

 Please be advised (check if applicable):

_____    You have requested to use paid leave during your FMLA leave. Any paid leave taken for this reason will count against your FMLA leave entitlement.

 

 _____   We are requiring you to substitute or use paid leave during your FMLA leave.

 

 ______   You will be required to present a fitness-for-duty certificate to be restored to employment. If such certification is not timely received, your return to work may be delayed until certification is provided. A list of the essential functions of your position ___ is ___is not attached. If attached, the fitness-for-duty certification must address your ability to perform these functions.

____________________________________________________________________________________________________________

 _____ Additional information is needed to determine if your FMLA leave request can be approved:

 

_____ The certification you have provided is not complete and sufficient to determine whether the FMLA applies to your leave   request. You must provide the following information no later than ______________________________, unless it is not practicable under the particular circumstances despite your diligent good faith efforts, or your leave may be denied.
                            (Provide at least seven calendar days)

__________________________________________________________________________________________
(Specify information needed to make the certification complete and sufficient)

____________________________________________________________________________________________________________

 

_____    We are exercising our right to have you obtain a second or third opinion medical certification at our expense, and we will   provide further details at a later time.

___________________________________________________________________________________________________________

_____    Your FMLA Leave request is Not Approved

_____    The FMLA does not apply to your leave request.

_____    You have exhausted your FMLA leave entitlement in the applicable 12-month period.

____________________________________________________________________________________________________________

PAPERWORK REDUCTION ACT NOTICE AND PUBLIC BURDEN STATEMENT

It is mandatory for employers to inform employees in writing whether leave requested under the FMLA has been determined to be covered under the FMLA. 29 U.S.C. § 2617; 29 C.F.R. §§ 825.300(d), (e). It is mandatory for employers to retain a copy of this disclosure in their records for three years. 29 U.S.C. § 2616; 29 C.F.R. § 825.500. Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. The Department of Labor estimates that it will take an average of 10 – 30 minutes for respondents to complete this collection of information, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have any comments regarding this burden estimate or any other aspect of this collection information, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, U.S. Department of Labor, Room S-3502, 200 Constitution Ave., NW, Washington, DC 20210. DO NOT SEND THE COMPLETED FORM TO THE WAGE AND HOUR DIVISION.                                                                                                                                   Form WH-382 January 2009    

 

dawn.gibson.cm… Mon, 11/29/2021 - 12:17

409.3E4D - Employer Response to Employee Request for Family or Medical Leave

409.3E4D - Employer Response to Employee Request for Family or Medical Leave

dawn.gibson.cm… Mon, 11/29/2021 - 12:14

409.3E5 - Certification of Qualifying Exigency For Military Family Leave

409.3E5 - Certification of Qualifying Exigency For Military Family Leave

SECTION I: For Completion by the EMPLOYER

INSTRUCTIONS to the EMPLOYER: The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA leave due to a qualifying exigency to submit a certification. Please complete Section I before giving this form to your employee. Your response is voluntary, and while you are not required to use this form, you may not ask the employee to provide more information than allowed under the FMLA regulations, 29 C.F.R. § 825.309.

 

Employer name: __________________________________________________________________________________

 

Contact Information: _______________________________________________________________________________

 

 

SECTION II: For Completion by the EMPLOYEE

INSTRUCTIONS to the EMPLOYEE: Please complete Section II fully and completely. The FMLA permits an employer to require that you submit a timely, complete, and sufficient certification to support a request for FMLA leave due to a qualifying exigency. Several questions in this section seek a response as to the frequency or duration of the qualifying exigency. Be as specific as you can; terms such as “unknown,” or “indeterminate” may not be sufficient to determine FMLA coverage. Your response is required to obtain a benefit. 29 C.F.R. § 825.310. While you are not required to provide this information, failure to do so may result in a denial of your request for FMLA leave. Your employer must give you at least 15 calendar days to return this form to your employer.

 

 Your Name: ____________________________________________________________________________________
                        First                                         Middle                          Last

 

 Relationship of covered military member to you: ________________________________________________________

 

 Period of covered military member’s active duty: ________________________________________________________

 

A complete and sufficient certification to support a request for FMLA leave due to a qualifying exigency includes written documentation confirming a covered military member’s active duty or call to active duty status in support of a contingency operation. Please check one of the following:

 ___ A copy of the covered military member’s active duty orders is attached.

 ___ Other documentation from the military certifying that the covered military member is on active duty (or has been notified of an impending call to active duty) in support of a contingency operation is attached.

 

___  I have previously provided my employer with sufficient written documentation confirming the covered military member’s active duty or call to active duty status in support of a contingency operation.

 

 

 

PART A: QUALIFYING REASON FOR LEAVE

1.         Describe the reason you are requesting FMLA leave due to a qualifying exigency (including the specific reason you are requesting leave):

__________________________________________________________________________________________

­­__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

 

2.         A complete and sufficient certification to support a request for FMLA leave due to a qualifying exigency includes any available written documentation which supports the need for leave; such documentation may include a copy of a meeting announcement for informational briefings sponsored by the military, a document confirming an appointment with a counselor or school official, or a copy of a bill for services for the handling of legal or financial affairs. Available written documentation supporting this request for leave is attached.

            ___ Yes ___ No ___ None Available

 

PART B: AMOUNT OF LEAVE NEEDED

1.         Approximate date exigency commenced: _________________________________________________________

            Probable duration of exigency: _________________________________________________________________

 

2.         Will you need to be absent from work for a single continuous period of time due to the qualifying exigency? ___No ___Yes.

            If so, estimate the beginning and ending dates for the period of absence:

__________________________________________________________________________________________

 

3.         Will you need to be absent from work periodically to address this qualifying exigency? ___No ___ Yes.

            Estimate schedule of leave, including the dates of any scheduled meetings or appointments: ________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

 

            Estimate the frequency and duration of each appointment, meeting, or leave event, including any travel

            time (i.e., 1 deployment-related meeting every month lasting 4 hours):

           

            Frequency: _____ times per _____ week(s) _____ month(s)

           

            Duration: _____ hours ___ day(s) per event.

 

PART C:

If leave is requested to meet with a third party (such as to arrange for childcare, to attend counseling, to attend meetings with school or childcare providers, to make financial or legal arrangements, to act as the covered military member’s representative before a federal, state, or local agency for purposes of obtaining, arranging or appealing military service benefits, or to attend any event sponsored by the military or military service organizations), a complete and sufficient certification includes the name, address, and appropriate contact information of the individual or entity with whom you are meeting (i.e., either the telephone or fax number or email address of the individual or entity). This information may be used by your employer to verify that the information contained on this form is accurate.

 

Name of Individual: ___________________________ Title: ___________________________________________

Organization: _________________________________________________________________________________

Address: _____________________________________________________________________________________

Telephone: (________)_________________________ Fax: (_______)____________________________________

Email: _______________________________________________________________________________________

Describe nature of meeting: ______________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

PART D:

 

I certify that the information I provided above is true and correct.

 

___________________________________________            ________________________________________
Signature of Employee                                                         Date

 

 

PAPERWORK REDUCTION ACT NOTICE AND PUBLIC BURDEN STATEMENT

If submitted, it is mandatory for employers to retain a copy of this disclosure in their records for three years. 29 U.S.C. § 2616; 29 C.F.R. § 825.500. Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. The Department of Labor estimates that it will take an average of 20 minutes for respondents to complete this collection of information, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have any comments regarding this burden estimate or any other aspect of this collection information, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, U.S. Department of Labor, Room S-3502, 200 Constitution AV, NW, Washington, DC 20210. DO NOT SEND THE COMPLETED FORM TO THE WAGE AND HOUR DIVISION; RETURN IT TO THE EMPLOYER.

 

 

 

 

 

 

                                                                                                                             Form WH-384 January 2009

dawn.gibson.cm… Mon, 11/29/2021 - 12:07

409.3E6 - Family and Medical Leave Request Work Sheet

409.3E6 - Family and Medical Leave Request Work Sheet

Complete this work sheet upon receiving a request for family and medical leave that may qualify under the Family Medical Leave Act.  Be sure to note the requirements relating to family and medical leave in the District's policy/collective bargaining agreement prior to relying on this work sheet as the sole source of the District's obligations.  Also be sure to note the definitions in the Regulations.

 

Section I:  Eligible Employee(Please check all that apply.)

                      Covered by a policy/collective bargaining agreement.  (If checked, please move to Section II.)

                      The employee must meet all criteria below to move to Section II.

                                     50 or more employees are on the payroll of or under contract to the District.

                                     Worked 52 weeks in the District (consecutive or nonconsecutive) or

                                     Worked 12 months in the District (consecutive or nonconsecutive).

                                     Worked 1250 hours for the District in 12 months prior to the request.  Full-time professional employees who are exempt from the wage and hour law may be presumed to have worked the minimum hours required.

 

Section II:  Family and Medical Leave Purpose. (One must be checked to move to Section III.)

                      Birth and care of newborn prior to first anniversary of child's birth.

                      Care of adopted child or foster care child prior to first anniversary of placement.

                      Care for serious health condition of spouse, child, child for which employee is "in loco parentis" and for any of these if they are over eighteen and have a disability which prevents the child from caring for himself or herself.

                                     Requested medical certification for family and medical leave due to a serious health condition of the spouse, parent or child on                                (date).

                                     Received medical certification within 15 days of the request on                                (date).

                      Serious health condition of the employee.

                                     Requested medical certification for family and medical leave due to a serious health condition of the employee on                              (date).

                                     Received medical certification within 15 days of the request on                               (date).

                      Other purposes contained in a policy/collective bargaining agreement.

 

Section III:  Timing of Family and Medical Leave Request.

                      Date of family and medical leave request                                     (date).

                      Date family and medical leave to begin                                      (date).

                      Provide FMLA leave information to employee at time of request                                                         (date).

(If one is checked, please move to Section IV.)

                      Leave request for foreseeable family and medical leave is 30 days prior to date family and medical leave begins.

                      Leave request for foreseeable family and medical leave is in compliance with policy/collective bargaining agreement.

                      Leave request for foreseeable family and medical leave was made as soon as practicable, and no later than one business day, prior to date family and medical leave begins.

                      Leave request for unforeseeable family and medical leave was made in accordance with the policy/collective bargaining agreement timelines.

 

Section IV:  Calculation of Available Family and Medical Leave.

Beginning date for 12-month entitlement period:  (Check the method adopted by the District.)

        X      July 1 (fiscal year)

                 January 1 (calendar year)

                 September I (school year)

                 First day of forward 12-month entitlement period

                 First day of rolling backward 12-month entitlement period______________________

                 Collective bargaining agreement year

                 Other

 

Total family and medical leave for the 12-month entitlement period                                                             12 weeks    
Leave taken to date in the entitlement period                                                                                                              -                   
Leave available for the entitlement period                                                                                                                                        

If sufficient family and medical leave is available and the employee qualifies for family and medical leave, the family and medical leave will be granted in accordance with the policy/collective bargaining agreement.

The employee must be informed that the actual family and medical leave taken will be credited to the employee's 12-week entitlement.

If both spouses are employed by the District, they may only take a combined total of 12 weeks during the entitlement period for the birth, adoption or foster care placement prior to the first anniversary of the child's birth or placement and for the care of a parent with a serious health condition.

If insufficient family and medical leave is available, the District may award only the family and medical leave available or award the family and medical leave in accordance with  other provisions of the policy/collective bargaining agreement.

 

Section V: Types of Family and Medical Leave. (Please check all that apply.)

                      Continuous leave for purposes listed in Section II.

                      Intermittent leave for birth, adoption or foster care placement prior to first anniversary of child's birth or placement with District approval in accordance with other provisions of the policy/collective bargaining agreement.

                      Reduced work schedule leave for birth, adoption or foster care placement prior to first anniversary of child's birth or placement with District approval in accordance with other provisions of the policy/collective bargaining agreement.

                      Intermittent leave if medically necessary for serious health condition of employee or family member and arranged as much as possible to not disrupt the District's operation.

                      Reduced work schedule leave if medically necessary for serious health condition of employee or family member and arranged as much as possible to not disrupt the District's operation.

                      Others contained in a policy/collective bargaining agreement. 

(Please specify.)                                                                                                          

 

Section VI:  Instructional Employee Intermittent or Reduced Schedule Leave.

                      A policy/collective bargaining agreement extends this rule to non-instructional employees.

                      A policy/collective bargaining agreement eliminates this rule for instructional employees.

                      Instructional employees' intermittent or reduced schedule leave for greater than 20 percent of the work days in the family and medical leave period.

                      Total number of days during leave period                        

                                                                                                        x  .20

                      20 percent of leave days                                                    

                      Days of leave requested                                                    

If the number of days requested exceeds 20 percent of the family and medical leave days, the District may require the instructional employee to take family and medical leave for the entire leave period OR transfer the instructional employee to an alternative position with equivalent pay and benefits.  The employee must be informed that the actual family and medical leave taken will be credited to the employee's 12-week entitlement.

 

Section VII:  Instructional Employees Family and Medical Leave Special Rules.

                      Instructional employee.

                      A policy/collective bargaining agreement extends one or all of these rules to noninstructional employees.

                      A policy/collective bargaining agreement eliminates one or all of these rules for instructional employees.

                      The District can require the employee to remain on family and medical leave until end of the semester if each of the following apply:

                                     Leave begins prior to five weeks before end of semester;

                                     Leave is for three weeks or more; and

                                     Employee will return during last three weeks of semester.

                      Last work day of the semester                                                    

                      Date of fifth week before end of the semester                            

                      Date of third week before end of the semester                            

                      Date of requested leave                                                               

                      Length of requested leave                                                           

                      Date of return from leave                                                            

 

                      The District can require employee to remain on family and medical leave for leave other than an employee's serious health condition until end of semester if each of the following apply:

                                     Leave begins during last five weeks before end of semester;

                                     Leave is greater than two weeks; and

                                     Employee will return during last two weeks of semester.

 

                      Last work day of the semester                                                     

                      Date of fifth week before end of the semester                             

                      Date of second week before end of the semester                         

 

                      Date of requested leave                                                                

                      Length of requested leave                                                            

                      Date of return from leave                                                             

 

                      The District can require the employee to remain on family and medical leave for purpose other than an employee's serious health condition until the end of the semester if each of the following apply:

                                     Leave begins during last three weeks before end of the semester; and

                                     Leave is greater than five working days.

                     

                      Last work day of the semester                                                      

                      Date of third week before end of the semester                             

 

                      Date of requested leave                                                                

                      Length of requested leave                                                            

 

The employee must be informed that the actual family and medical leave taken under these rules will be credited to the employee's 12-week entitlement.

 

Section VIII:  Paid or Unpaid Family and Medical Leave.

                      Provide employee notice whether the family and medical leave is paid or unpaid leave after completing the work sheet in accordance with the policy/collective bargaining agreement.

                      Policy/collective bargaining agreement allows or requires substitution of paid leave for family and medical leave.                                                                                                            

                      Family and medical leave is unpaid leave.

 

Section IX:  Employee Progress Report.

                      Arrangements are made with the employee to report to the District on a regular basis during the family and medical leave (please specify).

                                                                                                                                                 

                      Requested medical recertification for family and medical leave due to a serious health condition of the spouse, parent or child on                                                    (date).

                      Received medical recertification within 15 days of the request on                           (date).

 

Section X:  Employee Benefits During Family and Medical Leave.

The employee's health insurance coverage must be continued during the period of family and medical leave (up to 12 weeks).  The District may choose to continue other employee benefits to ensure their restoration along with the health insurance upon the employee's return to work.  The employee will pay the employee's share of health insurance and other benefits during the leave period.

                      Arrangements have been made with the employee to continue the employee's share of health insurance premiums while on family and medical leave:

                                     From monies due to the employee

                                     By the first of each month from the employee

                                     Other (please specify)

                      Arrangements have been made with the employee to continue the employee's share of the employee's other benefits while on family and medical leave:

                                     From monies due to the employee

                                     By the first of each month from the employee

                                     Other (please specify)                                                              

                      The employee has chosen to discontinue all employee benefits while on family and medical leave.                  

                      Employees who fail to provide payment of the employee's share of benefits premium during the period of family and medical leave have 15 days following notice to pay the employee's share.

                      Employees who fail to pay within 15 days after receiving notice of payment due may have employee benefits discontinued.

                      The District will deduct unpaid employee portion of benefits from monies due to the employee upon return to work, and the employee has signed a written statement authorizing the deduction.

                      The District will seek recovery of unpaid employee portion of benefits through small claims court or other appropriate recovery process.

 

Even if the employee chooses to discontinue employee benefits during the period of family and medical leave, the District should exercise great care before discontinuing employee benefits.  The District is required to restore the employee to full benefits when the employee returns to work, including group health insurance, without any qualifying period, physical examination, exclusion of pre-existing conditions and other similar requirements.

                      The District may discontinue the employee's benefits upon receipt of written notice of the employee's intent not to return to work.

 

Section XI:  Key Employees.

                      Salaried employees among the highest paid ten percent of a District's employees are considered key employees of the District.

                      Year-to-date earnings for employee                                             

                      Total weeks of work and paid leave                        –                   

                      Highest pay for employee                                       =                   

                      Provide notice to key employee stating the employee is a key employee and the employee may not be reinstated at end of the family and medical leave period if substantial and grievous economic injury exists.

                      Compile data to justify substantial and grievous economic injury.  Substantial and grievous economic injury does not include minor inconvenience and costs typical to the normal operation of the District.

                      The key employee is entitled to benefits during the family and medical leave in the same manner as other employees.

              

 

Section XII:  Employee's Return to Work.

                      Employee is fully restored to the same or an equivalent position with:

                                Pay and benefits

                                Health insurance

                                Life insurance

                          _____Other benefits or requirements in a policy/collective bargaining agreement

 

dawn.gibson.cm… Mon, 11/29/2021 - 11:54

409.3R1 - Licensed Employee Family and Medical Leave Regulation

409.3R1 - Licensed Employee Family and Medical Leave Regulation

A.      School district notice.

          1.       The school district will post the notice in Exhibit 409.3E1 regarding family and medical leave.

          2.       Information on the Family and Medical Leave Act and the board policy on family and medical leave, including leave provisions and employee
                    obligations will be provided annually.  The information will be in the Board Policy provided on-line.

          3.       When an employee requests family and medical leave, the school district will provide the employee with information listing the employee’s
                    obligations and requirements.  Such information will include:

                   a.       a statement clarifying whether the leave qualifies as family and medical leave and will, therefore, be credited to the employee’s annual
                            12-week entitlement or 26-week entitlement depending on the purpose of the leave;

                   b.       a reminder that employees requesting family and medical leave for their serious health condition or for that of an immediate family
                             member must furnish medical certification of the serious health condition and the consequences for failing to do so or proof of call to
                             active duty in the case of military family and medical leave;

                   c.       an explanation of the employee’s right to substitute paid leave for family and medical leave including a description of when the school
                             district requires substitution of paid leave and the conditions related to the substitution; and

                    d.       a statement notifying employees that they must pay and must make arrangement for paying any premium or other payments to maintain
                              health or 
other benefits.

 

B.      Eligible employees.

          Employees are eligible for family and medical leave if three criteria are met.

          1.       The school district has more than 50 employees on the payroll at the time leave is requested;

          2.       The employee has worked for the school district for at least 12 months or 52 weeks (the months and weeks need not be consecutive); and

          3.       The employee has worked at least 1,250 hours within the previous year.  Full-time professional employees who are exempt from the wage and
                    hour law may be presumed to have worked the minimum hour requirement.

If the employee requesting leave is unable to meet the above criteria, the employee is not eligible for family and medical leave.                            

 

C.      Employee requesting leave – two types of leave.

          1.       Foreseeable family and medical leave.

                   a.       Definition – leave is foreseeable for the birth or placement of an adopted or foster child with the employee or for planned medical
                             treatment.

                   b.       Employee must give at least 30 days notice for foreseeable leave.  Failure to give the notice may result in the leave beginning 30 days
                             after notice was received.  For those taking leave due to military family and medical leave, notice should be given as soon as possible.

                   c.       Employees must consult with the school district prior to scheduling planned medical treatment leave to minimize disruption to the school
                             district.  The scheduling is subject to the approval of the health care provider.

          2.       Unforeseeable family and medical leave.

                   a.       Definition – leave is unforeseeable, in such situations as emergency medical treatment or premature birth.

                   b.       Employee must give notice as soon as possible but no later than one to two work days after learning that leave will be necessary.

                   c.       A spouse or family member may give the notice if the employee is unable to personally give notice.

 

D.      Eligible family and medical leave determination.  The school district may require the employee giving notice of the need for leave to provide reasonable documentation or a statement of family relationship.

          1.       Six purposes.

                   a.       The birth of a son or daughter of the employee and in order to care for that son or daughter prior to the first anniversary of the child’s
                             birth;

                   b.       The placement of a son or daughter with the employee for adoption or foster care and in order to care for that son or daughter prior to the
                             first anniversary of the child’s placement;

                   c.       To care for the spouse, son, daughter, or parent of the employee if the spouse, son, daughter or parent has a serious health condition; or

                   d.       Employee’s serious health condition that makes the employee unable to perform the essential functions of the employee’s position.

                   e.       Because of a qualifying exigency arising out of the fact that an employee’s spouse; son or daughter; parent is on active duty or call to
                             active duty status in support of a contingency operation as a member of the National Guard or Reserves.

                    f.       Because the employee is the spouse; son or daughter; parent; next of kin of a covered service member with a serious injury or illness.

          2.       Medical certification.

                   a.       When required:

                             (1)     Employees shall be required to present medical certification of the employee’s serious health condition and inability to perform the
                                       essential functions of the job.

                             (2)     Employees will be required to present medical certification of the family member’s serious health condition and that it is medically
                                       necessary for the employee to take leave to care for the family member.

                     (3)    Employees will be required to present certification of the call to active duty when taking military family and medical leave.

                   b.       Employee’s medical certification responsibilities:

                             (1)     The employee must obtain the certification from the health care provider who is treating the individual with the serious health
                                       condition.

                             (2)     The school district may require the employee to obtain a second certification by a health care provider chosen by and paid for by
                                       the school district if the school district has reason to doubt the validity of the certification an employee submits.  The second health
                                       care provider cannot, however, be employed by the school district on a regular basis.

                             (3)     If the second health care provider disagrees with the first health care provider, then the school district may require a third health
                                       care provider to certify the serious health condition.  This health care provider must be mutually agreed upon by the employee and
                                       the school district and paid for by the school district.  This certification or lack of certification is binding upon both the employee
                                       and the school district.

                   c.       Medical certification will be required 15 days after family and medical leave begins unless it is impracticable to do so.  The school
                             district may request recertification every 30 days.  Recertification must be submitted within 15 days of the school district’s request.

                   d.       Employees taking military caregiver family and medical leave to care for a family service member cannot be required to obtain a second
                             opinion or to provide recertification.

Family and medical leave requested for the serious health condition of the employee or to care for a family member with a serious health condition which is not supported by medical certification will be denied until such certification is provided.

 

E.      Entitlement.

          1.       Employees are entitled to 12 weeks unpaid family and medical leave per year.  Employees taking military caregiver family and medical leave
                    to care for a family service member are entitled to 26 weeks of unpaid family and medical leave but only in a single 12 month period.

          2.       Year is defined as fiscal year – beginning July 1.

          3.       If insufficient leave is available, the school district may.

                   a.       Deny the leave if entitlement is exhausted.

                   b.       Award leave available.

                   c.       Award leave in accordance with other provisions of board policy or the collective bargaining agreement.

 

F.       Type of Leave Requested.

          1.       Continuous – employee

          2.       Intermittent – employee requests family and medical leave for separate periods of time.

                    a.      Intermittent leave is available for:

                             _____         birth of my child or adoption or foster care placement subject to agreement by the district;

                             _____         serious health condition of myself, parent, spouse, or child when medically necessary;

                             _____         because of a qualifying exigency arising out of the fact that my spouse; son or daughter; parent is on active duty or call to
                                                active duty status in support of a contingency operation as a member of the National Guard or Reserves.

                             _____         because I am the spouse; son or daughter; parent; next of kin of a covered service member with a serious injury or illness.

                   b.       In the case of foreseeable intermittent leave, the employee must schedule the leave to minimize disruption to the school district
                             operation.

                   c.       During the period of foreseeable intermittent leave, the school district may move the employee to an alternative position with equivalent
                             pay and benefits.

                             (For instructional employees, see G below.)

          3.       Reduced work schedule – employee requests a reduction in the employee’s regular work schedule.

                   a.       Reduced work schedule family and medical leave is available for:

                             _____         birth of my child or adoption or foster care placement subject to agreement by the district;

                             _____         serious health condition of myself, parent, spouse, or child when medically necessary;

                             _____         because of a qualifying exigency arising out of the fact that my spouse; son or daughter; parent is on active duty or call to
                                                active duty status in support of a contingency operation as a member of the National Guard or Reserves.

                             _____         because I am the spouse; son or daughter; parent; next of kin of a covered service member with a serious injury or illness.

                   b.       In the case of foreseeable intermittent leave, the employee must schedule the leave to minimize disruption to the school district
                             operation.

                   c.       During the period of foreseeable intermittent leave, the school district may move the employee to an alternative position with equivalent
                             pay and benefits.  (For instructional employees, see G below.)

 

G.      Special Rules for Instructional Employees.

          1.       Definition – an instructional employee is one whose principal function is to teach and instruct students in a class, a small group or an
                    individual setting.  This includes, but is not limited to, teachers, coaches, driver’s education instructors and special education assistants.

          2.       Instructional employees who request foreseeable medically necessary intermittent or reduced work schedule family and medical leave greater
                    than twenty percent of the work days in the leave period may be required to:

                   a.       Take leave for the entire period or periods of the planned medical treatment: or

                   b.       Move to an available alternative position, with equivalent pay and benefits, but not necessarily equivalent duties, for which the employee
                             is qualified.

          3.       Instructional employees who request continuous family and medical leave near the end of a semester may be required to extend the family and
                    medical leave through the end of the semester.  The number of weeks remaining before the end of a semester does not include scheduled
                    school breaks, such as summer, winter, or spring break.

                   a.       If an instructional employee begins family and medical leave for any purpose more than five weeks before the end of a semester, the
                             school district may require that the leave be continued until the end of the semester if the leave will last at least three weeks and the
                             employee would return to work during the last three weeks of the semester if the leave was not continued.

                   b.       If the employee begins family and medical leave for a purpose other than the employee’s own serious health condition during the last
                             five weeks of a semester, the school district may require that the leave be continued until the end of the semester if the leave will last
                             more than two weeks and the employee would return to work during the last two weeks of the semester.

                   c.       If the employee begins family and medical leave for a purpose other than the employee’s own serious health condition during the last
                             three weeks of the semester and the leave will last more than five working days, the school district may require the employee to continue
                             taking leave until the end of the semester.

          4.       The entire period of leave taken under the special rules is credited as family and medical leave.  The school district will continue to fulfill the
                    school district’s family and medical leave responsibilities and obligations, including the obligation to continue the employee’s health insurance
                    and other benefits, if an instructional employee’s family and medical leave entitlement ends before the involuntary leave period expires.

 

H.      Employee responsibilities while on family and medical leave.

          1.       Employee must continue to pay health care benefit contributions or other benefit contributions regularly paid by the employee unless
                    employee elects not to continue the benefits.

          2.       The employee contribution payments will be deducted from any money owed to the employee or the employee will reimburse the school
                    district at a time set by the superintendent.

          3.       An employee who fails to make the health care contribution payments within 30 days after they are due will be notified that the coverage may
                    be canceled if payment is not received within an additional 15 days.
         

          4.       An employee may be asked to re-certify the medical necessity of family and medical leave for the serious medical condition of any employee
                    or family member once every 30 days and return the certification within 15 days of the request.

          5.       The employee must notify the school district of the employee’s intent to return to work at least once each month during the leave and at least
                    two weeks prior to the conclusion for the family and medical leave.

          6.       If an employee intends not to return to work, the employee must immediately notify the school district, in writing, of the employee’s intent not
                    to return.  The school district will cease benefits upon receipt of this notification.

 

I.       Use of paid leave for family and medical leave.

An employee may substitute unpaid family and medical leave with appropriate paid leave available to the employee under board policy, individual contracts or the collective bargaining agreement.  Paid leave includes, but is not limited to, sick leave, family illness leave, vacation, personal leave.  When the school district determines that paid leave is being taken for an FMLA reason, the school district will notify the employee within two business days that the paid leave will be counted as FMLA leave.  Upon expiration of paid leave, the family medical leave is unpaid.

 

 

Approved: Oct. 12, 2009, February 18, 2019    
Reviewed:  Sept. 14, 2009, Apr. 5, 2013, Jan. 21, 2019
Revised: __Oct. 12, 2009, Jan. 21, 2019

 

dawn.gibson.cm… Mon, 11/29/2021 - 11:34

409.3R2 - Licensed Employee Family and Medical Leave Definitions

409.3R2 - Licensed Employee Family and Medical Leave Definitions

Active Duty – duty under a call or order to active duty under a provision of law referring to in section 101(a)(13) of title 10, U.S. Code.

Common Law Marriage – according to Iowa law, common law marriages exist when there is a present intent by the two parties to be married, continuous cohabitation, and a public declaration that the parties are husband and wife.  There is no time factor that needs to be met in order for there to be a common law marriage.

Contingency Operation – has the same meaning given such term in section 101(a)(13) of title 10, U.S. Code.

Continuing Treatment – a serious health condition involving continuing treatment by a health care provider includes any one or more of the following:

  •   A period of incapacity (i.e., inability to work, attend school or perform other regular daily activities due to the serious health condition, treatment for or recovery from) of more than three consecutive calendar days and any subsequent treatment or period of incapacity relating to the same condition that also involves:
    • treatment two or more times by a health care provider, by a nurse or physician’s assistant under direct supervision of a health care provider, or by a provider of health care services (e.g., physical therapist) under orders of, or in referral by, a health care provider; or
    • treatment by a health care provider on at least one occasion which results in a regimen of continuing treatment under the supervision of a health care provider.
  •   Any period of incapacity due to pregnancy or for prenatal care.
  •   Any period of incapacity or treatment for such incapacity due to a chronic serious health condition.  A chronic serious health condition is one which:
    • requires periodic visits for treatment by a health care provider or by a nurse or physician’s assistant under direct supervision of a health care provider;
    • continues over an extended period of time (including recurring episodes of a single underlying condition); and
    • may cause episodic rather than a continuing period of incapacity (e.g., asthma, diabetes, epilepsy, etc.).
  •   Any period of incapacity which is permanent or long-term due to a condition for which treatment may not be effective.  The employee or family member must be under the continuing supervision of, but need not be receiving active treatment by, a health care provider.  Examples include Alzheimer’s, a severe stroke or the terminal stages of a disease.
  •   Any period of absence to receive multiple treatments (including any period of recovery from) by a health care provider, either for restorative surgery after an accident or other injury, or for a condition that would likely result in a period of incapacity of more than 3 consecutive calendar days in the absence of medical intervention or treatment, such as cancer (chemotherapy, radiation, etc.), severe arthritis (physical therapy), kidney disease (dialysis).

Covered Service Member – a current member of the Armed Forces, including a member of the National Guard or Reserves, who is undergoing medical treatment, recuperation, or therapy, is otherwise in outpatient status, or is otherwise on the temporary disability retired list, for a serious injury or illness.

Eligible Employee – the district has more than 50 employees on the payroll at the time leave is requested.  The employee has worked for the district for at least 12 months and has worked at least 1,250 hours within the previous year.

Essential Functions of the Job – those functions which are fundamental to the performance of the job.  It does not include marginal functions.

Employment Benefits – all benefits provided or made available to employees by an employer, including group life insurance, health insurance, disability insurance, sick leave, annual leave, educational benefits, and pensions, regardless of whether such benefits are provided by a practice or written policy of an employer or through an “employee benefit plan.”

Family Member – individual who meets the definition of son, daughter, spouse or parent.

Group Health Plan – any plan of, or contributed to by, an employer (including a self-insured plan) to provide health care (directly or otherwise) to the employer’s employees, former employees, or the families of such employees or former employees.

Health Care Provider

  •   A doctor of medicine or osteopathy who is authorized to practice medicine or surgery by the state in which the doctor practices; or
  •   Podiatrists, dentists, clinical psychologists, optometrists, and chiropractors (limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by x-ray to exist) authorized to practice in the state and performing within the scope of their practice as defined under state law; and
  •   Nurse practitioners and nurse-midwives, and clinical social workers who are authorized to practice under state law and who are performing within the scope of their practice as defined under state law; and
  •   Christian Science practitioners listed with the First church of Christ Scientist in Boston, Massachusetts;
  •   Any health care provider from whom an employer or a group health plan’s benefits manager will accept certification of the existence of a serious health condition to substantiate a claim for benefits;
  •   A health care provider as defined above who practices in a country other than the United States who is licensed to practice in accordance with the laws and regulations of that country.

In Loco Parentis – individuals who had or have day-to-day responsibilities for the care and financial support of a child not their biological child or who had the responsibility for an employee when the employee was a child.

Incapable of Self-care – the individual requires active assistance or supervision to provide daily self-care in several of the “activities of daily living” or “ADLs.”  Activities of daily living include adaptive activities such as caring appropriately for one’s grooming and hygiene, bathing, dressing, eating, cooking, cleaning, shopping, taking public transportation, paying bills, maintaining a residence, using telephones and directories, using a post office, etc.

Instructional Employee – an employee employed principally in an instructional capacity by an educational agency or school whose principal function is to teach and instruct students in a class, a small group, or an individual setting, and includes athletic coaches, driving instructors, and special education assistants such as signers for hearing impaired.  The term does not include teacher assistants or aides who do not have as their principal function actual teaching or instructing, nor auxiliary personnel such as counselors, psychologists, curriculum specialists, cafeteria workers, maintenance workers, bus drivers, or other primarily non-instructional employees.

Intermittent Leave - leave taken in separate periods of time due to a single illness or injury, rather than for one continuous period of time, and may include leave or periods from an hour or more to several weeks.

Medically Necessary – certification for medical necessity is the same as certification for serious health condition.

"Needed to Care For" - the medical certification that an employee is "needed to care for" a family member encompasses both physical and psychological care.  For example, where, because of a serious health condition, the family member is unable to care for his or her own basic medical, hygienic or nutritional needs or safety or is unable to transport himself or herself to medical treatment.  It also includes situations where the employee may be needed to fill in for others who are caring for the family member or to make arrangements for changes in care.

Next of Kin - an individual's nearest blood relative

Outpatient Status - the status of a member of the Armed Forces assigned to –

  • either a military medical treatment facility as an outpatient; or
  • a unit established for the purpose of providing command and control of members of the Armed Forces receiving medical care as outpatients.

Parent - a biological parent or an individual who stands in loco parentis to a child or stood in loco parentis to an employee when the employee was a child.  Parent does not include parent-in-law.

Physical or Mental Disability - a physical or mental impairment that substantially limits one or more of the major life activities of an individual.

Reduced Leave Schedule - a leave schedule that reduces the usual number of hours per workweek, or hours per workday, of an employee.

Serious Health Condition -

·       An illness, injury, impairment, or physical or mental condition that involves:

  • Inpatient care (i.e. an overnight stay) in a hospital, hospice or residential medical care facility including any period of incapacity (for purposes of this section, defined to mean inability to work, attend school or perform other regular daily activities due to the serious health condition, treatment for or recovery from), or any subsequent treatment in connection with such inpatient care; or
  • Continuing treatment by a health care provider.  A serious health condition involving continuing treatment by a health care provider includes:

--       A period of incapacity (i.e., inability to work, attend school or perform other regular daily activities due to the serious health condition, treatment for or recovery from) of more than three consecutive calendar days, including any subsequent treatment or period of incapacity relating to the same condition, that also involves:

--    Treatment two or more times by a health care provider, by a nurse or physician's assistant under direct supervision of a health care provider, or by a provider of health care services (e.g., physical therapist) under orders or, or on referral by, a health care provider; or

--    Treatment by a health care provider on at least one occasion which results in a regimen of continuing treatment under the supervision of the health care provider.

--       Any period of incapacity due to pregnancy or for prenatal care.

--       Any period of incapacity or treatment for such incapacity due to a chronic serious health condition.  A chronic serious health condition is one which:

--    Requires periodic visits for treatment by a health care provider or by a nurse or physician's assistant under direct supervision of a health care provider;

--    Continues over an extended period of time (including recurring episodes of s single underlying condition); and

--    May cause episodic rather than a continuing period of incapacity (e.g., asthma, diabetes, epilepsy, etc.).

--    A period of incapacity which is permanent or long-term due to a condition for which treatment may not be effective.  The employee or family member must be under the continuing supervision of, but need not be receiving active treatment by, a health care provider.  Examples include Alzheimer's a severe stroke or the terminal stages of a disease.

--    Any period of absence to receive multiple treatments (including any period of recovery from) by a health care provider or by a provider of health care services under orders of, or on referral by, a health care provider, either for restorative surgery after an accident or other injury, or for a condition that would likely result in a period of incapacity of more than three consecutive calendar days in the absence of medical intervention or treatment, such as cancer (chemotherapy, radiation, etc.), severe arthritis (physical therapy), kidney disease (dialysis).

·      Treatment for purposes of this definition includes, but is not limited to, examinations to determine if a serious health condition exists and evaluation of the condition.  Treatment does not include routine physical examinations, eye examinations or dental examinations.  Under this definition, a regimen of continuing treatment includes, for example, a course of prescription medication (e.g., an antibiotic) or therapy requiring special equipment to resolve or alleviate the health condition (e.g., oxygen).  A regimen of continuing treatment that includes the taking of over-the-counter medications such as aspirin, antihistamines, or salves; or bed rest, drinking fluids, exercise and other similar activities that can be initiated without a visit to a health care provider, is not, by itself, sufficient to constitute a regimen of continuing treatment for purposes of FMLA leave.

·      Conditions for which cosmetic treatments are administered (such as most treatments for acne or plastic surgery) are not "serious health conditions" unless inpatient hospital care is required or unless complications develop.  Ordinarily, unless complications arise, the common cold, the flu, ear aches, upset stomach, ulcers, headaches other than migraine, routine dental or orthodontia problems, periodontal disease, etc., are examples of conditions that do not meet the definition of a serious health condition and do not qualify for FMLA leave.  Restorative dental or plastic surgery after an injury or removal of cancerous growths are serious health conditions provided all the other conditions of this regulation are met.  Mental illness resulting from stress or allergies may be serious health conditions, but only if all the conditions of this section are met.

·      Substance abuse may be a serious health condition if the conditions of this section are met.  However, FMLA leave may only be taken for treatment for substance abuse by a health care provider or by a provider of health care on referral by a health care provider.  On the other hand, absence because of the employee's use of the substance, rather than for treatment, does not qualify for FMLA leave.

·      Absence attributable to incapacity under this definition qualify for FMLA leave even though the employee or the immediate family member does not receive treatment from a health care provider during the absence, and even if the absence does not last more than three days.  For example, an employee with asthma may be unable to report for work due to the onset of an asthma attack or because the employee's health care provider has advised the employee to stay home when the pollen count exceeds a certain level.  An employee who is pregnant may be unable to report to work because of severe morning sickness.

Serious Injury or Illness - an injury or illness incurred by a member of the Armed forces, including the National Guard or Reserves in the line of duty on active duty in the Armed Forces that may render the member medically unfit to perform the duties of the member's office, grade, rank, or rating.

Son or daughter - a biological child, adopted child, foster child, stepchild, legal ward, or a child of a person standing in loco parentis.  The child must be under age 18 or, if over 18, incapable of self-care because of a mental or physical disability.

Spouse - a husband or wife recognized by Iowa law including common law marriages.

 

 

Approved: Oct 12, 2009, February 18, 2019      
Reviewed:  Sep. 14, 2009, Apr. 5, 2013, Jan. 21, 2019   
Revised:     Oct 12, 2009 , Jan. 21, 2019   

 

dawn.gibson.cm… Mon, 11/29/2021 - 11:32

409.4 - Licensed Employee Bereavement Leave

409.4 - Licensed Employee Bereavement Leave

In the event of a death of a member of a licensed employee's immediate family, bereavement leave may be granted.  Licensed personnel will be granted leave of absence at full pay in case of death of spouse, child, parent, brother, sister, grandparent, grandchild, mother-in-law, father-in-law, brother-in-law, sister-in-law, son-in-law, daughter-in-law, grandparent-in-law, or a member of the immediate household at the rate of three (3) days per death and two (2) days extra may be granted by the superintendent or designee.  This does not accumulate.  In the event of the death of an employee or student in the Fairfield Community School District, the principal or immediate supervisor of said employee shall grant to an appropriate number of employees sufficient time to attend the funeral.

The requirements stated in the Master Contract between employees in that certified collective bargaining unit and the board regarding the bereavement leave of such employees will be followed.

 

 

Legal Reference:  Iowa Code §§ 279.8

Cross Reference:  409 Licensed Employee Vacations and Leaves of Absence

Approved:  Feb. 11, 1985, Jan 21, 2013, February 28, 2019  
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, Jan. 21, 2019   
Revised:  Nov. 30, 2012, Jan. 21, 2019

 

dawn.gibson.cm… Mon, 11/29/2021 - 11:25

409.5 - Licensed Employee Political Leave

409.5 - Licensed Employee Political Leave

The board will provide a leave of absence to licensed employees to run for elective public office.  The superintendent will grant a licensed employee a leave of absence to campaign as a candidate for an elective public office as unpaid leave.

The licensed employee will be entitled to one period of leave to run for the elective public office, and the leave may commence within thirty days of a contested primary, special, or general election and continue until the day following the election.

The request for leave must be in writing to the superintendent of schools at least thirty days prior to the starting date of the requested leave.

 

 

Legal Reference:  Iowa Code ch. 55 2013.

Cross Reference:  401.9 Employee Political Activity
    
                                  409    Licensed Employee Vacations and Leaves of Absence

Approved:  Feb. 10, 1997, Jan 21, 2013, February 28, 2019        
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, Jan. 21, 2019    
Revised:   Nov. 30, 2012, Jan. 21, 2019

 

dawn.gibson.cm… Mon, 11/29/2021 - 11:19

409.6 - Licensed Employee Jury Duty Leave

409.6 - Licensed Employee Jury Duty Leave

The board will allow licensed employees to be excused for jury duty.  The superintendent has the discretion to request a waiver on behalf of the employee when extraordinary circumstances exist.

Employees who are called for jury service will notify the direct supervisor within twenty-four hours after notice of call to jury duty and suitable proof of jury service pay must be presented to the school district.  The employee will return to work on any day when the employee is excused from jury duty during regular working hours.

Licensed employees will receive their regular salary.  Any payment for jury duty will be paid to the school district.

 

 

Legal Reference:  Iowa Code §§ 20.9; 607A (2013).

Cross Reference:  409 Licensed Employee Vacations and Leaves of Absence

Approved:  Feb. 11, 1985, Jan 21, 2013, February 28, 2019        
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, Jan. 21, 2019    
Revised:  Nov. 30, 2012, Jan. 21, 2019

 

dawn.gibson.cm… Mon, 11/29/2021 - 11:18

409.7 - Licensed Employee Military Service Leave

409.7 - Licensed Employee Military Service Leave

The board recognizes licensed employees may be called to participate in the armed forces, including the National Guard. If a licensed employee is called to serve in the armed forces, the employee will have a leave of absence for military service until the military service is completed.

The leave is without loss of status or efficiency rating, and without loss of pay during the first thirty calendar days of the leave.

 

 

Legal Reference:  Bewley v. Villisca Community School District, 299 N.W. 2d 904 (Iowa 1980).
    
                                  Iowa Code §§ 20; 29A.28 (2013).

Cross Reference:  409 Licensed Employee Vacations and Leaves of Absence

Approved:  Feb. 11, 1985, Jan 21, 2013, February 28, 2019      
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, Jan. 21, 2019          
Revised:   Nov. 30, 2012, Jan. 21, 2019    

 

dawn.gibson.cm… Mon, 11/29/2021 - 11:17

409.8 - Licensed Employee Unpaid Leave

409.8 - Licensed Employee Unpaid Leave

Unpaid leave may be used to excuse an involuntary absence not provided for in this or other leave policies of the board.  Unpaid leave for licensed employees must be authorized by the superintendent. All paid leave must be exhausted before unpaid leave will be granted.

The superintendent will have complete discretion to grant or deny the requested unpaid leave.  In making this determination, the superintendent will consider the effect of the employee's absence on the education program and school district operations, length of service, previous record of absence, the financial condition of the school district, the reason for the requested absence and other factors the superintendent believes are relevant to making this determination.

If unpaid leave is granted, the duration of the leave period will be coordinated with the scheduling of the education program whenever possible to minimize the disruption of the education program and school district operations.

Whenever possible, licensed employees will make a written request for unpaid leave ten (10) days prior to the beginning date of the requested leave. 

The requirements stated in the Master Contract between employees in that certified collective bargaining unit and the board regarding the unpaid leave of such employees will be followed.

 

 

Legal Reference:  Iowa Code §§ 20; 85; 85A; 85B; 279.12; 509; 509A; 509B.

Cross Reference:  409 Licensed Employee Vacations and Leaves of Absence

Approved:  Feb. 11, 1985, Jan 21, 2013, February 28, 2019        
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, Jan. 21, 2019          
Revised:  Feb. 10, 1997, Nov. 30, 2012, Jan. 21, 2019    

 

dawn.gibson.cm… Mon, 11/29/2021 - 11:16

410 - Other Licensed Employees

410 - Other Licensed Employees dawn.gibson.cm… Mon, 11/29/2021 - 10:08

410.1 - Substitute Teachers

410.1 - Substitute Teachers

The board recognizes the need for substitute teachers.  Substitute teachers will be licensed to teach in Iowa.

It will be the responsibility of the central office to maintain a list of substitute teachers who may be called upon to replace regular contract licensed employees.  Individuals whose names do not appear on this list will not be employed as a substitute without specific approval of the superintendent.  It shall be the responsibility of the building principal to fill absences with substitute teachers immediately.

Substitute teachers will be paid a daily rate.  Following ten (10) consecutive days in the same position, substitutes will be paid at the per diem rate as calculated by dividing the prevailing salary schedule placement of BA Step 1, minus the Teacher Supplementary Salary funds which have been incorporated into the published salary schedule, by 192 days.  Substitute licensed employees are expected to perform the same duties as the licensed employees.

In cooperation with the Affordable Care Act (Federal Health Care Reform legislation), substitute teachers, substitute support staff, and part-time employees falling under variable-hour employee status will be offered insurance based on the hours worked during a twelve month look back period beginning July 1st and running through June 30th. If the variable-hour employee is deemed to have worked an average of 30 or more hours per week, participation in the Fairfield Community School group plan will be offered to the variable-hour employee at that employee’s cost.

 

 

Legal Reference:  Iowa Association of School Boards v. PERB, 400 N.W.2d 571 (Iowa 1987).
    
                                  Iowa Code §§ 20.1, .4(5), .9; Ch. 272 (2011).
    
                                  281 I.A.C. 12.4.

Cross Reference:  405.1 Licensed Employee Defined
    
                                  405.2 Licensed Employee Qualifications, Recruitment, and Selection

Approved:  Feb. 11, 1985, May 20, 2013, February 28, 2019        
Reviewed:  Aug. 24, 2005, June 14, 2010, Oct. 11, 2010, Nov. 30, 2012, Apr. 5, 2013, Jan. 21, 2019.  
Revised:  Feb. 10, 1997, Jul. 12, 2010, Nov. 8, 2010, Nov. 30, 2012, Apr. 5, 2013, Jan. 21, 2019.

 

dawn.gibson.cm… Mon, 11/29/2021 - 11:15

410.2 - Summer School Licensed Employees

410.2 - Summer School Licensed Employees

It is within the discretion of the board to offer an education program during the summer recess.  Licensed employees who volunteer or who are appointed to deliver the summer education program are compensated in addition to their regular duties during the school academic year, unless such arrangements are made prior to determining the employee's compensation for the year.

Licensed employees will be given the opportunity to volunteer for the positions available.  If the board determines a course must be offered and no licensed employee volunteers for the position, the board will make the necessary arrangements to fill the position.  The board will consider applications from volunteers of current licensed employees in conjunction with other applications.

It shall be the responsibility of the superintendent to make a recommendation to the board regarding the need for and the delivery of the summer education program.

 

 

Legal Reference:  Iowa Code §§ 279.8; 280.14 (2015).

Cross Reference:  603.2  Summer School Instruction

Approved:  Feb. 10, 1997, February 19, 2018               
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, January 15, 2018                                       
Revised:  Nov. 30, 2012, January 15, 2018  

 

dawn.gibson.cm… Mon, 11/29/2021 - 11:14

410.3 - Truancy Officer

410.3 - Truancy Officer

The board will appoint licensed employees from the district to serve as the district’s truancy officers.

The principal will notify the truancy officer when a student is truant.  The truancy officer will investigate the cause of a student’s truancy and attempt to ensure the student’s attendance.  The truancy officer may take the student into custody.  A student taken into custody will be placed in the custody of the principal.  The truancy officer will attempt to contact the student’s parents when the student is taken into custody.

 

 

Legal Reference:  Iowa Code §§ 299.10-.11, .15 (2013).

Cross Reference:  501.10 Truancy - Unexcused Absences

Approved:  Feb. 10, 1997, February 19, 2018               
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, January 15, 2018                                            
Revised:  Nov. 30, 2012, January 15, 2018          

 

dawn.gibson.cm… Mon, 11/29/2021 - 11:13

410.4 - Education Associate

410.4 - Education Associate

The board may employ education associates or other instructional support personnel to assist licensed personnel in nonteaching duties, including, but not limited to:

  •   managing and maintaining records, materials and equipment;
  •   attending to the physical needs of children; and
  •   performing other limited services to support teaching duties when such duties are determined and directed by the teacher.

Education associates who hold a current teaching certificate are compensated at the rate of pay established for their position as an education associate.  It shall be the responsibility of the principal to supervise education associates.

 

 

Legal Reference:  Iowa Code §§ 279.8; 280.3, (2013).
    
                                  281 I.A.C. 12.4(9); .5(9).

Cross Reference:  411.2 Classified Employee Qualifications, Recruitment, and Selection

Approved:  Feb. 11, 1985, February 19, 2018              
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, January 15, 2018                                            
Revised:  Feb. 10, 1997, Nov. 30, 2012, January 15, 2018    

 

dawn.gibson.cm… Mon, 11/29/2021 - 10:53

411 - Classified Employees General

411 - Classified Employees General dawn.gibson.cm… Mon, 11/29/2021 - 09:48

411.1 - Classified Employee Defined

411.1 - Classified Employee Defined

Classified employees are employees who are not administrators or employees in positions which require an Iowa Department of Education teaching license and who are employed to fulfill the duties listed on their job description on a monthly or hourly basis.  Classified employees will include, but not be limited to, teacher and classroom associates, custodial and maintenance employees, clerical employees, food service employees, bus drivers, and temporary help for summer or other maintenance.  The position may be full-time or part-time.

It will be the responsibility of the superintendent to establish job specifications and job descriptions for classified employee positions.  Job descriptions may be approved by the board.

Classified employees required to hold a license for their position must present evidence of their current license to the board secretary prior to payment of wages each year.

 

 

Legal Reference:  Iowa Code §§ 20; 279.8 (2013).

Cross Reference:  405.1   Licensed Employee Defined
    
                                  411.2   Classified Employee Qualifications, Recruitment, Selection
    
                                  412.3   Classified Employee Group Insurance Benefits

Approved:  Feb. 11, 1985, Sep 15, 2014, February 28, 2019        
Reviewed:  Aug. 24, 2005, Aug 18, 2014, Jan. 21, 2019.      
Revised:  Feb. 10, 1997, Aug 18, 2014, Jan. 21, 2019.

 

dawn.gibson.cm… Mon, 11/29/2021 - 09:55

411.2 - Classified Employee Qualifications, Recruitment and Selection

411.2 - Classified Employee Qualifications, Recruitment and Selection

Persons interested in a classified employee position will have an opportunity to apply and qualify for classified employee positions in the school district in accordance with applicable laws and school district policies regarding equal employment.  Job applicants for classified employee positions will be considered on the basis of the following:

  • Training, experience, and skill;
  • Nature of the occupation;
  • Demonstrated competence; and
  • Possession of, or ability to obtain, state or other license or certificate, if required, for the position.

All job openings shall be submitted to the Iowa Department of Education for posting on TeachIowa, the online state job posting system. Additional announcements of the position may occur through means the superintendent believes will inform potential applicants about the position. The application process will be via the district’s website at http://www.fairfieldsfuture.org. Whenever possible, the preliminary screening of applicants will be conducted by the administrator who directly supervises and oversees the position.

The superintendent has the authority to hire and issue support personnel letters of employment without board approval, for bus drivers, custodians, education associates, maintenance staff, clerical personnel, and food service workers.

 

 

Legal Reference:  29 U.S.C. §§ 621-634 (2006).
    
                                  42 U.S.C. §§ 2000e et seq. (2006).
    
                                  42 U.S.C. §§ 12101 et seq. (2006).
    
                                  Iowa Code §§ 35C; 216; 279.8; 294.1 (2011).

Cross Reference:  401.1  Equal Employment Opportunity
    
                                  411    Classified Employees - General    

Approved:  Feb. 11, 1985, February 19, 2018          
Reviewed:  July 20, 2007, Oct. 11, 2010, Nov. 30, 2012, January 15, 2018                                            
Revised:  Feb. 10, 1997, Aug. 9, 2004, Aug. 13, 2007, Nov. 8, 2010, Nov. 30, 2012, January 15, 2018                                            

 

dawn.gibson.cm… Mon, 11/29/2021 - 09:54

411.3 - Classified Employee Contracts

411.3 - Classified Employee Contracts

The board will enter into written contracts with bus drivers as required by law.  The contract will state the terms of employment. Other classified employees will receive a letter outlining their terms of employment.

Each contract and letter of employment will include a thirty-day cancellation clause.  Either the employee or the board must give notice of the intent to cancel the contract at the end of thirty days.  This notice will not be required when the employee is terminated during a probationary period or for cause.

Classified employees will receive a job description stating the specific performance responsibilities of their position.

It is the responsibility of the superintendent to draw up and process the classified employee contracts and present them to the board for approval.  The contracts, after being signed by the board president, are filed with the board secretary. The superintendent has the authority to draw up and process letters of employment, which will be included in the consent agenda of meetings.

 

 

Legal Reference:  Iowa Code §§ 20; 279.7A; 285.5(9) ((2011).

Cross Reference:  411    Classified Employees - General
    
                                  412.1  Classified Employee Compensation
    
                                  412.2  Classified Employee Wage and Overtime Compensation
    
                                  413    Classified Employee Termination of Employment

Approved:  Feb. 11, 1985, February 19, 2018               
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, January 15, 2018                                    
Revised:  Feb. 10, 1997, Aug. 9, 2004, Nov. 30, 2012

 

dawn.gibson.cm… Mon, 11/29/2021 - 09:53

411.4 - Classified Employee Licensing / Cerification

411.4 - Classified Employee Licensing / Cerification

Classified employees who require a special license or other certification will keep them current.  Licensing requirements needed for a position will be considered met if the employee meets the requirements established by law and by the Iowa Department of Education for the position.

 

 

Legal Reference:  Iowa Code §§ 272.6; 285.5(9) (2013).
    
                                  281 I.A.C. 12.4(10); 36; 43.12-.24.

Cross Reference:  411.2  Classified Employee Qualifications, Recruitment, and Selection

Approved:  Feb. 10, 1997, February 19, 2018              
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, January 15, 2018                                                 
Revised:     Nov. 30, 2012, January 15, 2018                      

 

dawn.gibson.cm… Mon, 11/29/2021 - 09:52

411.5 - Classified Employee Assignment

411.5 - Classified Employee Assignment

Determining the assignment of each classified employee is the responsibility of the superintendent and within the sole discretion of the board.  In making such assignments each year the superintendent will consider the qualifications of each classified employee and the needs of the school district.

It is the responsibility of the superintendent to assign classified employees and report such assignments to the board. Temporary assignments may vary day to day based on program needs.

 

 

Legal Reference:  Iowa Code §§ 20; 279.8 (2013).

Cross Reference:  200.2  Powers of the Board of Directors
    
                                  411.6  Classified Employee Transfers

Approved:  Feb. 11, 1985, February 19, 2018               
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, January 15, 2018                                                 
Revised:  Feb. 10, 1997, Nov. 30, 2012, January 15, 2018                                            

 

dawn.gibson.cm… Mon, 11/29/2021 - 09:52

411.6 - Classified Employee Transfers

411.6 - Classified Employee Transfers

Determining the location where a classified employee's assignment will be performed is the responsibility of the superintendent and within the sole discretion of the board.  In making such assignments each year the superintendent shall consider the qualifications of each classified employee and the needs of the school district.

A transfer may be initiated by the employee, the principal or the superintendent.

It is the responsibility of the superintendent to transfer classified employees and report such transfers to the board.

 

 

Legal Reference:  29 U.S.C. §§ 621-634 (1988).
    
                                  42 U.S.C. §§ 2000e et seq. (1988)
    
                                  42 U.S.C. §§ 12101 et seq. (Supp. 1990).
    
                                  Iowa Code §§ 20.9; 35C; 216; 279.8; 294.1 (2013).

Cross Reference:  411.2  Classified Employee Qualifications, Recruitment, and Selection
    
                                  411.5  Classified Employee Assignment

Approved:  Feb. 11, 1985, February 19, 2018               
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, January 15, 2018                                                 
Revised:  Feb. 10, 1997, Nov. 30, 2012, January 15, 2018                                            

 

dawn.gibson.cm… Mon, 11/29/2021 - 09:51

411.7 - Classified Employee Evaluation

411.7 - Classified Employee Evaluation

Evaluation of classified employees on their skills, abilities, and competence is an ongoing process supervised by the superintendent.  The goal of the formal evaluation of classified employees is to maintain classified employees who meet or exceed the board's standards of performance, to clarify each classified employee's role, to ascertain the areas in need of improvement, to clarify the immediate priorities of the board, and to develop a working relationship between the administrators and other employees.

It is the responsibility of the superintendent to ensure classified employees are formally evaluated annually. 

 

 

Legal Reference:  Aplington Community School District v. PERB, 392 N.W.2d 495 (Iowa 1986).
    
                                  Saydel Education Association v. PERB, 333 N.W.2d 486 (Iowa 1983).
    
                                  Iowa Code §§ 20.9; 279.14 (2013).
    
                                  281 I.A.C. 12.3(4).

Cross Reference:  411.2  Classified Employee Qualifications, Recruitment, and Selection
    
                                  411.8  Classified Employee Probationary Status

Approved:  Feb. 11, 1985, February 19, 2018               
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, January 15, 2018                                                 
Revised:  Feb. 10, 1997, Nov. 30, 2012, January 15, 2018 

 

dawn.gibson.cm… Mon, 11/29/2021 - 09:50

411.8 - Classified Employees Probationary Status

411.8 - Classified Employees Probationary Status

The first year of a newly employed classified employee's contract is a probationary period.  "Day" is defined as one work day regardless of full-time or part-time status of the employee.  New employees, regardless of experience, are subject to this probationary period.

"New" employees include individuals who are being hired for the first time by the school district and those who may have been employed by the school district in the past, but have not been employed by the board during the school year prior to the one for which contracts are being issued.

Only the board, in its discretion, may waive the probationary period.         

 

 

Legal Reference:  Iowa Code §§ 20; 279.8 (2011).

Cross Reference:  411.3  Classified Employee Contracts
    
                                  411.7  Classified Employee Evaluation

Approved:  Feb. 10, 1997, February 19, 2018               
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, January 15, 2018                                                 
Revised:  Nov. 30, 2012, January 15, 2018        

 

dawn.gibson.cm… Mon, 11/29/2021 - 09:48

412 - Classified Employees Compensation and Benefits

412 - Classified Employees Compensation and Benefits dawn.gibson.cm… Sun, 11/28/2021 - 21:12

412.1 - Classified Employee Compensation

412.1 - Classified Employee Compensation

The board will determine the compensation to be paid for the classified employees' positions, keeping in mind the education and experience of the classified employee, the educational philosophy of the school district, the financial condition of the school district and any other considerations as deemed relevant by the board.

It is the responsibility of the superintendent to make a recommendation to the board annually regarding the compensation of classified employees.

 

 

Legal Reference:  Iowa Code §§ 20.1, .4, .7, .9; 279.8 (2013).

Cross Reference:  411.3 Classified Employee Contracts
    
                                  412.2 Classified Employee Wage and Overtime Compensation

Approved:  Feb. 11, 1985, February 19, 2018               
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, January 15, 2018                                                 
Revised:  Feb. 10, 1997, Nov. 30, 2012, January 15, 2018  

 

dawn.gibson.cm… Sun, 11/28/2021 - 21:12

412.2 - Classified Employee Wage and Overtime Compensation

412.2 - Classified Employee Wage and Overtime Compensation

Each non-exempt employee compensated on an hour-by-hour basis, whether full-or part-time, permanent or temporary, will be paid no less than the prevailing minimum wage.  Whenever a non-exempt employee must work more than forty hours in a given work week, the employee is compensated at one and one-half times their regular hourly wage rate.  This compensation is in the form of overtime pay. Overtime will not be permitted without prior authorization of the superintendent. Whenever possible hours will be adjusted within the week to avoid the necessity of overtime.

The district electronic time system will be the record of hours worked for district classified employees. Any attempt to circumvent this record is grounds for disciplinary action.

It is the responsibility of the board secretary to maintain wage records.

 

 

Legal Reference:  Garcia v. San Antonio Metropolitan Transit Authority, 469 U.S. 528 (1985).
    
                                  29 U.S.C. §§ 206 et seq. (2013).
    
                                  29 C.F.R. Pt. 511-800 (2013).

Cross Reference:  411.3  Classified Employee Contracts
    
                                  412.1  Classified Employee Compensation

Approved:  Feb. 10, 1997, February 19, 2018               
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, January 15, 2018                                                 
Revised:     Nov. 30, 2012, January 15, 2018    

 

dawn.gibson.cm… Sun, 11/28/2021 - 21:13

412.2R1 - Classified Employee Weather Related Late Starts, Early Dismissals, and Professional Development Late Starts

412.2R1 - Classified Employee Weather Related Late Starts, Early Dismissals, and Professional Development Late Starts

Secretaries:

      Late Start Due to Weather:

  • All secretaries come to work at their regular time.

 

      Late Start Due to Weather and Then Cancellation After They Arrive:

  • All secretaries will have come to work at their regular time.
  • Elementary secretaries will leave 30 minutes after cancellation is announced and be paid for hours worked.  All other secretaries will work until 3:00 p.m. for full pay.
  • If secretaries (other than elementary) wish to leave before 3:00 p.m. they may, but will be paid for hours worked.
  • If they are late in getting to work, they may make up time after 3:00 p.m.

     

      Early Release Due to Weather (except heat related):

  • Receive full pay if they stay until 3:00 p.m.
  • If secretaries wish to leave before 3:00 p.m. they may, but will be paid for hours worked.

 

      School Cancelled Due to Weather:

  • Elementary secretaries do not come in.
  • Other secretaries work 7:30 a.m. to 3:00 p.m.  If they are unable to be here at 7:30 a.m., they may make up their time after 3:00 p.m.
  • If secretaries wish to leave before 3:00 p.m. they may, but will be paid for hours worked.

 

Associates:

      Late Start Due to Weather:

  • Start time delayed same as school delay.

 

      Late Start Due to Weather and Then Cancellation:

  • Associates should not have reported for work.
  • If they have already arrived, associates will be paid for time spent.

 

      Early Release Due to Weather (except heat related):

  • Receive full pay if they stay until 3:00 p.m.
  • If associates wish to leave before 3:00 p.m. they may, but will be paid for hours worked.

 

      School Cancelled Due to Weather:

  • Associates do not report for work.

 

      Late Start Due to Staff Development:

  • Report at 9:30 a.m. unless requested to report earlier for staff development or supervision purposes by the building principal with prior approval of the superintendent or business manager.

 

 

Approved: February 19, 2018          
Reviewed: January 15, 2018                                                 
Revised:    January 15, 2018                                            

 

dawn.gibson.cm… Sun, 11/28/2021 - 21:14

412.3 - Classified Employee Group Insurance Benefits

412.3 - Classified Employee Group Insurance Benefits

Classified employees may be eligible for group benefits as determined by the board and required by law. The board will select the group benefit program(s) and the insurance company or third party administrator which will provide or administer the program.

In accordance with the Patient Protection and Affordable Care Act (ACA), the board will offer classified employees, who work an average of at least thirty (30) hours per week or one hundred thirty (130) hours per month, based on the measurement method adopted by the board, with minimum essential coverage that is both affordable and provides minimum value. The board will have the authority and right to change or eliminate group benefit programs, other than the group health plan, for its classified employees.

Classified employees who work an average of at least thirty (30) hours per week or one hundred thirty (130) hours per month, based on the measurement method adopted by the board, are eligible to participate in the group health plan. Classified employees who work 30 hours per week are eligible to participate in the health and major medical, and long-term disability group insurance plans. Qualified employees will be eligible for benefits beginning the first of the month following the first day of service. Employers should maintain documents regarding eligible employees’ acceptance and rejection of coverage.

Variable-hour employees are employees normally scheduled to work less than 30 hours per week but work a variable shift with variable hours. If the variable-hour employee is deemed to have worked an average of 30 or more hours per week, participation in the Fairfield Community School group plan will be offered to the variable-hour employee at that employee’s cost.

  1. When an employer/employee relationship is severed, the length of continued benefits depends on several factors.  Employees will be informed of their COBRA Rights under the Consolidated Omnibus Budget Reconciliation Act at that time.
  2. If the employee resigns from his/her position mid-way through the school year, district paid health insurance will be discontinued at the end of the month following the last day of service.  COBRA rights will become effective. (see #3 below)
  3. If the employee works the full school year, district paid health insurance will continue through August 31st of that year.  A full school year is defined as working at least one hundred twenty (120) consecutive school days or more.
  4. If an employee is hired late into the year and leaves employment prior to the end of the year, district paid health insurance will be discontinued at the end of the month following the last day of service.  COBRA rights will become effective.
  5. If the employee is unable to perform his/her duties consider the flowchart:

 

 
 

 

 

The business office will administer such retirement plans, health and accident insurance, savings and annuity programs as the Board may authorize and the law may prescribe.

 

 

Legal Reference:  Iowa Code §§ 20.9; 85; 85B; 279.12; 509; 509A; 509B (2013).
                                           Internal Revenue Code § 4980H(c)(4); Treas. Reg. § 54.4980H-1(a)(21)(ii).
                                          Shared Responsibility for Employers Regarding Health Coverage, 26 CFR Parts 1, 54 and 301, 78 Fed. Reg. 217, (Jan 2, 2013).
                                          Shared Responsibility for Employers Regarding Health Coverage, 26 CFR Parts 1, 54 and 301, 79 Fed. Reg. 8543 (Feb. 12, 2014).

Cross Reference:  411.1 Classified Employee Defined

Approved:  Feb. 11, 1985, May 20, 2013, May 13, 2015, Sep 21, 2015, May 20, 2019
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, Apr. 5, 2013, Mar 16, 2015, Jul 27, 2015, Jan. 21, 2019, April 15, 2019          
Revised:  Nov. 30, 2012, Apr. 5, 2013, Mar 16, 2015, Jul 27, 2015, May 20, 2019

 

dawn.gibson.cm… Sun, 11/28/2021 - 21:17

412.4 - Classified Employee Tax Shelter Programs

412.4 - Classified Employee Tax Shelter Programs

Employees may elect to have amounts withheld from their pay for items authorized by law, subject to agreement of the district. The board may authorize the administration to make a payroll deduction for classified employees' tax-sheltered annuity premiums purchased from a company or in the state approved program.

Classified employees wishing to have payroll deductions for tax sheltered annuities will make a written request to the superintendent. 

 

 

Legal Reference:  Small Business Job Protection Act of 1996, Section 1450(a), repealing portions of IRS REG § 1.403(b)-1(b)(3).
   
                                    Iowa Code §§ 260C; 273; 294.16.
    
                                    1988 Op. Att'y Gen. 38.
    
                                    1976 Op. Att'y Gen. 462, 602.
                                        1966 Op. Att'y Gen. 211, 220.

Cross Reference:  706      Payroll Procedures

Approved:  Feb. 11, 1985, February 28, 2019        
Reviewed:  Aug. 24, 2005, Sep. 14, 2009, Nov. 30, 2012, Apr. 22, 2013, Jan. 21, 2019   
Revised:  Feb. 10, 1997, Oct. 12, 2009, Nov. 30, 2012, Jan. 21, 2019   

 

dawn.gibson.cm… Sun, 11/28/2021 - 21:20

413 - Classified Employee Termination of Employment

413 - Classified Employee Termination of Employment dawn.gibson.cm… Sun, 11/28/2021 - 21:07

413.1 - Classified Employee Resignation

413.1 - Classified Employee Resignation

Classified employees who wish to resign during the school year shall give the board notice of their intent to resign and final date of employment and cancel their contract thirty days prior to their last working day.

Notice of the intent to resign shall be in writing to the superintendent.

Employees who leave employment with the District for any reason will be eligible to return to employment following a wait period of twenty-six weeks.

 

 

Legal Reference:  Iowa Code §§ 91A.2, .3, .5; 279.19A; 285.5(9) (2013).

Cross Reference:  411.3  Classified Employee Contracts
    
                                  413    Classified Employee Termination of Employment

Approved:  Feb. 11, 1985, Sept 26, 2016    
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, Apr. 22, 2013, Jul 25, 2016    
Revised:  Feb. 10, 1997, Nov. 30, 2012

 

dawn.gibson.cm… Sun, 11/28/2021 - 21:11

413.3 - Classified Employee Suspension

413.3 - Classified Employee Suspension

Classified employees will perform their assigned job, respect and follow board policy and obey the law.  The superintendent is authorized to suspend a classified employee with or without pay pending board action on a discharge or during investigation of charges against the employee or for disciplinary purposes.  It will be within the discretion of the superintendent to suspend a classified employee with or without pay.

In the event of a suspension, due process will be followed.

 

 

Legal Reference:  Northeast Community Education Association v. Northeast Community School District, 402 N.W.2d 765 (Iowa 1987).
    
                                  McFarland v. Board of Education, of Norwalk Community School District, 277 N.W.2d 901 (Iowa 1979).
    
                                  Iowa Code §§ 20.7, .24 (2013).

Cross Reference:  404   Employee Conduct and Appearance
    
                                  413   Classified Employee Termination of Employment

Approved:  Feb. 10, 1997, February 28, 2019        
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, Apr. 22, 2013, Jan. 21, 2019        
Revised:  Nov. 30, 2012, Jan. 21, 2019   

 

dawn.gibson.cm… Sun, 11/28/2021 - 21:09

413.4 - Classified Employee Dismissal

413.4 - Classified Employee Dismissal

The board believes classified employees should perform their jobs, respect board policy and obey the law.  A classified employee may be dismissed upon thirty days notice or immediately for cause.  Due process procedures will be followed.

It shall be the responsibility of the superintendent to make a recommendation for dismissal to the board.  A classified employee may be dismissed for any reason, including, but not limited to, incompetence, willful neglect of duty, reduction in force, willful violation of board policy or administrative regulations, or a violation of the law.

 

 

Legal Reference:  Iowa Code §§ 20.7, .24 (2013).

Cross Reference:  404    Employee Conduct and Appearance
    
                                  413.3 Classified Employee Suspension
    
                                  413.5 Classified Employee Reduction in Force

Approved:  Feb. 11, 1985, February 28, 2019        
Reviewed:  Aug. 24, 2005, Nov. 30, 2012, Apr. 22, 2013, Jan. 21, 2019            
Revised:  Feb. 10, 1997, Nov. 30, 2012, Jan. 21, 2019       

 

dawn.gibson.cm… Sun, 11/28/2021 - 21:08

413.5 - Classified Employee Reduction in Force

413.5 - Classified Employee Reduction in Force

It is the exclusive power of the board to determine when a reduction in classified employees is necessary.  Employees who are terminated due to a reduction in force shall be given thirty days notice.  Due process will be followed for terminations due to a reduction in force.

It is the responsibility of the superintendent to make a recommendation for termination to the board.  The superintendent will consider years in the district, the relative qualifications, skills, ability and demonstrated performance through evaluation procedures in making the recommendations.

 

 

Legal Reference:  Iowa Code §§ 20.7, .24 (2013).

Cross Reference:  407.5  Licensed Employee Reduction in Force
    
                                  413.3  Classified Employee Suspension
    
                                  413.4  Classified Employee Dismissal
    
                                  703    Budget

Approved:  Feb. 11, 1985, Sept 26, 2016    
Reviewed:  Aug. 24, 2005, Apr. 22, 2013    
Revised:  Feb. 10, 1997, September 18, 2017 

 

dawn.gibson.cm… Sun, 11/28/2021 - 21:07

414 - Classified Employees Vacations and Leaves of Absence

414 - Classified Employees Vacations and Leaves of Absence dawn.gibson.cm… Sun, 11/28/2021 - 19:46

414.1 - Classified Employee Vacations - Holidays - Personal Leave

414.1 - Classified Employee Vacations - Holidays - Personal Leave

The board shall determine the amount of vacation, holidays and personal leave that will be allowed on an annual basis for classified employees.

Classified twelve month employees will receive 5 days of vacation the first year and 10 days annually the second through the 10th year.  Classified twelve month employees who have worked 10 continuous years will receive 15 days of vacation each year.  Classified employees who leave prior to the end of their contract will receive their pro rata share of vacation for the year.

The vacation may be taken any time during the year when the vacation will not disrupt the school district operations.  The employee must submit a vacation request to the superintendent, who shall be responsible for determining whether the request will disrupt the school district operation.

Full-time regular classified employees will be allowed a maximum of 2 days of personal leave. The employee must submit a personal leave request, stating the reason for the leave, 5 days prior to the leave day.  This leave may be denied if it falls on the day before or the day after a holiday or vacation, it falls on a special day when services would be necessary, it would cause undue interruption to the education program or to a program demanding the employee's services to the department, or other reasons deemed relevant by the superintendent.  It shall be within the discretion of the superintendent to grant personal leave.

Classified employees who work twelve months a year will be allowed ten paid holidays.  The six holidays shall be New Year's Day, Memorial Day, July 4, Labor Day, Thanksgiving Day and Christmas Day.   Employees will also get one extra day at Christmas, one extra day for New Year’s Day, the Friday following Thanksgiving and the Friday of Spring Break. Classified employees who work only during the academic year will be allowed eight paid holidays: the holidays listed above, excluding July 4 and the Friday of Spring Break.

Classified employees will be paid only for the hours they would have been scheduled for the day.  Vacation shall not be accrued from year to year without a prior arrangement with the superintendent.

 

 

Legal Reference:  Iowa Code §§ 1C.1-.2; 4.1(34); 20.9 (2013).

Cross Reference:  414.1    Classified Employee Vacations - Holidays - Personal Leave
    
                                    601.1    School Calendar

Approved:  Feb. 10, 1997, June 17, 2013, Feb 20, 2017     
Reviewed:  Aug. 24, 2005, Apr. 22, 2013, Dec 7, 2016   
Revised:  August 11, 2003, Apr. 22, 2013, Dec 7, 2016

 

dawn.gibson.cm… Sun, 11/28/2021 - 21:03

414.2 - Classified Employee Personal Illness Leave

414.2 - Classified Employee Personal Illness Leave

Classified employees will be granted ten days of sick leave in their first year of employment.  Each year thereafter, one additional day of sick leave will be granted to the employees up to a maximum of fifteen days.  "Day" is defined as one workday regardless of full-time or part-time status of the employee.  A new employee will  report for work at least one full workday prior to receiving sick leave benefits.  A returning employee will be granted the appropriate number of days at the commencement of each letter of employment.  Sick leave may be accumulated up to a maximum of 125 days for classified employees. Should the personal illness occur after or extend beyond the accumulated sick leave, the employee may apply for FMLA or long term disability benefits requiring medical certification.

Evidence may be required regarding the mental or physical health of the employee including, but not limited to, confirmation of the following: the employee's illness, the need for the illness leave, the employee's ability to return to work, and the employee's capability to perform the duties of the employee's position. 

 

 

Legal Reference:  Whitney v. Rural Ind. School District, 232 Iowa 61, 4 N.W.2d 394 (1942).
 
                                     26 U.S.C. § 2601 et seq. (2012).
    
                                  29 C.F.R. Pt. 825 (1993).
    
                                  Iowa Code §§ 20; 85.33, .34, .38(3); 279.40 (1995).
    
                                  1980 Op. Att'y. Gen. 605.
    
                                  1972 Op. Att'y. Gen. 177, 353.
    
                                  1952 Op. Att'y. Gen. 91.

Cross Reference:  403.2 Employee Injury on the Job
    
                                  414.3 Classified Employee Family and Medical Leave
    
                                  414.8 Classified Employee Unpaid Leave

Approved:  Feb. 11, 1985, June 17, 2013, February 28, 2019       
Reviewed:  Aug. 24, 2005, Nov. 9, 2009, Apr. 22, 2013, Jan. 21, 2019           
Revised:  Feb. 10, 1997, Oct. 9, 2000, Dec. 14, 2009, Apr. 22, 2013, Jan. 21, 2019       

 

dawn.gibson.cm… Sun, 11/28/2021 - 19:47

414.3 - Classified Employee Family and Medical Leave

414.3 - Classified Employee Family and Medical Leave

Unpaid family and medical leave will be granted up to 12 weeks per year to assist employees in balancing family and work life.  For purposes of this policy, year is defined as the 12-month period beginning July 1.  Requests for family and medical leave will be made to the superintendent.

Employees may be allowed to substitute paid leave for unpaid family and medical leave by meeting the requirements set out in the family and medical leave administrative rules.  Employees eligible for family and medical leave must comply with the family and medical leave administrative rules prior to starting family and medical leave.  It is the responsibility of the superintendent to develop administrative rules to implement this policy.

 

Links:  WH-380-E Certification of Health Care Provider for Employee’s Serious Health Condition (PDF)
WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Condition (PDF)
WH-381 Notice of Eligibility and Rights & Responsibilities (PDF)
WH-382 Designation Notice (PDF)
WH-384 Certification of Qualifying Exigency for Military Family Leave (PDF)
WH-385 Certification for Serious Injury or Illness of Covered Service member – for Military Family Leave            (PDF)

 

 

Legal Reference:  Whitney v. Rural Ind. School. District, 232 Iowa 61, 4 N.W.2d 394 (1942).
                                       26 U.S.C. § 2601 et seq. (Supp. 1993)
                                       29 C.F.R. Pt. 825 (1993).
                                       Iowa Code §§ 20; 85.33, .34, .38(3); 216; 279.40 (2013).
                                       
1980 Op. Att'y Gen. 605.
                                       1972 Op. Att'y Gen. 177, 353.
                                       1952 Op. Att'y Gen. 91.

Cross Reference:  409.3   Licensed Employee Family and Medical Leave
    
                                  414.2   Classified Employee Personal Illness Leave
    
                                  414.8   Classified Employee Unpaid Leave

Approved:  Feb. 11, 1985, February 28, 2019       
Reviewed:  Aug. 24, 2005, Sep. 14, 2009, Apr. 22, 2013, Jan. 21, 2019             
Revised:   Oct. 12, 2009, Jan. 21, 2019       

 

dawn.gibson.cm… Sun, 11/28/2021 - 19:55

414.3E1 - Classified Employee Family and Medical Leave Notice to Employees

414.3E1 - Classified Employee Family and Medical Leave Notice to Employees

YOUR RIGHTS UNDER THE FAMILY AND MEDICAL LEAVE ACT OF 1993

FMLA requires covered employers to provide up to 12 weeks of unpaid, job-protected leave to eligible employees for the following reasons:

  •   For incapacity due to pregnancy, prenatal medical care or child birth;
  •   To care for the employee’s child after birth, or placement for adoption or foster care;
  •   To care for the employee’s spouse, son or daughter, or parent, who has a serious health condition; or
  •   For a serious health condition that makes the employee unable to perform the employee’s job.

 

MILITARY FAMILY LEAVE ENTITLEMENTS

Eligible employees with a spouse, son, daughter, or parent on active duty or call to active duty status in the National Guard or Reserves in support of a contingency operation may use their 12-week leave entitlement to address certain qualifying exigencies.

Qualifying exigencies may include attending certain military events, arranging for alternative childcare, addressing certain financial and legal arrangements, attending certain counseling sessions, and attending post-deployment reintegration briefings.

FMLA also includes a special leave entitlement that permits eligible employees to take up to 26 weeks of leave to care for a covered service member during a single 12-month period.  A covered service member is a current member of the Armed Forces, including a member of the National Guard or Reserves, who has a serious injury or illness incurred in the line of duty on active duty that may render the service member medically unfit to perform his or her duties for which the service member is undergoing medical treatment, recuperation, or therapy; or is in outpatient status; or is on the temporary disability retired list.

 

BENEFITS AND PROTECTION

During FMLA leave, the employer must maintain the employee’s health coverage under any “group health plan” on the same terms as if the employee had continued to work.  Upon return from FMLA leave, most employees must be restored to their original or equivalent positions with equivalent pay, benefits, and other employment terms.

Use of FMLA leave cannot result in the loss of any employment benefit that accrued prior to the start of any employee’s leave.

 

JOB ELIGIBILITY REQUIREMENTS

Employees are eligible if they have worked for a covered employer for at least one year, for 1,250 hours over the previous 12 months, and if at least 50 employees are employed by the employer within 75 miles.

 

DEFINITION OF SERIOUS HEALTH CONDITION

A serious health condition is an illness, injury, impairment, or physical or mental condition that involves either an overnight stay in a medical care facility, or continuing treatment by a health care provider for a condition that either prevents the employee from performing the functions of the employee’s job, or prevents the qualified family member from participating in school or other daily activities.

Subject to certain conditions, the continuing treatment requirement may be met by a period of incapacity of more than three consecutive calendar days combined with at least two visits to a health care provider or one visit and a regimen of continuing treatment, or incapacity due to pregnancy, or incapacity due to a chronic condition.  Other conditions may meet the definition of continuing treatment.

 

USE OF LEAVE

An employee does not need to use this leave entitlement in one block.  Leave can be taken intermittently or on a reduced leave schedule when medically necessary.  Employees must make reasonable efforts to schedule leave for planned medical treatment so as not to unduly disrupt the employer’s operations.  Leave due to qualifying exigencies may also be taken.

 

SUBSTITION OF PAID LEAVE FOR UNPAID LEAVE

Employees may choose or employers may require use of accrued paid leave while taking FMLA leave.  In order to use paid leave for FMLA leave, employees must comply with the employer’s normal paid leave policies.

 

EMPLOYEE RESPONSIBILITIES

Employees must provide 30 days advance notice of the need to take FMLA leave when the need is foreseeable.  When 30 days notice is not possible, the employee must provide notice as soon as practicable and generally must comply with an employer’s normal call-in procedures.

Employees must provide sufficient information for the employer to determine if the leave may qualify for FMLA protection and the anticipated timing and duration of the leave.  Sufficient information may include that the employee is unable to perform job functions, the family member is unable to perform daily activities, the need for hospitalization or continuing treatment by a health care provider, or circumstances supporting the need for military family leave.  Employees also must inform the employer if the requested leave is for a reason for which FMLA leave was previously taken or certified.  Employees also may be required to provide a certification and periodic recertification supporting the need for leave.

 

EMPLOYER REQPONSIBILITIES

Covered employers must inform employees requesting leave whether they are eligible under FMLA.  If they are, the notice must specify any additional information required as well as the employees’ rights and responsibilities.  If they are not eligible, the employer must provide a reason for the ineligibility.

Covered employers must inform employees if leave will be designated as FMLA-protected and the amount of leave counted against the employee’s leave entitlement.  If the employer determines that the leave is not FMLA-protected, the employer must notify the employee.

 

UNLAWFUL ACTS BY EMPLOYERS

FMLA makes it unlawful for any employer to:

  • Interfere with, restrain, or deny the exercise of any right provided under FMLA;
  • Discharge or discriminate against any person for opposing any practice made unlawful by FMLA or for involvements in any proceeding under or relating to FMLA.

 

ENFORCEMENT

An employee may file a complaint with the U. S. Department of Labor or may bring a private lawsuit against an employer.

FMLA does not affect any Federal or State law prohibiting discrimination, or supersede any State or local law or collective bargaining agreement which provides greater family or medical leave rights.

 

NOTE:  FMLA section 109 (29 U.S.C. § 2619) requires FMLA covered employers to post the text of this notice.  Regulations 29 C.F.R. § 825.300(a) may require additional disclosures.

If you have access to the Internet visit FLMA’s website: http://www.dol.gov/esa/whd/fmla.  

To locate your nearest Wage-Hour Office, phone our toll-free information at 1-866-487-9243 or to the website at:  http://www.wagehour.dol.gov.

For a listing of records that must be kept by employers to comply with FMLA visit the U.S. Dept. of Labor’s website: http://www.dol.gov/dol/allcfr/ESA/Title_29/Part_825/29CFR825.500.htm.

 

 

Approved:  Oct. 12, 2009, February 28, 2019        
Reviewed:  Sep. 14, 2009, Apr. 22, 2013, Jan. 21, 2019         
Revised:                            

 

dawn.gibson.cm… Sun, 11/28/2021 - 21:00

414.3E2 - Classified Employee Family and Medical Leave Request Form

414.3E2 - Classified Employee Family and Medical Leave Request Form

Date:  ___________________

 

I, _______________________, request family and medical leave for the following reason:

(check all that apply)

          _____         for the birth of my child;

          _____         for the placement of a child for adoption or foster care;

          _____         to care for my child who has a serious health condition;

          _____         to care for my parent who has a serious health condition;

          _____         to care for my spouse who has a serious health condition;

                             or

          _____         because I am seriously ill and unable to perform the essential functions of my position.

          _____         because of a qualifying exigency arising out of the fact that my
                                ___ spouse;                                      ___ son or daughter; ___ parent is on active duty or call to active duty status in support of a
                            contingency operation as a member of the National Guard or Reserves.

          _____         because I am the ___ spouse; ___ son or daughter; ___ parent; ___ next of kin of a covered service member with a serious injury or
                             illness.

 

I acknowledge my obligation to provide medical certification of my serious health condition or that of a family member in order to be eligible for family and medical leave within 15 days of the request for certification.

I acknowledge receipt of information regarding my obligations under the family and medical leave policy of the school district.

I request that my family and medical leave begin on ___________ and I request leave as follows:  (check one)

          _____         continuous

                             I anticipate that I will be able to return to work on __________.

          _____         intermittent leave for the:

                             _____         birth of my child or adoption or foster care placement subject to agreement by the district;

                             _____         serious health condition of ___ myself, ___ parent, ___ spouse, or  ___ child when medically necessary;

                             _____         because of a qualifying exigency arising out of the fact that my  ___ spouse; ___ son or daughter; ___ parent is on active
                                                duty or call to active duty status in support of a contingency operation as a member of the National Guard or Reserves.

                             _____         because I am the ___ spouse; ___ son or daughter; ___ parent;

                                                ___ next of kin of a covered service member with a serious injury or illness.

 

Details of the needed intermittent leave:

                   _______________________________________________________________

                   _______________________________________________________________

                   _______________________________________________________________

 

                             I anticipate returning to work at my regular schedule on _________________.

          _____         reduced work schedule for the:

                              _____         birth of my child or adoption or foster care placement subject to agreement by the district;

                             _____         serious health condition of myself, parent, spouse, or child when medically necessary;

                              _____         because of a qualifying exigency arising out of the fact that my ___ spouse; ___ son or daughter; ___ parent is on active
                                                 duty or call to active duty status in support of a contingency operation as a member of the National Guard or Reserves.

                              _____         because I am the ___ spouse; ___ son or daughter; ___ parent;

                                                ___ next of kin of a covered service member with a serious injury or illness.

 

                              Details of needed reduction in work schedule as follows:

                    _______________________________________________________________        

                   _______________________________________________________________

                     _______________________________________________________________

                            

                             I anticipate returning to work at my regular schedule on   _________________.

I realize I may be moved to an alternative position during the period of the family and medical intermittent or reduced work schedule leave.  I also realize that with foreseeable intermittent or reduced work schedule leave, subject to the requirements of my health care provider, I may be required to schedule the leave to minimize interruptions to school district operations.

While on family and medical leave, I agree to pay my regular contributions to employer-sponsored benefit plans.  My contributions will be deducted from monies owed me during the leave period.  If no monies are owed me, I will reimburse the school district by personal check or cash for my contributions.  I understand that I may be dropped from the employer-sponsored benefit plans for failure to pay my contribution.

I agree to reimburse the school district for any payment of my contributions with deductions from future monies owed to me or the school district may seek reimbursement of payments of my contributions in court.

 

I acknowledge that the above information is true to the best of my knowledge.

 

Signed  _________________________________________________________________

 

Date     _________________________________________________________________

 

 

Approved:  Oct. 12, 2009, February 28, 2019        
Reviewed:  Sep. 14, 2009, Apr. 22, 2013, Jan. 21, 2019
Revised:  ___________________                  

 

dawn.gibson.cm… Sun, 11/28/2021 - 20:56

414.3E3A - Certification of Health Care Provider for Employee's Serious Health Condition

414.3E3A - Certification of Health Care Provider for Employee's Serious Health Condition

SECTION I: For Completion by the EMPLOYER

INSTRUCTIONS to the EMPLOYER: The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave due to a serious health condition to submit a medical certification issued by the employee’s health care provider. Please complete Section I before giving this form to your employee. Your response is voluntary. While you are not required to use this form, you may not ask the employee to provide more information than allowed under the FMLA regulations, 29 C.F.R. §§ 825.306-825.308. Employers must generally maintain records and documents relating to medical certifications, re-certifications, or medical histories of employees created for FMLA purposes as confidential medical records in separate files/records from the usual personnel files and in accordance with 29 C.F.R. § 1630.14(c)(1), if the Americans with Disabilities Act applies.

 

Employer name and contact: _____________________________________________________________

 

Employee’s job title: _______________________ Regular work schedule: _______________________

 

Employee’s essential job functions: ______________________________________________________

 

Check if job description is attached: _____

 

SECTION II: For Completion by the EMPLOYEE

INSTRUCTIONS to the EMPLOYEE: Please complete Section II before giving this form to your medical provider. The FMLA permits an employer to require that you submit a timely, complete, and sufficient medical certification to support a request for FMLA leave due to your own serious health condition. If requested by your employer, your response is required to obtain or retain the benefit of FMLA protections. 29 U.S.C. §§ 2613, 2614(c)(3). Failure to provide a complete and sufficient medical certification may result in a denial of your FMLA request. 20 C.F.R. § 825.313. Your employer must give you at least 15 calendar days to return this form. 29 C.F.R. § 825.305(b).

Your name: _______________________________________________________________________________

                        First                                         Middle                                      Last

 

SECTION III: For Completion by the HEALTH CARE PROVIDER

INSTRUCTIONS to the HEALTH CARE PROVIDER: Your patient has requested leave under the FMLA. Answer, fully and completely, all applicable parts. Several questions seek a response as to the frequency or duration of a condition, treatment, etc. Your answer should be your best estimate based upon your medical knowledge, experience, and examination of the patient. Be as specific as you can; terms such as “lifetime,” “unknown,” or “indeterminate” may not be sufficient to determine FMLA coverage. Limit your responses to the condition for which the employee is seeking leave. Please be sure to sign the form on the last page.

 

Provider’s name and business address: ____________________________________________________

 

Type of practice / Medical specialty: _____________________________________________________

 

Telephone: (________)____________________________Fax:(_________)_______________________

 

PART A: MEDICAL FACTS                                                                                                                                                                                                                                   

1. Approximate date condition commenced: ________________________

 

Probable duration of condition: __________________________________________________________

 

Mark below as applicable:

Was the patient admitted for an overnight stay in a hospital, hospice, or residential medical care facility? ___No ___Yes. If so, dates of admission:

Date(s) you treated the patient for condition:

____________________________________________________________________________________

 

Will the patient need to have treatment visits at least twice per year due to the condition? ___No ___ Yes.

 

Was medication, other than over-the-counter medication, prescribed? ___No ___Yes.

 

Was the patient referred to other health care provider(s) for evaluation or treatment (e.g., physical therapist)? ____No Yes____. If so, state the nature of such treatments and expected duration of treatment:

 

2. Is the medical condition pregnancy? ___No ___Yes. If so, expected delivery date: ________________

 

3. Use the information provided by the employer in Section I to answer this question. If the employer fails        to provide a list of the employee’s essential functions or a job description, answer these questions based upon the employee’s own description of his/her job functions.

 

Is the employee unable to perform any of his/her job functions due to the condition: ____ No ____ Yes.

 

If so, identify the job functions the employee is unable to perform:

 

4. Describe other relevant medical facts, if any, related to the condition for which the employee seeks leave (such medical facts may include symptoms, diagnosis, or any regimen of continuing treatment such as the use of specialized equipment):

____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

 

 

PART B: AMOUNT OF LEAVE NEEDED

5. Will the employee be incapacitated for a single continuous period of time due to his/her medical condition, including any time for treatment and recovery? ___No Yes. ___

 

            If so, estimate the beginning and ending dates for the period of incapacity: __________________

 

6. Will the employee need to attend follow-up treatment appointments or work part-time or on a reduced schedule because of the employee’s medical condition? ___No ___Yes.

 

            If so, are the treatments or the reduced number of hours of work medically necessary?

             ___No ___Yes.

 

            Estimate treatment schedule, if any, including the dates of any scheduled appointments and the time required for each appointment, including any recovery period:

____________________________________________________________________________

            Estimate the part-time or reduced work schedule the employee needs, if any:

            _________hour(s) per day; ________ days per week from ____________through ____________

 

7. Will the condition cause episodic flare-ups periodically preventing the employee from performing his/her job functions? ____No Yes____.

 

            Is it medically necessary for the employee to be absent from work during the flare-ups?     ____ No Yes____ . If so, explain:

______________________________________________________________________________

______________________________________________________________________________

 

Based upon the patient’s medical history and your knowledge of the medical condition, estimate the frequency of flare-ups and the duration of related incapacity that the patient may have over the next 6 months (e.g., 1 episode every 3 months lasting 1-2 days):

Frequency: _____ times per       _____ week(s) month(s) _____

 

            Duration: _____ hours or ___ day(s) per episode

 

ADDITIONAL INFORMATION: IDENTIFY QUESTION NUMBER WITH YOUR ADDITIONAL ANSWER.

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

 

 

____________________________________________________________________________________
Signature of Health Care Provider                                                                      Date

 

 

 

PAPERWORK REDUCTION ACT NOTICE AND PUBLIC BURDEN STATEMENT

If submitted, it is mandatory for employers to retain a copy of this disclosure in their records for three years. 29 U.S.C. § 2616; 29 C.F.R. § 825.500.Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. The Department of Labor estimates that it will take an average of 20 minutes for respondents to complete this collection of information, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have any comments regarding this burden estimate or any other aspect of this collection information, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, U.S. Department of Labor, Room S-3502, 200 Constitution Ave., NW, Washington, DC 20210. DO NOT SEND COMPLETED FORM TO THE DEPARTMENT OF LABOR; RETURN TO THE PATIENT.

 

dawn.gibson.cm… Sun, 11/28/2021 - 20:51

414.3E3B - Certification for Serious Injury or Illness of Covered Servicemember - For Military Family Leave

414.3E3B - Certification for Serious Injury or Illness of Covered Servicemember - For Military Family Leave

Notice to the EMPLOYER INSTRUCTIONS to the EMPLOYER:  The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA leave due to a serious injury or illness of a covered servicemember to submit a certification providing sufficient facts to support the request for leave.  Your response is voluntary.  While you are not required to use this form, you may not ask the employee to provide more information than allowed under the FMLA regulations, 29 C.F.R. § 825.310.  Employers must generally maintain records and documents relating to medical certifications, recertifications, or medical histories of employees or employees’ family members, created for FMLA purposes as confidential medical records in separate files/records from the usual personnel files and in accordance with 29 C.F.R. § 1630.14(c)(1), if the Americans with Disabilities Act applies.

 

SECTION I:  For Completion by the EMPLOYEE and/or the COVERED SERVICEMEMBER for whom the Employee Is Requesting Leave INSTRUCTIONS to the EMPLOYEE or COVERED SERVICEMEMBER:  Please complete Section I before having Section II completed.  The FMLA permits an employer to require that an employee submit a timely, complete, and sufficient certification to support a request for FMLA leave due to a serious injury or illness of a covered servicemember.  If requested by the employer, your response is required to obtain or retain the benefit of FMLA-protected leave.  29 U.S.C. §§ 2613, 2614(c)(3).  Failure to do so may result in a denial of an employee’s FMLA request.  29 C.F.R. § 825.310(f).  The employer must give an employee at least 15 calendar days to return this form to the employer.

 

SECTION II:  For Completion by a UNITED STATES DEPARTMENT OF DEFENSE (“DOD”) HEALTH CARE PROVIDER or a HEALTH CARE PROVIDER who is either:  (1) a United States Department of Veterans Affairs (“VA”) health care provider; (2)  a DOD TRICARE network authorized private health care provider; or (3) a DOD non-network TRICARE authorized private health care provider INSTRUCTIONS to the HEALTH CARE PROVIDER:   The employee listed on Page 2 has requested leave under the FMLA to care for a family member who is a member of the Regular Armed Forces, the National Guard, or the Reserves who is undergoing medical treatment, recuperation, or therapy, is otherwise in outpatient status, or is otherwise on the temporary disability retired list for a serious injury or illness.  For purposes of FMLA leave, a serious injury or illness is one that was incurred in the line of duty on active duty that may render the servicemember medically unfit to perform the duties of his or her office, grade, rank, or rating.

 

A complete and sufficient certification to support a request for FMLA leave due to a covered servicemember’s serious injury or illness includes written documentation confirming that the covered servicemember’s injury or illness was incurred in the line of duty on active duty and that the covered servicemember is undergoing treatment for such injury or illness by a health care provider listed above.  Answer, fully and completely, all applicable parts.  Several questions seek a response as to the frequency or duration of a condition, treatment, etc.  Your answer should be your best estimate based upon your medical knowledge, experience, and examination of the patient.  Be as specific as you can; terms such as “lifetime,” “unknown,” or “indeterminate” may not be sufficient to determine FMLA coverage.  Limit your responses to the condition for which the employee is seeking leave.

 

SECTION I:  For Completion by the EMPLOYEE and /or the COVERED SERVICE MEMBER for whom the Employee Is Requesting Leave:  (This section must be completed first before any of the below sections can be completed by a health care provider.)

 

PART A:  EMPLOYEE INFORMATION

 

Name and Address of Employer (this is the employer of the employee requesting leave to care for covered servicemember):

 

______________________________________________________________________________

 

Name of Employee Requesting Leave to Care for Covered Servicemember:

 

______________________________________________________________________________
                      First                                       Middle                                     Last

 

Name of Covered Servicemember (for whom employee is requesting leave to care):

 

______________________________________________________________________________
                      First                                       Middle                                     Last

 

Relationship of Employee to Covered Servicemember Requesting Leave to Care:

  Spouse          Parent          Son               Daughter         Next of Kin

 

PART B:  COVERED SERVICE MEMBER INFORMATION

 

 

1.       Is the covered service member a current member of the Regular Armed Forces, the    National Guard or Reserves?    

   Yes         No

 

If “yes,” please provide the covered service member’s military branch, rank and unit currently assigned to:  ______________________________________________________

 

 

Is the covered service member assigned to a military medical treatment facility as an outpatient or to a  unit established for the purpose of providing command control of members of the Armed Forces receiving medical care as outpatients (such as a medical hold or warrior transition unit)?  _____ Yes  _____ No.  If “yes, please provide the name of the medical treatment facility or unit:  ________________________________________

 

 

 

 

 

 

2.       Is the covered service member on the Temporary Disability Retired List (TDRL)?        _____Yes   _____No. 

 

PART C:  CARE TO BE PROVIDED TO THE COVERED SERVICE MEMBER

 

Describe the care to be provided to the covered service member and an estimate of the leave needed to provide the care: 

______________________________________________________________________________

______________________________________________________________________________

 

 

SECTION II:  For Completion by a United States Department of Defense (“DOD”) Health Care Provider or Health Care Provider who is either:  (1) a United States Department of Veterans Affairs (“VA”) health care provider; (2) a DOD TRICARE network authorized private health care provider; or (3) a DOD non-network TRICARE authorized private health care provider. If you are unable to make certain of the military-related determinations contained below in Part B, you are permitted to rely upon determinations from an authorized DOD representative (such as a DOD recovery care coordinator).  (Please ensure that Section I above has been completed before completing this section.)  Please be sure to sign the form on the last page.

 

PART A:  HEALTH CARE PROVIDER INFORMATION

Health Care Provider’s Name and Business Address:  

_________________________________________________________________________________________

 

Type of Practice/Medical Specialty:  ___________________________________________________________

 

Please state whether you are either:  (1) a DOD health care provider; (2) a VA health care provider; (3) a DOD TRICARE network authorized private health care provider; or (4) a DOD non-network TRICARE authorized private health care provider:  __________________________________________________________________

 

Telephone: (     ) ________________   Fax: (     ) ________________   Email: __________________________

 

PART B:  MEDICAL STATUS

 

1.       Covered servicemember’s medical condition is classified as (check one of the appropriate boxes):

 

             (VSI) Very Seriously Ill/Injured – Illness/Injury is of such a severity that life is imminently endangered.  Family members are requested at bedside immediately.  (Please note this is an internal DOD casualty assistance designation used by DOD healthcare providers.)         

             (SI) Seriously Ill/Injured – Illness/injury is of such severity that there is cause for immediate concern, but there is no imminent danger to life.  Family members are requested at bedside.  (Please note this is an internal DOD casualty assistance designation used by DOD healthcare providers.)

             OTHER Ill/Injured – A serious injury or illness that may render the service member medically unfit to perform the duties of the member’s office, grade, rank, or rating.

             NONE OF THE ABOVE (Note to Employee:  If this box is checked, you may still be eligible to take                            leave to care for a covered family member with a “serious health condition” under § 825.113 of the       FMLA.  If such leave is requested, you may be required to complete DOL FORM WH-380 or an employer-provided form seeking the same information.)

 

2.       Was the condition for which the covered service member is being treated incurred in line of duty on active duty in the Armed Forces?   ____ Yes   ____ No

 

3.       Approximate date condition commenced:  _______________________________________

                                                                                                                       

4.       Probably duration of condition and/or need for care:  ______________________________                                 

 

 

5.       Is the covered service member undergoing medical treatment, recuperation, or therapy?

 Yes      No                               If “yes,” please describe medical treatment, recuperation or therapy:          

 

_________________________________________________________________________

 

 

PART C:  COVERED SERVICEMEMBER’S NEED FOR CARE BY FAMILY MEMBER

 

1.       Will the covered servicemember need care for a single continuous period of time, including any time for treatment and recovery?

   Yes      No. 

 

          If “yes,” estimate the beginning and ending dates for this period of time: _________________________

 

2.       Will the covered service member require periodic follow-up treatment appointments? 

 

           ___Yes   ___ No.  If  “yes.” Estimate the treatment schedule:  _________________________________

 

 

 

 

3.       Is there a medical necessity for the covered service member to have periodic care for these follow-up treatment appointments?  

___ Yes   ___ No

 

 

 

4.       Is there a medical necessity for the covered servicemember to have periodic care for other than scheduled follow-up treatment appointments (e.g., episodic flare-ups of medical condition)?  ___ Yes   ___ No.  If “yes,” please estimate the frequency and duration of the periodic care:  __________________________________________________________________________________________

 

 

__________________________________________________________________________________________

 

 

______________________________________     _____________________________________
Signature of Health Care Provider                       Date

 

       

 

PAPERWORK REDUCTION ACT NOTICE AND PUBLIC BURDEN STATEMENT

If  submitted,  it  is  mandatory  for  employers  to  retain  a  copy  of  this  disclosure  in  their records for 3 years in accordance with  29 U.S.C.  § 2616; 29 C.F.R. § 825.500.  Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number.  The Department of Labor estimates that it will take an average of 20 minutes for respondents to complete this collection of information, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  If you have any comments regarding this burden estimate or any other aspect of this collection information, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, U.S. Department of Labor, Room S-3502, 200 Constitution Ave., NW, Washington, DC   20210.  DO NOT SEND COMPLETED FORM TO THE DEPARTMENT OF LABOR; RETURN TO THE PATIENT.

 

 

Approved:  
Reviewed:  Apr. 22, 2013
Revised:     

 

dawn.gibson.cm… Sun, 11/28/2021 - 20:41

414.3E4 - Designation Notice

414.3E4 - Designation Notice

Leave covered under the Family and Medical Leave Act (FMLA) must be designated as FMLA-protected and the employer must inform the employee of the amount of leave that will be counted against the employee’s FMLA leave entitlement. In order to determine whether leave is covered under the FMLA, the employer may request that the leave be supported by a certification. If the certification is incomplete or insufficient, the employer must state in writing what additional information is necessary to make the certification complete and sufficient. While use of this form by employers is optional, a fully completed Form WH-382 provides an easy method of providing employees with the written information required by 29 C.F.R. §§ 825.300(c), 825.301, and 825.305(c).________

 To:  _____________________________________________

 Date: ____________________________________________

We have reviewed your request for leave under the FMLA and any supporting documentation that you have provided.

We received your most recent information on ______________________________________________ and decided:                     

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 _____ Your FMLA leave request is approved. All leave taken for this reason will be designated as FMLA leave.

 

The FMLA requires that you notify us as soon as practicable if dates of scheduled leave change or are extended, or were initially unknown. Based on the information you have provided to date, we are providing the following information about the amount of time that will be counted against your leave entitlement:

 _____   Provided there is no deviation from your anticipated leave schedule, the following number of hours, days, or weeks will be counted against your leave entitlement: _____________________________________________

 

 _____   Because the leave you will need will be unscheduled, it is not possible to provide the hours, days, or weeks that will be counted against your FMLA entitlement at this time. You have the right to request this information once in a 30-day period (if leave was taken in the 30-day period).

 

 Please be advised (check if applicable):

_____    You have requested to use paid leave during your FMLA leave. Any paid leave taken for this reason will count against your FMLA leave entitlement.

 

 _____   We are requiring you to substitute or use paid leave during your FMLA leave.

 

 ______   You will be required to present a fitness-for-duty certificate to be restored to employment. If such certification is not timely received, your return to work may be delayed until certification is provided. A list of the essential functions of your position ___ is ___is not attached. If attached, the fitness-for-duty certification must address your ability to perform these functions.

____________________________________________________________________________________________________________

 _____ Additional information is needed to determine if your FMLA leave request can be approved:

 

_____ The certification you have provided is not complete and sufficient to determine whether the FMLA applies to your leave   request. You must provide the following information no later than ______________________________, unless it is not practicable under the particular circumstances despite your diligent good faith efforts, or your leave may be denied.
                            (Provide at least seven calendar days)

__________________________________________________________________________________________
(Specify information needed to make the certification complete and sufficient)

____________________________________________________________________________________________________________

 

_____    We are exercising our right to have you obtain a second or third opinion medical certification at our expense, and we will   provide further details at a later time.

___________________________________________________________________________________________________________

_____    Your FMLA Leave request is Not Approved

_____    The FMLA does not apply to your leave request.

_____    You have exhausted your FMLA leave entitlement in the applicable 12-month period.

____________________________________________________________________________________________________________

PAPERWORK REDUCTION ACT NOTICE AND PUBLIC BURDEN STATEMENT

It is mandatory for employers to inform employees in writing whether leave requested under the FMLA has been determined to be covered under the FMLA. 29 U.S.C. § 2617; 29 C.F.R. §§ 825.300(d), (e). It is mandatory for employers to retain a copy of this disclosure in their records for three years. 29 U.S.C. § 2616; 29 C.F.R. § 825.500. Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. The Department of Labor estimates that it will take an average of 10 – 30 minutes for respondents to complete this collection of information, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have any comments regarding this burden estimate or any other aspect of this collection information, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, U.S. Department of Labor, Room S-3502, 200 Constitution Ave., NW, Washington, DC 20210. DO NOT SEND THE COMPLETED FORM TO THE WAGE AND HOUR DIVISION.                                                                                                                                   Form WH-382 January 2009    

 

dawn.gibson.cm… Sun, 11/28/2021 - 20:39

414.3E5 - Certification of Qualifying Exigency for Military Family Leave

414.3E5 - Certification of Qualifying Exigency for Military Family Leave

SECTION I: For Completion by the EMPLOYER

INSTRUCTIONS to the EMPLOYER: The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA leave due to a qualifying exigency to submit a certification. Please complete Section I before giving this form to your employee. Your response is voluntary, and while you are not required to use this form, you may not ask the employee to provide more information than allowed under the FMLA regulations, 29 C.F.R. § 825.309.

 

Employer name: __________________________________________________________________________________

 

Contact Information: _______________________________________________________________________________

 

 

SECTION II: For Completion by the EMPLOYEE

INSTRUCTIONS to the EMPLOYEE: Please complete Section II fully and completely. The FMLA permits an employer to require that you submit a timely, complete, and sufficient certification to support a request for FMLA leave due to a qualifying exigency. Several questions in this section seek a response as to the frequency or duration of the qualifying exigency. Be as specific as you can; terms such as “unknown,” or “indeterminate” may not be sufficient to determine FMLA coverage. Your response is required to obtain a benefit. 29 C.F.R. § 825.310. While you are not required to provide this information, failure to do so may result in a denial of your request for FMLA leave. Your employer must give you at least 15 calendar days to return this form to your employer.

 

 Your Name: ____________________________________________________________________________________
                        First                                         Middle                          Last

 

 Relationship of covered military member to you: ________________________________________________________

 

 Period of covered military member’s active duty: ________________________________________________________

 

A complete and sufficient certification to support a request for FMLA leave due to a qualifying exigency includes written documentation confirming a covered military member’s active duty or call to active duty status in support of a contingency operation. Please check one of the following:

 ___ A copy of the covered military member’s active duty orders is attached.

 ___ Other documentation from the military certifying that the covered military member is on active duty (or has been notified of an impending call to active duty) in support of a contingency operation is attached.

 

 

___  I have previously provided my employer with sufficient written documentation confirming the covered military member’s active duty or call to active duty status in support of a contingency operation.

 

 

 

PART A: QUALIFYING REASON FOR LEAVE

1.         Describe the reason you are requesting FMLA leave due to a qualifying exigency (including the specific reason you are requesting leave):

__________________________________________________________________________________________

­­__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

 

2.         A complete and sufficient certification to support a request for FMLA leave due to a qualifying exigency includes any available written documentation which supports the need for leave; such documentation may include a copy of a meeting announcement for informational briefings sponsored by the military, a document confirming an appointment with a counselor or school official, or a copy of a bill for services for the handling of legal or financial affairs. Available written documentation supporting this request for leave is attached.

 

            ___ Yes ___ No ___ None Available

 

PART B: AMOUNT OF LEAVE NEEDED

1.         Approximate date exigency commenced: _________________________________________________________

            Probable duration of exigency: _________________________________________________________________

 

 

2.         Will you need to be absent from work for a single continuous period of time due to the qualifying exigency? ___No ___Yes.

            If so, estimate the beginning and ending dates for the period of absence:

__________________________________________________________________________________________

 

 

3.         Will you need to be absent from work periodically to address this qualifying exigency? ___No ___ Yes.

            Estimate schedule of leave, including the dates of any scheduled meetings or appointments: ________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

 

            Estimate the frequency and duration of each appointment, meeting, or leave event, including any travel

            time (i.e., 1 deployment-related meeting every month lasting 4 hours):

           

            Frequency: _____ times per _____ week(s) _____ month(s)

           

            Duration: _____ hours ___ day(s) per event.

 

PART C:

If leave is requested to meet with a third party (such as to arrange for childcare, to attend counseling, to attend meetings with school or childcare providers, to make financial or legal arrangements, to act as the covered military member’s representative before a federal, state, or local agency for purposes of obtaining, arranging or appealing military service benefits, or to attend any event sponsored by the military or military service organizations), a complete and sufficient certification includes the name, address, and appropriate contact information of the individual or entity with whom you are meeting (i.e., either the telephone or fax number or email address of the individual or entity). This information may be used by your employer to verify that the information contained on this form is accurate.

 

Name of Individual: ___________________________ Title: ___________________________________________

Organization: _________________________________________________________________________________

Address: _____________________________________________________________________________________

Telephone: (________)_________________________ Fax: (_______)____________________________________

Email: _______________________________________________________________________________________

Describe nature of meeting: ______________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

_____________________________________________________________________________________________

PART D:

 

I certify that the information I provided above is true and correct.

 

___________________________________________            ________________________________________
Signature of Employee                                                         Date

 

 

PAPERWORK REDUCTION ACT NOTICE AND PUBLIC BURDEN STATEMENT

If submitted, it is mandatory for employers to retain a copy of this disclosure in their records for three years. 29 U.S.C. § 2616; 29 C.F.R. § 825.500. Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. The Department of Labor estimates that it will take an average of 20 minutes for respondents to complete this collection of information, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have any comments regarding this burden estimate or any other aspect of this collection information, including suggestions for reducing this burden, send them to the Administrator, Wage and Hour Division, U.S. Department of Labor, Room S-3502, 200 Constitution AV, NW, Washington, DC 20210. DO NOT SEND THE COMPLETED FORM TO THE WAGE AND HOUR DIVISION; RETURN IT TO THE EMPLOYER.

 

 

 

 

 

 

                                                                                                                             Form WH-384 January 2009

 

dawn.gibson.cm… Sun, 11/28/2021 - 20:16

414.3R1 - Classified Employee Family and Medical Leave Regulation

414.3R1 - Classified Employee Family and Medical Leave Regulation

A.      School district notice.

  1. The school district will post the notice in Exhibit 414.3E1 regarding family and medical leave.
     
  2. Information on the Family and Medical Leave Act and the board policy on family and medical leave, including leave provisions and employee obligations will be provided annually.  The information will be in the Board Policy provided on-line.
     
  3. When an employee requests family and medical leave, the school district will provide the employee with information listing the employee’s obligations and requirements.  Such information will include:

                   a.       a statement clarifying whether the leave qualifies as family and medical leave and will, therefore, be credited to the employee’s annual
                            12-week entitlement or 26-week entitlement depending on the purpose of the leave;

                   b.       a reminder that employees requesting family and medical leave for their serious health condition or for that of an immediate family
                             member must furnish medical certification of the serious health condition and the consequences for failing to do so or proof of call to
                             active duty in the case of military family and medical leave;

                   c.       an explanation of the employee’s right to substitute paid leave for family and medical leave including a description of when the school
                             district requires substitution of paid leave and the conditions related to the substitution; and

                   d.       a statement notifying employees that they must pay and must make arrangement for paying any premium or other payments to maintain
                             health or 
other benefits.

B.      Eligible employees.

          Employees are eligible for family and medical leave if three criteria are met.

          1.       The school district has more than 50 employees on the payroll at the time leave is requested;

          2.       The employee has worked for the school district for at least 12 months or 52 weeks (the months and weeks need not be consecutive); and

          3.       The employee has worked at least 1,250 hours within the previous year.  Full-time professional employees who are exempt from the wage and
                    hour law may be presumed to have worked the minimum hour requirement.

If the employee requesting leave is unable to meet the above criteria, the employee is not eligible for family and medical leave.                            

C.      Employee requesting leave – two types of leave.

          1.       Foreseeable family and medical leave.

                   a.       Definition – leave is foreseeable for the birth or placement of an adopted or foster child with the employee or for planned medical
                             treatment.

                   b.       Employee must give at least 30 days notice for foreseeable leave.  Failure to give the notice may result in the leave beginning 30 days
                             after notice was received.  For those taking leave due to military family and medical leave, notice should be given as soon as possible.

                   c.       Employees must consult with the school district prior to scheduling planned medical treatment leave to minimize disruption to the school
                             district.  The scheduling is subject to the approval of the health care provider.

          2.       Unforeseeable family and medical leave.

                   a.       Definition – leave is unforeseeable, in such situations as emergency medical treatment or premature birth.

                   b.       Employee must give notice as soon as possible but no later than one to two work days after learning that leave will be necessary.

                   c.       A spouse or family member may give the notice if the employee is unable to personally give notice.

D.      Eligible family and medical leave determination.  The school district may require the employee giving notice of the need for leave to provide reasonable documentation or a statement of family relationship.

          1.       Six purposes.

                   a.       The birth of a son or daughter of the employee and in order to care for that son or daughter prior to the first anniversary of the child’s
                             birth;

                   b.       The placement of a son or daughter with the employee for adoption or foster care and in order to care for that son or daughter prior to the
                             first anniversary of the child’s placement;

                   c.       To care for the spouse, son, daughter, or parent of the employee if the spouse, son, daughter or parent has a serious health condition; or

                   d.       Employee’s serious health condition that makes the employee unable to perform the essential functions of the employee’s position.

                   e.       Because of a qualifying exigency arising out of the fact that an employee’s spouse; son or daughter; parent is on active duty or call to
                             active duty status in support of a contingency operation as a member of the National Guard or Reserves.

                   f.       Because the employee is the spouse; son or daughter; parent; next of kin of a covered service member with a serious injury or illness.

          2.       Medical certification.        

                   a.       When required:

                             (1)     Employees shall be required to present medical certification of the employee’s serious health condition and inability to perform the
                                       essential functions of the job.

                             (2)     Employees shall be required to present medical certification of the family member’s serious health condition and that it is
                                       medically necessary for the employee to take leave to care for the family member.

                             (3)     Employees shall be required to present certification of the call to active duty when taking military family and medical leave.

                   b.       Employee’s medical certification responsibilities:

                             (1)     The employee must obtain the certification from the health care provider who is treating the individual with the serious health
                                       condition.

                             (2)     The school district may require the employee to obtain a second certification by a health care provider chosen by and paid for by
                                       the school district if the school district has reason to doubt the validity of the certification an employee submits.  The second health
                                       care provider cannot, however, be employed by the school district on a regular basis.

                             (3)     If the second health care provider disagrees with the first health care provider, then the school district may require a third health
                                       care provider to certify the serious health condition.  This health care provider must be mutually agreed upon by the employee and
                                       the school district and paid for by the school district.  This certification or lack of certification is binding upon both the employee
                                       and the school district.

                   c.       Medical certification will be required 15 days after family and medical leave begins unless it is impracticable to do so.  The school
                             district may request recertification every 30 days.  Recertification must be submitted within 15 days of the school district’s request.

                   d.       Employees taking military caregiver family and medical leave to care for a family service member cannot be required to obtain a second
                             opinion or to provide recertification.

Family and medical leave requested for the serious health condition of the employee or to care for a family member with a serious health condition which is not supported by medical certification will be denied until such certification is provided.

E.      Entitlement.

          1.       Employees are entitled to 12 weeks unpaid family and medical leave per year.  Employees taking military caregiver family and medical leave
                    to care for a family service member are entitled to 26 weeks of unpaid family and medical leave but only in a single 12 month period.

          2.       Year is defined as fiscal year – beginning July 1.

          3.       If insufficient leave is available, the school district may.

                   a.       Deny the leave if entitlement is exhausted.

                   b.       Award leave available.

                   c.       Award leave in accordance with other provisions of board policy or the collective bargaining agreement.

F.       Type of Leave Requested.

          1.       Continuous – employee

          2.       Intermittent – employee requests family and medical leave for separate periods of time.

                    a.      Intermittent leave is available for:

                             _____         birth of my child or adoption or foster care placement subject to agreement by the district;

                             _____         serious health condition of myself, parent, spouse, or child when medically necessary;

                             _____         because of a qualifying exigency arising out of the fact that my spouse; son or daughter; parent is on active duty or call to
                                                active duty status in support of a contingency operation as a member of the National Guard or Reserves.

                             _____         because I am the spouse; son or daughter; parent; next of kin of a covered service member with a serious injury or illness.

                   b.       In the case of foreseeable intermittent leave, the employee must schedule the leave to minimize disruption to the school district
                             operation.

                   c.       During the period of foreseeable intermittent leave, the school district may move the employee to an alternative position with equivalent
                             pay and benefits.

                             (For instructional employees, see G below.)

          3.       Reduced work schedule – employee requests a reduction in the employee’s regular work schedule.

                   a.       Reduced work schedule family and medical leave is available for:

                             _____         birth of my child or adoption or foster care placement subject to agreement by the district;

                             _____         serious health condition of myself, parent, spouse, or child when medically necessary;

                             _____         because of a qualifying exigency arising out of the fact that my spouse; son or daughter; parent is on active duty or call to
                                                active duty status in support of a contingency operation as a member of the National Guard or Reserves.

                             _____         because I am the spouse; son or daughter; parent; next of kin of a covered service member with a serious injury or illness.

                   b.       In the case of foreseeable intermittent leave, the employee must schedule the leave to minimize disruption to the school district
                             operation.

                   c.       During the period of foreseeable intermittent leave, the school district may move the employee to an alternative position with equivalent
                             pay and benefits.  (For instructional employees, see G below.)

G.      Special Rules for Instructional Employees.

          1.       Definition – an instructional employee is one whose principal function is to teach and instruct students in a class, a small group or an
                    individual setting.  This includes, but is not limited to, teachers, coaches, driver’s education instructors and special education assistants.
        

          2.       Instructional employees who request foreseeable medically necessary intermittent or reduced work schedule family and medical leave greater
                    than twenty percent of the work days in the leave period may be required to:

                   a.       Take leave for the entire period or periods of the planned medical treatment: or

                   b.       Move to an available alternative position, with equivalent pay and benefits, but not necessarily equivalent duties, for which the employee
                             is qualified.

          3.       Instructional employees who request continuous family and medical leave near the end of a semester may be required to extend the family and
                    medical leave through the end of the semester.  The number of weeks remaining before the end of a semester does not include scheduled
                    school breaks, such as summer, winter, or spring break.

                   a.       If an instructional employee begins family and medical leave for any purpose more than five weeks before the end of a semester, the
                             school district may require that the leave be continued until the end of the semester if the leave will last at least three weeks and the
                             employee would return to work during the last three weeks of the semester if the leave was not continued.

                   b.       If the employee begins family and medical leave for a purpose other than the employee’s own serious health condition during the last
                             five weeks of a semester, the school district may require that the leave be continued until the end of the semester if the leave will last
                             more than two weeks and the employee would return to work during the last two weeks of the semester.

                   c.       If the employee begins family and medical leave for a purpose other than the employee’s own serious health condition during the last
                             three weeks of the semester and the leave will last more than five working days, the school district may require the employee to continue
                             taking leave until the end of the semester.

          4.       The entire period of leave taken under the special rules is credited as family and medical leave.  The school district will continue to fulfill the
                    school district’s family and medical leave responsibilities and obligations, including the obligation to continue the employee’s health insurance
                    and other benefits, if an instructional employee’s family and medical leave entitlement ends before the involuntary leave period expires.

H.      Employee responsibilities while on family and medical leave.

          1.       Employee must continue to pay health care benefit contributions or other benefit contributions regularly paid by the employee unless
                    employee elects not to continue the benefits.

          2.       The employee contribution payments will be deducted from any money owed to the employee or the employee will reimburse the school
                    district at a time set by the superintendent.

          3.       An employee who fails to make the health care contribution payments within 30 days after they are due will be notified that the coverage may
                    be canceled if payment is not received within an additional 15 days.

          4.       An employee may be asked to re-certify the medical necessity of family and medical leave for the serious medical condition of any employee
                    or family member once every 30 days and return the certification within 15 days of the request.

          5.       The employee must notify the school district of the employee’s intent to return to work at least once each month during the leave and at least
                    two weeks prior to the conclusion for the family and medical leave.

          6.       If an employee intends not to return to work, the employee must immediately notify the school district, in writing, of the employee’s intent not
                    to return.  The school district will cease benefits upon receipt of this notification.

I.       Use of paid leave for family and medical leave.

          An employee may substitute unpaid family and medical leave with appropriate paid leave available to the employee under board policy, individual
          contracts or the collective bargaining agreement.  Paid leave includes, but is not limited to, sick leave, family illness leave, vacation and personal
          leave.  When the school district determines that paid leave is being taken for an FMLA reason, the school district will notify the employee within
          two business days that the paid leave will be counted as FMLA leave.  Upon expiration of paid leave, the family medical leave is unpaid.

 

dawn.gibson.cm… Sun, 11/28/2021 - 20:21

414.3R2 - Classified Employee Family and Medical Leave Definitions

414.3R2 - Classified Employee Family and Medical Leave Definitions

Active Duty – duty under a call or order to active duty under a provision of law referring to in section 101(a) (13) of title 10, U.S. Code.

Common Law Marriage – according to Iowa law, common law marriages exist when there is a present intent by the two parties to be married, continuous cohabitation, and a public declaration that the parties are husband and wife.  There is no time factor that needs to be met in order for there to be a common law marriage.

Contingency Operation – has the same meaning given such term in section 101(a)(13) of title 10, U.S. Code.

Continuing Treatment – a serious health condition involving continuing treatment by a health care provider includes any one or more of the following:

  •   A period of incapacity (i.e., inability to work, attend school or perform other regular daily activities due to the serious health condition, treatment for or recovery from) of more than three consecutive calendar days and any subsequent treatment or period of incapacity relating to the same condition that also involves:
    • treatment two or more times by a health care provider, by a nurse or physician’s assistant under direct supervision of a health care provider, or by a provider of health care services (e.g., physical therapist) under orders of, or in referral by, a health care provider; or
    • treatment by a health care provider on at least one occasion which results in a regimen of continuing treatment under the supervision of a health care provider.
  •   Any period of incapacity due to pregnancy or for prenatal care.
  •   Any period of incapacity or treatment for such incapacity due to a chronic serious health condition.  A chronic serious health condition is one which:
    • requires periodic visits for treatment by a health care provider or by a nurse or physician’s assistant under direct supervision of a health care provider;
    • continues over an extended period of time (including recurring episodes of a single underlying condition); and
    • may cause episodic rather than a continuing period of incapacity (e.g., asthma, diabetes, epilepsy, etc.).
  •   Any period of incapacity which is permanent or long-term due to a condition for which treatment may not be effective.  The employee or family member must be under the continuing supervision of, but need not be receiving active treatment by, a health care provider.  Examples include Alzheimer’s, a severe stroke or the terminal stages of a disease.
  •   Any period of absence to receive multiple treatments (including any period of recovery from) by a health care provider, either for restorative surgery after an accident or other injury, or for a condition that would likely result in a period of incapacity of more than 3 consecutive calendar days in the absence of medical intervention or treatment, such as cancer (chemotherapy, radiation, etc.), severe arthritis (physical therapy), kidney disease (dialysis).

Covered Service Member – a current member of the Armed Forces, including a member of the National Guard or Reserves, who is undergoing medical treatment, recuperation, or therapy, is otherwise in outpatient status, or is otherwise on the temporary disability retired list, for a serious injury or illness.

Eligible Employee – the district has more than 50 employees on the payroll at the time leave is requested.  The employee has worked for the district for at least 12 months and has worked at least 1,250 hours within the previous year.

Essential Functions of the Job – those functions which are fundamental to the performance of the job.  It does not include marginal functions.

Employment Benefits – all benefits provided or made available to employees by an employer, including group life insurance, health insurance, disability insurance, sick leave, annual leave, educational benefits, and pensions, regardless of whether such benefits are provided by a practice or written policy of an employer or through an “employee benefit plan.”

Family Member – individual who meets the definition of son, daughter, spouse or parent.

Group Health Plan – any plan of, or contributed to by, an employer (including a self-insured plan) to provide health care (directly or otherwise) to the employer’s employees, former employees, or the families of such employees or former employees.

Health Care Provider

  •   A doctor of medicine or osteopathy who is authorized to practice medicine or surgery by the state in which the doctor practices; or
  •   Podiatrists, dentists, clinical psychologists, optometrists, and chiropractors (limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by x-ray to exist) authorized to practice in the state and performing within the scope of their practice as defined under state law; and
  •   Nurse practitioners and nurse-midwives, and clinical social workers who are authorized to practice under state law and who are performing within the scope of their practice as defined under state law; and
  •   Christian Science practitioners listed with the First church of Christ Scientist in Boston, Massachusetts;
  •   Any health care provider from whom an employer or a group health plan’s benefits manager will accept certification of the existence of a serious health condition to substantiate a claim for benefits;
  •   A health care provider as defined above who practices in a country other than the United States who is licensed to practice in accordance with the laws and regulations of that country.

In Loco Parentis – individuals who had or have day-to-day responsibilities for the care and financial support of a child not their biological child or who had the responsibility for an employee when the employee was a child.

Incapable of Self-care – the individual requires active assistance or supervision to provide daily self-care in several of the “activities of daily living” or “ADLs.”  Activities of daily living include adaptive activities such as caring appropriately for one’s grooming and hygiene, bathing, dressing, eating, cooking, cleaning, shopping, taking public transportation, paying bills, maintaining a residence, using telephones and directories, using a post office, etc.

Instructional Employee – an employee employed principally in an instructional capacity by an educational agency or school whose principal function is to teach and instruct students in a class, a small group, or an individual setting, and includes athletic coaches, driving instructors, and special education assistants such as signers for hearing impaired.  The term does not include teacher assistants or aides who do not have as their principal function actual teaching or instructing, nor auxiliary personnel such as counselors, psychologists, curriculum specialists, cafeteria workers, maintenance workers, bus drivers, or other primarily non-instructional employees.

Intermittent Leave - leave taken in separate periods of time due to a single illness or injury, rather than for one continuous period of time, and may include leave or periods from an hour or more to several weeks.

Medically Necessary – certification for medical necessity is the same as certification for serious health condition.

“Needed to Care For” – the medical certification that an employee is “needed to care for” a family member encompasses both physical and psychological care.  For example, where, because of a serious health condition, the family member is unable to care for his or her own basic medical, hygienic or nutritional needs or safety

Next of Kin - an individual's nearest blood relative

Outpatient Status - the status of a member of the Armed Forces assigned to –

  • either a military medical treatment facility as an outpatient; or
  • a unit established for the purpose of providing command and control of members of the Armed Forces receiving medical care as outpatients.

Parent - a biological parent or an individual who stands in loco parentis to a child or stood in loco parentis to an employee when the employee was a child.  Parent does not include parent-in-law.

Physical or Mental Disability - a physical or mental impairment that substantially limits one or more of the major life activities of an individual.

Reduced Leave Schedule - a leave schedule that reduces the usual number of hours per workweek, or hours per workday, of an employee.

Serious Health Condition -

·       An illness, injury, impairment, or physical or mental condition that involves:

  • Inpatient care (i.e. an overnight stay) in a hospital, hospice or residential medical care facility including any period of incapacity (for purposes of this section, defined to mean inability to work, attend school or perform other regular daily activities due to the serious health condition, treatment for or recovery from), or any subsequent treatment in connection with such inpatient care; or
  • Continuing treatment by a health care provider.  A serious health condition involving continuing treatment by a health care provider includes:

--      A period of incapacity (i.e., inability to work, attend school or perform other regular daily activities due to the serious health condition, treatment for or recovery from) of more than three consecutive calendar days, including any subsequent treatment or period of incapacity relating to the same condition, that also involves:

--   Treatment two or more times by a health care provider, by a nurse or physician's assistant under direct supervision of a health care provider, or by a provider of health care services (e.g., physical therapist) under orders or, or on referral by, a health care provider; or

--   Treatment by a health care provider on at least one occasion which results in a regimen of continuing treatment under the supervision of the health care provider.

--      Any period of incapacity due to pregnancy or for prenatal care.

--      Any period of incapacity or treatment for such incapacity due to a chronic serious health condition.  A chronic serious health condition is one which:

--   Requires periodic visits for treatment by a health care provider or by a nurse or physician's assistant under direct supervision of a health care provider;

--   Continues over an extended period of time (including recurring episodes of s single underlying condition); and

--   May cause episodic rather than a continuing period of incapacity (e.g., asthma, diabetes, epilepsy, etc.).

--   A period of incapacity which is permanent or long-term due to a condition for which treatment may not be effective.  The employee or family member must be under the continuing supervision of, but need not be receiving active treatment by, a health care provider.  Examples include Alzheimer's a severe stroke or the terminal stages of a disease.

--   Any period of absence to receive multiple treatments (including any period of recovery from) by a health care provider or by a provider of health care services under orders of, or on referral by, a health care provider, either for restorative surgery after an accident or other injury, or for a condition that would likely result in a period of incapacity of more than three consecutive calendar days in the absence of medical intervention or treatment, such as cancer (chemotherapy, radiation, etc.), severe arthritis (physical therapy), kidney disease (dialysis).

·      Treatment for purposes of this definition includes, but is not limited to, examinations to determine if a serious health condition exists and evaluation of the condition.  Treatment does not include routine physical examinations, eye examinations or dental examinations.  Under this definition, a regimen of continuing treatment includes, for example, a course of prescription medication (e.g., an antibiotic) or therapy requiring special equipment to resolve or alleviate the health condition (e.g., oxygen).  A regimen of continuing treatment that includes the taking of over-the-counter medications such as aspirin, antihistamines, or salves; or bed rest, drinking fluids, exercise and other similar activities that can be initiated without a visit to a health care provider, is not, by itself, sufficient to constitute a regimen of continuing treatment for purposes of FMLA leave.

·      Conditions for which cosmetic treatments are administered (such as most treatments for acne or plastic surgery) are not "serious health conditions" unless inpatient hospital care is required or unless complications develop.  Ordinarily, unless complications arise, the common cold, the flu, ear aches, upset stomach, ulcers, headaches other than migraine, routine dental or orthodontia problems, periodontal disease, etc., are examples of conditions that do not meet the definition of a serious health condition and do not qualify for FMLA leave.  Restorative dental or plastic surgery after an injury or removal of cancerous growths are serious health conditions provided all the other conditions of this regulation are met.  Mental illness resulting from stress or allergies may be serious health conditions, but only if all the conditions of this section are met.

·      Substance abuse may be a serious health condition if the conditions of this section are met.  However, FMLA leave may only be taken for treatment for substance abuse by a health care provider or by a provider of health care on referral by a health care provider.  On the other hand, absence because of the employee's use of the substance, rather than for treatment, does not qualify for FMLA leave.

·      Absence attributable to incapacity under this definition qualify for FMLA leave even though the employee or the immediate family member does not receive treatment from a health care provider during the absence, and even if the absence does not last more than three days.  For example, an employee with asthma may be unable to report for work due to the onset of an asthma attack or because the employee's health care provider has advised the employee to stay home when the pollen count exceeds a certain level.  An employee who is pregnant may be unable to report to work because of severe morning sickness.

Serious Injury or Illness - an injury or illness incurred by a member of the Armed forces, including the National Guard or Reserves in the line of duty on active duty in the Armed Forces that may render the member medically unfit to perform the duties of the member's office, grade, rank, or rating.

Son or daughter - a biological child, adopted child, foster child, stepchild, legal ward, or a child of a person standing in loco parentis.  The child must be under age 18 or, if over 18, incapable of self-care because of a mental or physical disability.

Spouse - a husband or wife recognized by Iowa law including common law marriages.

 

 

Approved: February 28, 2019        
Reviewed:  Sep. 14, 2009, Apr. 22, 2013, Jan. 21, 2019  
Revised:     Oct 12, 2009, Jan. 21, 2019  

 

dawn.gibson.cm… Sun, 11/28/2021 - 20:07

414.4 - Classified Employee Bereavement Leave

414.4 - Classified Employee Bereavement Leave

In the event of a death of a member of a classified employee's immediate family, classified personnel will be granted leave of absence at full pay in case of death of spouse, child, parent, brother, sister, grandparent, grandchild, mother-in-law, father-in-law, brother-in-law, sister-in-law, son-in-law, daughter-in-law, grandparent-in-law, or a member of the immediate household at the rate of three (3) days per death and two (2) days extra may be granted by the superintendent or designee.  This does not accumulate.  In the event of the death of an employee or student in the Fairfield Community School District, the principal or immediate supervisor of said employee will grant to an appropriate number of employees sufficient time to attend the funeral.

 

 

Legal Reference:  Iowa Code §§ 20.9; 279.8

Cross Reference:  414    Classified Employee Vacations and Leaves of Absence

Approved:  Feb. 11, 1985, February 28, 2019       
Reviewed:  Aug. 24, 2005, Apr. 22, 2013, Jan. 21, 2019    
Revised:  Feb. 10, 1997, Oct. 9, 2000, Jan. 21, 2019 

 

dawn.gibson.cm… Sun, 11/28/2021 - 19:54

414.5 - Classified Employee Political Leave

414.5 - Classified Employee Political Leave

The board will provide a leave of absence to classified employees to run for elective public office.  The superintendent shall grant a classified employee a leave of absence to campaign as a candidate for an elective public office as unpaid leave.

The classified employee will be entitled to one period of leave to run for the elective public office to commence any time within thirty days of a contested primary, special, or general election and continue until the day following the election.

The request for leave must be in writing to the superintendent at least thirty days prior to the starting date of the requested leave.

 

 

Legal Reference:  Iowa Code ch. 55

Cross Reference:  401.9 Employee Political Activity
    
                                  414    Classified Employee Vacations and Leaves of Absence

Approved:  Feb. 10, 1997, June 17, 2013, February 28, 2019        
Reviewed:  Aug. 24, 2005, Apr. 22, 2013, Jan. 21, 2019          
Revised:   Apr. 22, 2013, Jan. 21, 2019    

 

dawn.gibson.cm… Sun, 11/28/2021 - 19:53

414.6 - Classified Employee Jury Duty Leave

414.6 - Classified Employee Jury Duty Leave

The board will allow classified employees to be excused for jury duty.  The superintendent has the discretion to request a waiver on behalf of the employee when extraordinary circumstances exist.

Employees who are called for jury service will notify the direct supervisor within twenty-four hours after notice of call to jury duty and suitable proof of jury service pay must be presented to the school district.  The employee will report to work within one hour on any day when the employee is excused from jury duty during regular working hours.

Classified employees will receive their regular salary.  Any payment for jury duty will be turned over to the school district.

 

 

Legal Reference:  Iowa Code §§ 20.9; 607A (2013).

Cross Reference:  414    Classified Employee Vacations and Leaves of Absence

Approved:  Feb. 11, 1985, June 17, 2013, February 28, 2019       
Reviewed:  Aug. 24, 2005, Apr. 22, 2013, Jan. 21, 2019          
Revised: Apr. 22, 2013, Jan. 21, 2019    

 

dawn.gibson.cm… Sun, 11/28/2021 - 19:52

414.7 - Classified Employee Military Service Leave

414.7 - Classified Employee Military Service Leave

The board recognizes classified employees may be called to participate in the armed forces, including the National Guard. If a classified employee is called to serve in the armed forces, the employee will have a leave of absence for military service until the military service is completed.

The leave is without loss of status or efficiency rating, and without loss of pay during the first thirty calendar days of the leave.

 

 

Legal Reference:  Bewley v. Villisca Community School District, 299 N.W. 2d 904 (Iowa 1980).
    
                                  Iowa Code §§ 20; 29A.28

Cross Reference:  414     Classified Employee Vacations and Leaves of Absence

Approved:  Feb. 11, 1985, June 17, 2013, February 28, 2019       
Reviewed:  Aug. 24, 2005, Apr. 22, 2013, January 21, 2019    
Revised:   Apr. 22, 2013, January 21, 2019 

 

dawn.gibson.cm… Sun, 11/28/2021 - 19:51

414.8 - Classified Employee Unpaid Leave

414.8 - Classified Employee Unpaid Leave

Unpaid leave may be used to excuse an involuntary absence not provided for in this or other leave policies of the board.  Unpaid leave for classified employees must be authorized by the superintendent. All paid leave must be exhausted before unpaid leave will be granted.

The superintendent will have complete discretion to grant or deny the requested unpaid leave.  In making this determination, the superintendent will consider the effect of the employee's absence on the education program and school district operations, length of service, previous record of absence, the financial condition of the school district, the reason for the requested absence and other factors the superintendent believes are relevant to making this determination.

If unpaid leave is granted, the duration of the leave period will be coordinated with the scheduling of the education program whenever possible to minimize the disruption of the education program and school district operations.

Whenever possible, classified employees will make a written request for unpaid leave ten (10) days prior to the beginning date of the requested leave. 

 

 

Legal Reference:  Iowa Code §§ 20.9; 279.8 (2013)

Cross Reference:  414   Classified Employee Vacations and Leaves of Absence

Approved:  Feb. 11, 1985, June 17, 2013, February 28, 2019       
Reviewed:  Aug. 24, 2005, Apr. 22, 2013, Jan. 21, 2019    
Revised:  Feb. 10, 1997, Apr. 22, 2013, Jan. 21, 2019    

 

dawn.gibson.cm… Sun, 11/28/2021 - 19:49

414.9 - Classified Employee Professional Leave

414.9 - Classified Employee Professional Leave

Professional leave may be granted to classified employees for the purpose of attending meetings and conferences directly related to their assignments.  Application for the leave must be presented to the superintendent ten (10) days prior to the meeting or conference.

It will be within the discretion of the superintendent to grant professional leave.  The leave may be denied on the day before or after a vacation or holiday, on special days when services are needed, when it would cause undue interruption of the education program and school district operations, or for other reasons deemed relevant by the superintendent.

 

 

Legal Reference:  Iowa Code § 279.8 (2013).
                                
          281 I.A.C. 12.7.

Cross Reference:  408.1 Licensed Employee Professional Development
    
                                  411    Classified Employees - General

Approved:  Feb. 10, 1997, Sep 15, 2014, February 28, 2019        
Reviewed:  Aug. 24, 2005, Apr. 22, 2013, Aug 18, 2014, Jan. 21, 2019          
Revised:     Aug 18, 2014, Jan. 21, 2019    

 

dawn.gibson.cm… Sun, 11/28/2021 - 21:04

415 - Employee Request for Leave at Full Pay

415 - Employee Request for Leave at Full Pay

Employees satisfying one of the three standards noted below are eligible for two weeks of leave capped at 80 hours paid at the employee’s full regular compensation rate. For a part-time employee it is the number of hours equal to the average number of hours that the employee works over a typical two-week period. Please select the applicable reason and follow the related instructions.

I am unable to work or telework for the following reason:

___I am quarantined pursuant to Federal, State or local government order.

___I am quarantined on the advice of a health care provider due to COVID-19 concerns.

___I am experiencing COVID-19 symptoms and seeking a medical diagnosis.

Please attach the applicable government order or documentation from a medical provider corresponding to the item(s) selected. If you are experiencing symptoms and seeking a medical diagnosis, please identify your symptoms and the date of your medical appointment.

 

Reason for Leave

Employees satisfying the standards below are eligible for 12 weeks* of leave. The first two weeks of the leave are unpaid time unless the employee selects available options in the next box. The remaining 10 weeks of leave are paid at 2/3 of the employee’s regular compensation rate unless other options are selected on this form. Please select the applicable reason and follow he related instructions.

I, _________________________________, request family and medical leave because I am unable to work or telework because I need to care for my child(ren) under 18 because my child(ren)’s elementary or secondary school, childcare provider, or child’s place of care has been closed or is unavailable due to COVID-19. During this period of unavailability or closure, I represent that no other person will be providing care for my child during the period for which I am receiving expanded family medical leave benefits.

If the age of one or more of the children is between 14 and 18, the following special circumstances exist requiring me to care for the child during daylight hours:

Please attach notice or documentation related to the unavailability of the school, daycare, place of care or person providing care to the child. The District reserves the right to request confirmation regarding the nature of the closure or unavailability.

*An employee who qualifies for and utilizes the Emergency Paid Sick Leave provision is entitled to an additional 10 weeks of Emergency FMLA

 

 

Approved:
Reviewed:  July 27, 2020      
Revised:  

 

dawn.gibson.cm… Sun, 11/28/2021 - 19:41

415.1 - COVID-10 Temporary Supplemental Policy

415.1 - COVID-10 Temporary Supplemental Policy

NOTE: This Policy involves a rapidly evolving public health emergency. The District will continue to reassess this policy as the public health emergency and the law evolves. The District reserves the right to amend or revise this policy at any time.

 

  1. PURPOSE. The purpose of this temporary and supplement policy is to protect students, employees, and community members; to establish a consistent approach to an infectious disease which is potentially impactful to the quality and timeliness of services provided by the District; and to provide a way to disseminate information to employees and answer questions or concerns.

This is a working document that may be updated as information is released, or if additional legislation is passed by the federal and state government. The District will strive to follow all guidelines put in place by the Centers for Disease Control (CDC), Iowa Department of Public Health (IDPH), and the County Department of Public Health.

 

  1. COVID-19.  COVID-19, or coronavirus, is a respiratory illness for which no vaccine currently exists and people do not possess immunities from previous exposure/infection. The incubation period for COVID-19 is estimated to be approximately 14 days. On March 11, 2020, the World Health Organization characterized COVID-19 as a pandemic. Because of the possibility of person-to-person transmission, it is important that employees stay a minimum of six (6) feet away from persons with whom they are interacting and refrain from handshakes and other forms of human touching.  Common areas such as computers, mice, public countertops, chairs, tables, doors, knobs, light switches, restroom sinks and toilet handles, manual soap and sanitizer dispensers should be regularly wiped down with disinfectant. Employees using these items should wash their hands or use sanitizer with at least 60% alcohol following the contact.

 

  1. DISTRICT RESPONSE TO PANDEMIC. In response to the pandemic, the District has temporarily closed all buildings.  Some employees have been deemed essential employees required to report to work at their designated building site, including, but not necessarily limited to: maintenance and grounds keeping staff, food service staff, drivers aiding in food distribution, and other administrators of the district. Other employees may be directed to work remotely. In some instances, these employees may be required to work overtime or otherwise adjust their regular schedules to assist during this crisis. All employees performing work during this temporary closure will be compensated pursuant to their individual contracts or letters of assignment, applicable collective bargaining agreements, Board policy, and/or state and federal law.

The District may modify work schedules as follows: (1) work from home entirely; (2) work partially from home and work partially at their worksite; (3) work staggered shifts either on a full-time or part-time basis; or (4) adjusted or otherwise reduced hours.

Any employee working from home will be required to comply with all applicable District policies and procedures, including but not limited to the Acceptable Use of Technology Policy (Board Policy No. 401.13, Student Records/FERPA (506.1), and District policies and procedures for reporting and using available leave.

During this time, if you are reporting to work or working from home, you may be asked to perform tasks that are not normal for your job description. Changes in your job duties, including the direction to work remotely (if applicable), are temporary in nature and do not constitute permanent changes to the essential functions of your job or other District policies or procedures. These changes do not set precedent for future requests for leave, remote work, or other accommodations.

The District will periodically re-evaluate this situation and workplace attendance and leave policies.

 

  1. EMERGENCY PAID SICK LEAVE: Pursuant to the Families First Coronavirus Response Act, a federal law passed on March 18, 2020, and effective April 1, 2020, the District will provide paid sick leave for employees who meet the following criteria:
    1. A federal, state, or local quarantine or isolation order related to COVID-19.
    2. The employee has been advised by a healthcare provider to self-quarantine due to concerns related to COVID-19.
    3. The employee is experiencing symptoms of COVID-19 and seeking a medical diagnosis.
    4. The employee is caring for an individual who is subject to (1) a federal, state, or local quarantine or isolation order related to COVID-19; or (2) advice by a healthcare provider to self-quarantine due to concerns related to COVID-19.
    5. The employee is caring for a son or daughter (under age eighteen (18)) of the employee if the school or place of care of the son or daughter has closed or the child care provider of such son or daughter is unavailable due to COVID-19 precautions.
    6. 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 Department of Labor.

Employees meeting one of these criteria shall report their desire to take this leave to their direct supervisor and the Office of Human Resources [or Business Office]. At this time employees shall not be required to provide an FMLA certification for this leave but may be required to provide proof of the need for such leave, which may include through a quarantine or isolation order or proof that their child’s school/childcare has closed.

If an employee needs leave for one of these COVID-19 related reasons prior to April 1, 2020, the employee may use any source of existing, accrued leaves. If the employee does not have any accrued paid leave, they may take the leave unpaid.

Beginning April 1, 2020, employees shall be entitled to paid leave in the following amounts:

  • For full-time employees, 80 hours.
  • For part-time employees, a number of hours equal to the number of hours that such employee works on average, over a two-week period.
  • There are caps on the amount of money an employee taking this leave may be compensated.  The District will enforce these legally required caps.

This 80 hours of paid leave for full-time employees, or two-week equivalent of pay for part-time employees, is a separate source of paid leave required by the Families First Coronavirus Response Act. During this time, the District will not deduct from other categories of accrued leave, and employees will be paid in accordance with the legally required amounts and caps.

 

  • For employees absent for reasons (1), (2) or (3) above, they shall receive 100% of their pay with a daily cap of $511 per day or an aggregate of $5,110 over the two-week period.
  • For employees absent for reasons (4), (5) or (6) above, they shall receive two-thirds (2/3) of their regular pay with a daily cap of $200 per day or an aggregate of $2,000 over the two-week period.
  • If the rate of pay described above is less than the employee’s regular rate of pay, the employee may use other available leave, if any, to supplement the difference between the payments described above and their regular rate of pay.

If employees exhaust this two weeks of pay and cannot return to work and their absence is related to reasons (1), (2), (3), (4), and (6), the employee may be paid through the use of any applicable accrued leave.  If employees exhaust this two weeks of pay and cannot return to work and their absence is related to reason (5) above and they have been employed for at least thirty (30) days, the employee is entitled to additional leave as described below in the EMERGENCY EXPANDED FMLA section.

The District will allow employees who are requesting this Emergency Paid Leave Sick Leave for school or childcare closures or unavailability to use the leave on an intermittent basis. For example, for an employee requesting this leave for school or childcare closure or unavailability who is able to work part-time due to other individuals being able to care for the child(ren), that employee shall be able to use their hours intermittently for any leave experienced until the hours they are entitled to are exhausted. However, the employee shall work with the District to schedule the intermittent leave to minimize the impact on the District’s business operations as much as practicable.

Employees seeking to use this Emergency Paid Sick Leave for any other reason other than school or childcare closure or unavailability are not permitted to use this leave on an intermittent basis.

 

  1. EMERGENCY EXPANDED FMLA: Through the passage of the Families First Coronavirus Relief Act, the federal government temporarily expanded the FMLA to include a new qualifying reason for FMLA leave related to the public health emergency. A qualifying need related to a public health emergency means that the employee is unable to work (or telework) due to a need for leave to care for the son or daughter under 18 years of age of such employee if the school or place of care has been closed, or the child care provider of such son or daughter is unavailable, due to a public health emergency.

In addition to the District’s FMLA policy already in place, the following guidelines apply to this new qualifying reason:

  • The only eligibility requirement for employees to be eligible for this leave is that the employee has been employed for thirty (30) calendar days prior taking the leave.
  • The employee shall be paid for this leave as follows:
    • Employees will be paid two-thirds (2/3) of the employee’s regular rate of pay (as determined by Section 7(e) of the FLSA).
    • For employees whose schedules vary from week to week, the employee will be paid two-thirds of their regular rate of pay for those hours that the employee would have worked if the leave was not necessary. If the hours the employee would have normally worked are not apparent, the hours the employee should be compensated for will be calculated as follows:
      • A number equal to the average number of hours that the employee was scheduled per day over the 6-month period ending on the date on which the employee takes such leave, including hours for which the employee took leave of any type.
      • If the employee did not work over the 6-month period, the reasonable expectation of the employee at the time of hiring of the average number of hours per day that the employee would normally be scheduled to work.
  • Under no circumstances will an employee be compensated more than $200/day or

$10,000 in the aggregate for this leave.

  • If the rate of pay described above is less than the employee’s regular rate of pay, the employee may use other available leave, if any, to supplement the difference between the payments described above and their regular rate of pay.

Employee’s medical benefits will be maintained during an FMLA Expansion leave.

Requests for FMLA Expansion leave should be made directly to the Human Resources department as soon as reasonably possible.

During the 12 workweeks of approved FMLA Expansion leave, employees are entitled to be reinstated to their same job or to an equivalent position with the same pay, benefits and working conditions, as provided by law.

 

  1. ILLNESS REPORTING: Do Not Enter any District facility or perform any in-person job functions for the District, regardless of location, if:
  • You are experiencing any of the following flu-like/respiratory symptoms,
    • Fever – over 100 degrees Fahrenheit
    • Coughing
    • Sneezing
    • Shortness of Breath
    • Any other flu-like symptom. Uncommon symptoms of COVID-19 include diarrhea, nausea, and fatigue.
    • YOU MAY NOT RETURN TO WORK UNTIL THE LATER OF THE FOLLOWING: (1) seven (7) days from the onset symptoms; (2) fever free for seventy-two (72) hours without any fever reducing medication.
  • Have been diagnosed with COVID-19 and/or tested positive for COVID-19.
  • Been around someone who has been diagnosed with COVID-19 or tested positive for COVID-19. This includes living in the same household or spending time within six (6) feet of someone who has been diagnosed with COVID-19 or tested positive for COVID- 19.

Employees experiencing any of the above should report it immediately. Employees should call their supervisor to report these conditions.

 

  1. HIGH RISK EMPLOYEES: If you are someone who is at “higher risk” for becoming ill from the virus (pursuant to the CDC’s guidance, see: https://www.cdc.gov/coronavirus/2019- ncov/specific-groups/high-risk-complications.html), please feel free to communicate that to the Director of Human Resources [or the District administrator who handles FMLA requests]. The information you provide will be kept strictly confidential in your medical file and will be used solely for the purposes of determining your potential need for a leave of absence or for modifications to your work schedule and/or work environment during the pandemic.

The District will assess situations with high-risk employees on a case-by-case basis. In the event an employee is high risk and unable to report to work, the employee will either be allowed to work from home if practicable or be excused from reporting to work and receive two-thirds of their normal salary as described under the non-essential employees who are not required to work from home in this policy. If a doctor recommends the employee self-quarantine due to underlying health conditions, the employee will receive 100% of their normal salary for up to eighty (80) hours and then may use any applicable leave thereafter.

 

  1. TRAVEL: As of the date of this policy all employees who travel as defined by this policy will be subject to the following requirements:

For purposes of this policy, "Travel" is defined as follows:

  • Non-essential: (1) traveling to any location outside of a fifty (50) mile radius of the District or (2) attending a gathering of more than ten (10) people regardless of the location.
  • Essential: (1) necessary travel that does not meet the definition of non-essential travel.  The District will authorize essential travel on a case by case basis.

All District-related Non-Essential Travel as defined by this policy is suspended without prior approval of the Superintendent or her/his designee (i.e. conferences or non-essential meetings.) Any employee who engages in Non-essential Travel pursuant to this policy shall report their plans to travel (or if already traveling as of the date of this policy, their return plans from travel) to their direct supervisor. These reports shall be made via phone or e-mail rather than in person to minimize contacts and limit person-to-person exposure.

For anyone engaged in Non-essential Travel as defined by this policy and planning to return to work, you will be required to self-isolate away from work for fourteen (14) days.  You will only be allowed to return to work if symptom and fever free (without the use of fever-reducing medications such as Tylenol) as defined by the CDC guidelines. You are required to use vacation, personal leave and sick leave during this time and in that order to be compensated for your normal working hours. If, after April 1, 2020, you need leave relating to reasons (1) through (6) outlined above, the employee may be eligible for Emergency Paid Sick Leave and Emergency Expanded FMLA Leave.

 

  1. MEETINGS: Except for school board meetings, which may be held in person or electronically as determined by the Board, no group meetings shall be held in-person for the duration of this policy without prior approval from the Superintendent or her/his designee.  All meetings shall be held electronically or over the phone. This includes meetings required under the Individuals with Disabilities Education Act (“IDEA”) or Section 504 of the Rehabilitation Act. Employees with questions about scheduling IEP or 504 meetings should contact the District’s special education director and/or 504 coordinator. Any approved in-person meetings shall only include internal staff unless the Superintendent or her/his has approved the presence of others prior to the meeting.

 

  1. STAFF UPDATES: The Superintendent or her/his designee shall update all staff on developments throughout this time period.

 

  1. POLICY: The leave authorized by this policy shall expire on December 31, 2020 and no leave shall be carried forward to 2021.

 

 

Approved: May 18, 2020
Reviewed:  April 13, 2020      
Revised:  

 

dawn.gibson.cm… Sun, 11/28/2021 - 19:42