Employee Personnel Records Content

1.        Employee personnel records may contain the following information:

                Personal information including, but not limited to, name, address, telephone number, emergency numbers, birth date;

                Evaluations;

                Application, resume and references;

                Salary information;

                Copy of the employee's license or certificate, if needed for the position;

                Educational transcripts;

                Medical professional signed physical form;

                Reasonable accommodation made by the school district to accommodate the employee's disability;

                Records of disciplinary matters.

2.        Employee health and medical records shall be kept in a file separate from the employee's personnel records.  Health and medical records may contain, but are not limited to:

                Medical professional signed physical form;

                Long-term disability leave days;

                Worker's compensation claims;

                Family and medical leave request forms.

Applicant File Records Content

Records on applicants for positions with the school district shall be maintained in the central administration office.  The records shall include, but not be limited to:

                Application for employment;

                Resume;

                References;

                Evidence of appropriate license or certificate, if necessary for the position for which the individual applied;

                Affirmative action form, if submitted.

Record Access

Only authorized school officials shall have access to an employee's records without the written consent of the employee. Authorized school officials may include, but not be limited to, the superintendent, building principal, or board secretary. In the case of a medical emergency, the school nurse or other first aid or safety personnel may have access to the employee's health or medical file without the consent of the employee. Board members will generally only have access to an employee's personnel file without the consent of the employee when necessary for the conducting of board business.

Confidential records include, but are not necessarily limited to, birth dates, addresses, gender, employment applications, performance evaluations and individual test scores.

Employee Record Retention

All employee records, except payroll and salary records, shall be maintained for a minimum of seven years after termination of employment with the district. Applicant records shall be maintained for a minimum of seven years after the position was filled. Payroll and salary records shall be maintained for a minimum of three years after payment.

Iowa law requires licensed employees to report to the Iowa Department of Human Services (DHS) instances of suspected child abuse which they become aware of within the scope of their professional duties.

The law further specifies that a licensed employee who knowingly or willfully fails to report a suspected case of child abuse is guilty of a simple misdemeanor and that the licensed employee may be subject to civil liability for damages caused by the failure to report.

Employees participating in good faith in the making of a report or in a judicial proceeding that may result from the report, are immune from liability.  

Child Abuse Defined

"Child abuse" is defined as:

        Any nonaccidental physical injury, or injury which is at variance with the history given of it, suffered by a child as the result of the acts or omissions of a person responsible for the care of the child.

        The commission of a sexual offense with or to a child . . . as a result of the acts or omissions of the person responsible for the child. . . .  Sexual offense includes sexual abuse, incest, and sexual exploitation of a minor.

        The failure on the part of a person responsible for the care of a child to provide for the adequate food, shelter, clothing or other care necessary for the child's welfare when financially able to do so, or when offered financial or other reasonable means to do so. A parent or guardian legitimately practicing religious beliefs who does not provide specified medical treatment for a child for that reason alone shall not be considered abusing the child.

        The acts or omissions of a person responsible for the care of a child which allow, permit or encourage the child to engage in acts prohibited pursuant to Iowa Code, § 725.1 which deals with prostitution.

• Any mental injury to a child’s intellectual or psychological capacities evidenced by an observable and substantial impairment in the child’s ability to function within the child’s normal range of performance and behavior as the result of the acts or omissions of a person responsible for the care of the child, if the impairment is diagnosed by a licensed physician or qualified mental health professional.
• An illegal drug is present in a child’s body as a direct and foreseeable consequence of the acts of omissions of the person responsible for the care of the child.
• The person responsible for the care of a child has, in the presence of the child, as defined in section 232.2, subsection 6, paragraph “p”, manufactured a dangerous substance, as defined in section 232, subsection 6, paragraph “p”, or in the presence of the child possesses a product containing ephedrine, its salts, optical isomers, salts of optical isomers, pseudoephedrine or its salts, with the intent to use the product as a precursor or an intermediary to a dangerous substance.
• The commission of bestiality in the presence of a minor under section 717C.1 by a person who resides in a home with a child, as a result of the acts of omissions of a person responsible for the care of the child.

Teachers in public schools are not "persons responsible for the care of the child" under this definition.

Reporting Procedures

Licensed employees, including teachers and school nurses, are required to report, orally within twenty-four hours to the Iowa Department of Human Services (DHS) when the employee, within the scope of employment, reasonably believes a child has suffered from abuse. Within forty-eight hours of an oral report, a written report must be filed with DHS.

Each report should contain as much of the following information as can be obtained within the time limit. However, the law specifies a report will be considered valid even if it does not contain all of the following information:

• name, age, and home address of the child;
• name and home address of the parents, guardians or other persons believed to be responsible for the care of the child;
• the child's present whereabouts if not the same as the parent's or other person's home address;
• description of injuries, including evidence of previous injuries;
• name, age, and condition of other children in the same home;
• any other information considered helpful; and,
• name and address of the person making the report.

Board policy states it is not the responsibility of employees to prove that a child has been abused or neglected.  Employees should not take it upon themselves to investigate the case or contact the family of the child. DHS is responsible for investigating the incident of alleged abuse.

 

COMPLAINT OF INJURY TO OR ABUSE OF A STUDENT BY A SCHOOL DISTRICT EMPLOYEE

Please complete the following as fully as possible.  If you need assistance, contact the Level I investigator in your school.

Student's name and address:  ______________________________________________________________
______________________________________________________________________________________

Student's telephone no.  __________________________________________________________________

Student's school:  _______________________________________________________________________

Accused employee's place of employement:  
______________________________________________________________________________________
______________________________________________________________________________________

Allegations is of ______________ phylsical abuse ______________ sexual abuse *

Please describe what happened.  Include the date, time and where the incident took place, if known.  If physical abuse is alleged,
also state the nature of the student's injury:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

Were there any witnesses to the incident or are there students or persons who may have information about this incident?
           yes             no

If yes, please list by name, if known, or classification (for example "third grade class," "fourth period geometry class"):
______________________________________________________________________________________

*Parents of children who are in pre-pre-kindergarten through sixth grade and whose children are the alleged victims of or
witnesses to sexual abuse have the right to see and hear any interviews of their children in this investigation.  Please indicate
"yes" if the parent/guardian wishes to exercise this right:

                       Yes                  No      Telephone Number                                       

Has any professional person examined or treated the student as a result of the incident?          yes           no           unknown

If yes, please provide the name and address of the professional(s) and the date(s) of examination or treatment, if known
______________________________________________________________________________________
______________________________________________________________________________________

Has anyone contacted law enforcement about this incident?          yes           no

Please provide any additional information you have which would be helpful to the investigator.  Attach additional pages if needed.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

Your name, address, and telephone number:
______________________________________________________________________________________
______________________________________________________________________________________

Relationship to student:  __________________________________________________________________

___________________________________________     _________________________________________
Complainant Signature                                                          Witness Signature

___________________________________________     _________________________________________
Date                                                                                       Witness name (please print)

                                                                                           _________________________________________
                                                                                               Witness Address

 

Be advised that you have the right to contact the police or sheriff's office, the county attorney, a private attorney, or the State Board of Educational Examiners (if the accused is a licensed employee) for investigation of this incident.  The filing of this report does not deny you that opportunity. 

You will receive a copy of this report (if you are the named student's parent or guardian) and a copy of the Investigator's Report within fifteen calendar days of filing this report unless the investigation is turned over to law enforcement.

 

REPORT OF LEVEL I INVESTIGATION

Student's name:  _______________________________________________________________________

Student's age:  _______________     Student's grade:  _______________    

Student's address:  _____________________________________________________________________

Student's school:  _______________________________________________________________________

Name of accused school employee:  _________________________________  Building:  ______________

Name and address of person filing report:  
______________________________________________________________________________________

Name and address of student's parent or guardian, if different from person filing report:  ________________ 
______________________________________________________________________________________

Date report of abuse was filed:  _______________________________

Allegations is of __________________ physical abuse  __________________ sexual abuse*

Describe the nature, extent and cause of the student's injury, if any and if known:    (Attach additional pages if needed).
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

Describe your investigation:  Attach additional pages if needed.  (Please do not use student witnesses' full names.)
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

*Were parent(s) or guardian(s) advised of their right to see and hear any interview of their pre-pre-kindergarten through
sixth grade children who are alleged victims of or a witness in a sexual abuse investigation?

Yes            No        Was the right exercised?             Yes               No

Were audiotapes made of any interviews?            yes              no

Were videotapes made of any interviews?            yes              no

Was any action taken to protect the student during or as a result of the investigation?          yes           no

If yes, describe:

                 student excused from school                                                    school employee placed on leave

                 student assigned to different class                                              other (please specify)

 

Level I investigator's conclusions:

                         The complaint is being dismissed for lack of jurisdiction.

                                     Physical abuse was alleged, but no allegation of injury was made.

                                     Physical abuse was alleged, but no evidence of physical injury exists and the nature of the alleged incident makes it unlikely an injury,
                                     as defined in the rules, occurred.

                                     Sexual abuse was alleged, but the alleged actions of the school employee, even if true, would not meet the definition of sexual abuse
                                     in the rules.

                                     Alleged victim was not a student at the time of the incident.

                                     Alleged school employee is not currently employed by this school district.

                                     Alleged incident did not occur on school grounds, on school time, at a school-sponsored activity, nor in a school-related context.

                         The complaint has been investigated and concluded at Level I as unfounded.

                                     Complaint was withdrawn.

                                     Insufficient evidence exists that an incident of abuse, as defined in the rules, took place.

                         The complaint has been investigated at Level I and is founded.

                                     The investigation is founded at Level I and is being turned over to Level II for further investigation.

                                     Investigation of the complaint was deferred at Level I and referred to law enforcement at this time.

                                     The investigation is concluded at Level I because the accused school employee has admitted the violation, has resigned, or has
                                     agreed to relinquish any teaching license held.

Current status of investigation:

                         No further investigation is warranted.

                         Closed and referred to school officials for further investigation as a personnel matter.

                         Deferred to law enforcement officials.

                         Turned over to Level II investigator.

Other comments:  _______________________________________________________________________
______________________________________________________________________________________

I have given a copy of the report of abuse and of this investigative report to the employee named in the report,
the employee's supervisor, and the student's parent or guardian and informed the person filing the report of the
options of contacting law enforcement, private counsel, or the State Board of Educational Examiners, if the
accused school employee holds an Iowa teacher's certificate or license.

 

___________________________________________            ________________________________________
Name of investigator (please print)                                           Investigator's place of employment 

___________________________________________            ________________________________________
Signature of investigator                                                           Date

 

An individual who has knowledge an employee has physically or sexually abused a student may immediately report it to high school assistant principal, middle school assistant principal or counselors, who are the school district's Level I investigators.  "Employee" means one who works for pay or as a volunteer under the direction and control of the school district.  The report shall be written, signed and witnessed by a person of majority age.  The witness may be the Level I investigator.  The reporter is the individual filing the report.  The report shall contain the following:

• The full name, address, and telephone number of the person filing.
• The full name, age, address, and telephone number, and attendance center of the student.
• The name and place of employment of the employee who allegedly committed the abuse.
• A concise statement of the facts surrounding the incident, including date, time, and place of occurrence, if known.
• A list of possible witnesses by name, if known.
• Names and locations of persons who examined, counseled or treated the student for the alleged abuse, including the dates on which those services were provided, if known.

Upon request, the Level I investigator may assist the reporter in completing the report.  An incomplete report shall not be rejected unless the missing information would render the investigation futile or impossible.  An employee receiving a report of alleged abuse of a student by an employee shall pass the report to the investigator and shall keep the report confidential to the maximum extent possible.  In performing the investigation, the investigator shall have access to the educational records of the alleged student victim as well as access to the student for interviewing purposes.

In order for the school district to have jurisdiction over the acts and to constitute a violation of the law, acts of the employee must be alleged to have occurred on school grounds, on school time, at a school-sponsored activity, or in a school-related context.  However, the student need not be a student in the school district.  The student can be from another school district.  To be investigable, the written report must include basic information showing that the victim of the alleged abuse is or was a student at the time of the incident, that the alleged act of the employee resulted in injury or otherwise meets the definition of abuse in these rules, and that the person responsible for the act is currently an employee.  If the report is not investigable due to lack of jurisdiction, the investigator shall dismiss the complaint and inform the reporter of other options available.  Other options available to the reporter include contacting law enforcement authorities, private counsel, or the Board of Educational Examiners in the case of a licensed employee.

If the Level I investigator believes the student is in imminent danger if continued contact is permitted between the employee and the student, the Level I investigator may:

• temporarily remove the student from contact with the employee;
• temporarily remove the employee from service; or,
• take other appropriate action to ensure the student's safety.

The Level I investigator shall have access to the educational records of the student and access to the student for purposes of interviewing the student about the report.

 

Physical Abuse Allegations

When physical abuse is reported, the Level I investigator shall make copies of the report and give a copy to the person filing the report, the students' parents and the immediate supervisor of the employee named in the report. 

The employee named in the report shall not receive a copy of the report until the employee is initially interviewed.

The Level I investigator shall use discretion in handling the information received regarding an investigation of abuse by an employee, and those persons involved in the investigation shall not discuss information regarding the complaint outside the investigation.  The entire investigative procedure will be thoroughly explained, including the confidential nature of the proceedings, to the student and other persons involved in the investigation.

Within five days of receipt of an investigable report, the Level I investigator shall complete an informal investigation.  The informal investigation shall consist of interviews with the student, the employee and others who may have knowledge of the alleged incident.  If the Level I investigator determines that the allegations in the report are founded and that immediate and professional investigation is necessary, the Level I investigator may defer further investigation and contact appropriate law enforcement officials, the student's parents and the person filing the report.  Within fifteen days of receipt of the report, the Level I investigator shall complete a written investigative report, unless the investigation was temporarily deferred.

The written investigative report shall include:

1. The name, age, address and attendance center of the student named in the report.
2. The name and address of the student's parent or guardian and the name and address of the person filing the report, if different from the student's parent or guardian.
3. The name and work address of the employee named in the report as allegedly responsible for the abuse of the student.
4. An identification of the nature, extent and cause, if known, of any injuries or abuse to the student named in the report.
5. A general review of the investigation.
6. Any actions taken for the protection and safety of the student.
7. A statement that, in the investigator's opinion, the allegations in the report are either:
    - Unfounded.  (It is not likely that an incident, as defined in these rules, took place), or
    - Founded.  (It is likely that an incident took place.)
8. The disposition or current status of the investigation.
9. A listing of the options available to the parents or guardian of the student to pursue the allegations.  These options include, but are not limited to:

• Contacting law enforcement officials.
• Contacting private counsel for the purpose of filing a civil suit or complaint.
• Filing a complaint with the Board of Educational Examiners if the employee is a licensed employee.

The investigator shall retain the original and provide a copy of the written investigative report to the school employee named in the report, the employee's supervisor and the student's parent or guardian.  The person filing the report, if not the student's parent or guardian, shall be notified only that the Level I investigation has been concluded and of the disposition or anticipated disposition of the case.

It is the responsibility of the Level I investigator to determine whether it is more likely than not that an incident of abuse as defined in the rules took place between the student and employee.  The Level I investigator does not make the determination of whether the use of physical contact was appropriate or whether any of the exceptions apply.  That is the responsibility of the Level II investigator.  Upon completion of the report, if the Level I investigator determines the allegations of physical abuse are founded and serious, the Level I investigator shall notify law enforcement authorities.  If the allegations are founded but the physical abuse is not of a serious nature, the Level I investigator shall refer the case on to the Webster City Police Department, the Level II investigator.

The Level II investigator shall review the Level I investigator's final investigative report and conduct further investigation.  The Level II investigative report shall state the conclusion as to the occurrence of the alleged incident, the applicability of exceptions, the reason for the contact or force used, and recommendations regarding the need for further investigation.  In determining the applicability of the exceptions or the reasonableness of the contact or force used, the Level II investigator will use the following definitions:

Physical abuse is non-accidental physical injury to the student as a result of the action of an employee.  Injury occurs when evidence of it is still apparent at least twenty-four hours after its occurrence.  The following do not constitute physical abuse, and no employee is prohibited from:

a.      Using reasonable and necessary force, not designed or intended to cause pain:

1. To quell a disturbance or prevent an act that threatens physical harm to any person.
2. To obtain possession of a weapon or other dangerous object within a pupil's control.
3. For the purposes of self-defense of defense of others as provided for in Iowa Code § 704.3.
4. For the protection of property as provided for in Iowa Code §§ 704.4, .5.
5. To remove a disruptive pupil from class, or any area of school premises or from school-sponsored activities off school premises.
6. To prevent a student from the self-infliction of harm.
7. To protect the safety of others.

b.      Using incidental, minor, or reasonable physical contact to maintain order and control. 

In determining the reasonableness of the contact or force used, the following factors shall be considered:

a.      The nature of the misconduct of the student, if any, precipitating the physical contact by the school employee.
b.      The size and physical condition of the student.
c.      The instrumentality used in making the physical contact.
d.      The motivation of the school employee in initiating the physical contact.
e.      The extent of injury to the student resulting from the physical contact.

"Reasonable force" is that force and no more which a reasonable person, in like circumstances, would judge to be necessary to prevent an injury or loss and can include deadly force if it is reasonable to believe that such force is necessary to avoid injury or risk to one's life or safety or the life or safety of another, or it is reasonable to believe that such force is necessary to resist a like force or threat.

Upon completion of the Level II investigation, the Level I investigator shall forward copies of the Level II investigative report to the employee, the employee's immediate supervisor and the student's parent.  The Level I investigator shall notify the person filing the report of the current status of the case.

If the Level II investigator's report or law enforcement officials conclude abuse occurred, or the employee admits the violation, or the employee has surrendered the employee's certificate or license, the Level I investigator shall file a complaint with the State Board of Educational Examiners.  The Level I investigator shall also arrange for counseling services for the student if the student or student's parents request counseling services.

 

Sexual Abuse

Sexual abuse is defined as including sexual acts involving a student, acts that encourage the student to engage in prostitution, as well as inappropriate, intentional sexual behavior or sexual harassment by the employee toward a student.  "Sexual harassment" is defined as unwelcome sexual advances, requests for sexual favors or other verbal or physical conduct of a sexual nature when:

1. Submission to the conduct is made either implicitly or explicitly a term or condition of the student's education or benefits;
2. Submission to or rejection of the conduct is used as the basis for academic decisions affecting that student; or,
3. The conduct has the purpose or effect of substantially interfering with a student's academic performance by creating an intimidating, hostile or offensive education environment.

When sexual abuse is reported, the Level I investigator shall make copies of the report and give a copy to the person filing the report, the students' parents and the immediate supervisor of the employee named in the report.  The employee named in the report shall not receive a copy of the report until the employee is initially interviewed.  The designated investigator shall not interview the school employee named in a report of sexual abuse until after a determination is made that jurisdiction exists, the alleged victim has been interviewed and a determination made that the investigation will not be deferred.

The investigator shall notify the parent, guardian or legal custodian of a student in prekindergarten through grade six, of the date and time of the interview and of the right to be present or to see and hear the interview or send a representative in the parent's place.  The Level I investigator shall interview the student as soon as possible, but in no case later than five days from the receipt of a report or notice of the allegation of sexual abuse.  The Level I investigator may record the interview electronically.

The Level I investigator shall exercise discretion in the investigative process to preserve the privacy interests of the individuals involved.  To the maximum extent possible, the investigator shall maintain the confidentiality of the report.

It is the responsibility of the Level I investigator to determine whether it is more likely than not that an incident took place between the employee and the student.  If the Level I investigator believes the employee committed a sex act with a student or sexually exploited a student, the Level I investigator shall defer the Level I investigation and immediately notify law enforcement officials, the student's parents and the person filing the report.

If the Level I investigator determines an incident occurred, while not an illegal sex act with a student or sexual exploitation of a student, but where the employee engaged in inappropriate, intentional sexual behavior, further investigation is warranted.

If further investigation is warranted, the Level I investigator may proceed to interview the employee and other individuals who may have knowledge of the circumstances contained in the report.  Prior to interviewing other individuals who may have knowledge of the circumstance contained in the report, the Level I investigator shall provide notice of the impending interview of student witnesses or the student who is in prekindergarten through grade six, to their parent, guardian, or legal custodian, and may provide notice to the parent or guardian of older students, prior to interviewing those students.  The Level I investigator shall, if founded, arrange for the Level II investigator to further investigate the allegations.

Within fifteen days of receipt of the report or notice of alleged sexual abuse, the Level I investigator shall complete a written investigative report unless the investigation was temporarily deferred.  The written investigative report shall include:

1. The name, age, address and attendance center of the student named in the report.
2. The name and address of the student's parent or guardian and the name and address of the person filing the report, if different from the student's parent or guardian.
3. The name and work address of the school employee named in the report as allegedly responsible for the abuse of the student.
4. An identification of the nature, extent and cause, if known, of any injuries or abuse to the student named in the report.
5. A general review of the investigation.
6. Any actions taken for the protection and safety of the student.
7. A statement that, in the investigator's opinion, the allegations in the report are either:
    - Unfounded.  (It is not likely that an incident, as defined in these rules, took place), or
    - Founded.  (It is likely that an incident took place.)
8. The disposition or current status of the investigation.
9. A listing of the options available to the parents or guardian of the student to pursue the allegations. 

            These options include, but are not limited to:

• Contacting law enforcement officials.
• Contacting private counsel for the purpose of filing a civil suit or complaint.
• Filing a complaint with the Board of Educational Examiners if the school employee is certificated.

The investigator shall retain the original and provide a copy of the investigative report to the school employee named in the report, the school employee's supervisor and the named student's parent or guardian.  The person filing the report, if not the student's parent or guardian, shall be notified only that the Level I investigation has been concluded and of the disposition or anticipated disposition of the case.

If the allegations are founded, the Level I investigation shall refer the case to the Level II investigator.  The Level II investigator shall review the Level I investigator's final investigative report and conduct further investigation if necessary.  The Level II investigative report shall state conclusively as to the occurrence of the alleged incident, conclusively as to the nature of the sexual abuse and recommendations regarding the need for further investigation.  Upon completion of the Level II investigation, the Level I investigator shall forward copies of the Level II investigative report to the employee, the employee's immediate supervisor and the student's parent.  The Level I investigator shall notify the person filing the report of the current status of the case.

If the Level II investigator's report or law enforcement officials conclude sexual abuse occurred, or the employee admits the violation, or the employee has surrendered the employee's certificate or license, the Level I investigator shall file a complaint on behalf of the district after obtaining the superintendent's signature with the State Board of Educational Examiners.  The Level I investigator shall also arrange for counseling services for the student if the student or student's parents request counseling services.

In cases involving founded physical or sexual abuse by a licensed employee, the board shall notify the Board of Educational Examiners.  Information of unfounded abuse at Level I or Level II shall not be kept in the employee's personnel file.  If the Level I investigative report is founded but Level II is unfounded, then the Level I report shall be removed from the employee's permanent file.  Notes, tapes memorandums and related materials compiled in the investigations must be kept for two years.

It shall be the responsibility of the board to annually identify a Level I and Level II investigator.  The board shall also designate annually an alternate Level I investigator, preferably of the opposite sex of the designated Level I investigator, to whom reports may also be made.  The names and telephone numbers of the Level I investigator and the alternate Level I investigator shall be included in employee handbooks, student handbooks, annually published in the local newspaper, and prominently displayed in all school buildings.

 

See form attached 

 

 

If the Superintendent suspects an employee has a substance abuse problem, he/she shall follow these procedures:

1. Identification - The Superintendent shall document the evidence which leads him/her to conclude the employee has violated the Substance-Free Workplace policy. After the Superintendent has determined there has been a violation of the Substance-Free Workplace policy, he/she shall discuss the problem with the employee.
2. Discipline - If, after the discussion with the employee, the Superintendent determines there has been a violation of the Substance-Free Workplace policy, the Superintendent may recommend discipline up to and including termination or may recommend the employee seek substance abuse treatment. Participation in a substance abuse treatment program is voluntary.
3. Failure to participate in referral – If the employee refuses to participate in a substance abuse treatment program or if the employee does not successfully complete a substance abuse treatment program, the employee may be subject to discipline up to and including termination.
4. Conviction - If an employee is convicted of a criminal drug offense committed in the workplace, the employee must notify the employer of the conviction within five days of the conviction.

EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING POLICY ARE HEREBY NOTIFIED they are subject to the District’s drug and alcohol testing program for pre-employment drug testing and in addition are subject to random, reasonable suspicion and post-accident drug and alcohol testing as outlined in the Drug and Alcohol Testing Program policy, its supporting documents 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 that 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 to inform employees of the drug and alcohol testing program requirements. Employees with questions regarding the drug and alcohol testing requirements will contact the District’s contact person.

EMPLOYEES GOVERNED BY THE DRUG AND ALCOHOL TESTING 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 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.

I,   ( Name of Employee  ), have received a copy, read and understand the Drug and Alcohol Testing Program policy of the Webster City School District and its supporting documents.                                  

I understand that if I violate the Drug and Alcohol Testing Program policy, its supporting documents or the law, I may be subject to discipline up to and including termination.

I also understand that I must inform my supervisor of any prescription medication I use.  

In addition, I have received a copy of the U.S. DOT publication, “What Employees Need to Know about DOT Drug & Alcohol Testing,” and have read and understand its contents.

Furthermore, I know and understand that I am required to submit to a controlled substance (drug) test, the results of which must be received by this employer before being employed by the school district and before being allowed to perform a safety-sensitive function.  I also understand that if the results of the pre-employment test are positive, that I will not be considered further for employment with the school district.

I further understand that drug and alcohol testing records and information about me are confidential, and may be released at my request or in accordance with the district’s drug and alcohol testing program policy, its supporting documents or the law.

 

__________________________________________________               ________________________

(Signature of Employee)                                                                            (Date)

Name of complainant:  __________________________________________________________________

Position of complainant:  _________________________________________________________________

Date of complaint:  _____________________________________________________________________

Name of alleged harasser:  _______________________________________________________________

Date and place of incident or incidents:  _____________________________________________________
_____________________________________________________________________________________

Description of misconduct:  _______________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Name of witnesses (if any):  ______________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Evidence of harassment, i.e., letters,  photos, etc. (attach evidence if possible):  _____________________
_____________________________________________________________________________________

Any other information:  __________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

I agree that all of the information this form is accurate and true to the best of my knowledge.

 

Signature:  __________________________________________

Date:  ________________________

 

Name of witness:  ______________________________________________________

Position of witness:  _____________________________________________________

Date of testimony, interview:  ______________________________________________

Description of instance witnessed:  _________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

Any other information:  __________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

I agree that all of the information on this form is accurate and true to the best of my knowledge.

 

Signature:  ____________________________________

Date:  ___________________________

 

Complaint Procedure

An employee or student who believes that they have been harassed shall notify the building administrator, the designated investigator.  The alternate investigator is the superintendent.  The investigator may request that the employee or student complete the Harassment Complaint form and turn over evidence of the harassment, including, but not limited to, letters, tapes, or pictures.  Information received during the investigation shall be kept confidential to the extent possible.

The investigator, with the approval of the superintendent, or the superintendent has the authority to initiate a harassment investigation in the absence of a written complaint.

 

Investigation Procedure

The investigator shall reasonably and promptly commence the investigation upon receipt of the complaint.  The investigator shall interview the complainant and the alleged harasser.  The alleged harasser may file a written statement refuting or explaining the behavior outlined in the complaint.  The investigator may also interview witnesses as deemed appropriate.

Upon completion of the investigation, the investigator shall report to the superintendent.  The investigator will outline the findings of the investigation to the superintendent. 

 

Resolution of the Complaint

The superintendent will complete the next step in the investigation reasonably and promptly upon receipt of the investigator's report.  Following the investigator's report, the superintendent may investigate further, if deemed necessary, and make a determination of the appropriate next step which may include discipline up to and including discharge.

Prior to the determination of the appropriate remedial action, the superintendent may, at the superintendent's discretion, interview the complainant and the alleged harasser.  The superintendent shall file a written report closing the case.  The complainant, the alleged harasser and the investigator shall receive notice as to the conclusion of the investigation.

 

Points to Remember in the Investigation

• Evidence uncovered in the investigation is confidential.
• Complaints must be taken seriously and investigated.
• No retaliation will be taken against individuals involved in the investigation process.
• Retaliators will be disciplined up to and including discharge.

 

Conflicts

If the investigator is the alleged harasser or a witness to the incident, the alternate investigator shall be the investigator. 

 

EMPLOYEES ARE HEREBY NOTIFIED it is a violation of the Substance-Free Workplace policy for an employee to 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 or alcohol, as defined in Schedules I through V of section 202 of the Controlled Substances Act (21 U.S.C. 812) and as further defined by regulation at 21 C.F.R. 1300.11 through 1300.15 and Iowa Code Chapter 204.

"Workplace" is defined as the site for the performance of work done in the capacity as a employee.  This includes school district facilities, other school premises or school district vehicles.  Workplace also includes nonschool 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.

Employees who violate the terms of the Substance-Free Workplace policy may be required to successfully participate in a substance abuse treatment program approved by the board.  The superintendent retains the discretion to discipline an employee for violation of the Substance-Free Workplace policy.  If the employee fails to successfully participate in such a program the employee shall be subject to discipline up to and including termination.

EMPLOYEES ARE FURTHER NOTIFIED it is a condition of their continued employment that they comply with the above policy of the school district and will notify their supervisor of their conviction of any criminal drug statute for a violation committed in the workplace, no later than five days after the conviction.

 

SUBSTANCE-FREE WORKPLACE ACKNOWLEDGMENT FORM

I, ( Name of Employee ), have read and understand the Substance-Free Workplace policy.  I understand that if I violate the Substance-Free Workplace policy, I may be subject to discipline up to and including termination or I may be required to participate in a substance abuse treatment program.   If I fail to successfully participate in a substance abuse treatment program, I understand I may be subject to discipline up to and including termination.  I understand that if I am required to participate in a substance abuse treatment program and I refuse to participate, I may be subject to discipline up to and including termination.  I also understand that if I am convicted of a criminal drug offense committed in the workplace, I must report that conviction to my supervisor within five days of the conviction.

 

_____________________________________________________        ________________________________
(Signature of Employee)                                                                            (Date)

 

A superintendent who suspects an employee has a substance abuse problem shall follow these procedures:

1. Identification - the superintendent shall document the evidence the superintendent has which leads the superintendent to conclude the employee has violated the Substance-Free Workplace policy.  After the superintendent has determined there has been a violation of the Substance-Free Workplace policy, the superintendent shall discuss the problem with the employee.

2. Discipline - if, after the discussion with the employee, the superintendent determines there has been a violation of the Substance-Free Workplace policy, the superintendent may recommend discipline up to and including termination or may recommend the employee seek substance abuse treatment.  Participation in a substance abuse treatment program is voluntary.

3. Failure to participate in referral – if the employee refuses to participate in a substance abuse treatment program or if the employee does not successfully complete a substance abuse treatment program, the employee may be subject to discipline up to and including termination.

4. Conviction - if an employee is convicted of a criminal drug offense committed in the workplace, the employee must notify the employer of the conviction within five days of the conviction.

 

FMLA requires covered employers to provide up to 12 weeks of unpaid, job-protected leave to "eligible" employees for certain family and medical reasons.

Employees are eligible if they have worked for a covered employer for at least one year, and for 1,250 hours over the previous 12 months, and if there are at least 50 employees within 75 miles.  The FMLA permits employees to take leave on an intermittent basis or to work a reduced schedule under certain circumstances.

Reasons for Taking Leave:

Unpaid leave must be granted for any of the following reasons:

• 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.

At the employee's or employer's option, certain kinds of paid leave may be substituted for unpaid leave.

Advance Notice and Medical Certification:

The employee may be required to provide advance leave notice and medical certification.  Taking of leave may be denied, if requirements are not met.

• The employee ordinarily must provide 30 days advance notice when the leave is "foreseeable."

• An employer may require medical certification to support a request for leave because of a serious health condition, and may require second or third opinions (at the employer's expense) and fitness for duty report to return to work.

Job Benefits and Protection:

• For the duration of FMLA leave, the employer must maintain the employee's health coverage under any "group health plan."
• Upon return from FMLA leave, most employees must be restored to their original or equivalent positions with equivalent pay, benefits, and other employment terms.
• The use of FMLA leave cannot result in the loss of any employment benefit that accrued prior to the start of an employee's leave.

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 involvement in any proceeding under or relating to FMLA.

Enforcement:

• The U.S. Department of Labor is authorized to investigate and resolve complaints of violations.
• An eligible employee may bring a civil action against an employer for violations.

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

For Additional Information:

 

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.

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, or child when medically necessary

 

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 school district

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

 

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 shall be deducted from moneys owed me during the leave period.  If no monies are owed me, I shall 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

1.	Employee's Name
2.	Patient's Name (if different from employee)

3.  The attached sheet describes what is meant by a "serious health condition" under the Family and Medical Leave Act.  Does the patient's condition, for which the employee is taking FMLA leave, qualify under any of the categories described?  If so, please check the applicable category.

 

         (1)                    (2)                   (3)                     (4)                     (5)                    (6)           

                                                                       

                                                                   or                                             None of the above

 

4.  Describe the medical facts which support your certification, including a brief statement as to how the medical facts meet the criteria of one of these categories:

 

5.  a.  State the approximate date the condition commenced, and the probable duration of the condition (and also the probable duration of the patient's present incapacity, i.e. inability to work, attend school or perform other regular activities due to the serious health condition, treatment therefore, or recovery therefrom, if different):

 

b.  Will it be necessary for the employee to take work only intermittently or to work on a less than full schedule as a result of the condition (including for treatment described in Item 6 below)?

                  If yes, give the probable duration:

 

 

c.  If the condition is a chronic condition (condition #4) or pregnancy, state whether the patient is presently incapacitated and the likely duration and frequency of episodes of incapacity:

 

 

6.  a.  If additional treatments will be required for the condition, provide an estimate of the probable number of such treatments:

 

If the patient will be absent from work or other daily activities because of treatment on an intermittent or part-time basis, also provide an estimate of the probable number of and interval between such treatments, actual or estimated dates of treatment if known, and period required for recovery if any:

 

b.  If any of these treatments will be provided by another provider of health services (e.g., physical therapist), please state the nature of the treatments:

 

c.  If a regimen of continuing treatment by the patient is required under your supervision, provide a general description of such regimen (e.g. prescription drugs, physical therapy requiring special equipment):

 

7.  a.  If medical leave is required for the employee's absence from work because of the employee's own condition (including absences due to pregnancy or a chronic condition), is the employee unable to perform work of any kind?

b.  If able to perform some work, is the employee unable to perform any one or more of the essential functions of the employee's job (the employee or the employer should supply you with information about the essential job functions)?

                  If yes, please list the essential functions the employee is unable to perform.

 

c.  If neither a. nor b. applies, is it necessary for the employee to be absent from work for treatment?

 

8.  a.  If leave is required to care for a family member of the employee with a serious health condition, does the patient require assistance for basic medical or personal needs or safety, or for transportation?

 

b.  If no, would the employee's presence to provide psychological comfort be beneficial to the patient or assist in the patient's recovery?

 

c.  If the patient will need care only intermittently or on a part-time basis, please indicate the probable duration of this need:

 

(Signature of Health Care Provider)		(Type of Practice)
(Address)		(Telephone Number)

To be completed by the employee needing family leave to care for a family member.

State the care you will provide and an estimate of the period during which care will be provided, including a schedule if leave is to be taken intermittently or if it will be necessary for you to work less than a full schedule:

 

 

 

 

(Employee Signature)

(Date)

A serious health condition means an illness, injury impairment, or physical or mental condition that involves one of the following:

 

1.  Hospital Care - In patient care (i.e. an overnight stay) in a hospital, hospice, or residential medical care facility, including any period of incapacity or subsequent treatment in connection with or consequent to such inpatient care.

2.  Absence Plus Treatment - A period of incapacity of more than three consecutive calendar days (including any subsequent treatment or period of incapacity relating to the same condition), that also involves:

a.  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 the orders of, or on referral by, a health care provider; or

b.  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.

3.  Pregnancy - Any period of incapacity due to pregnancy or for prenatal care.

4.  Chronic Conditions Requiring Treatments - A chronic condition which:

a.  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;

b.  continues over an extended period of time (including recurring episodes of a single underlying condition); and

c.  may cause episodic rather than a period of incapacity (e.g. asthma, diabetes, epilepsy, etc.).

5.  Permanent/Long-term Conditions Requiring Supervision - 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.

6.   Multiple Treatments (Non-chronic Conditions) - Any period of absence to receive multiple treatments (including any period of recovery therefrom) 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) and kidney disease (dialysis).

A.     District notice.

1.  The 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 employee handbook.

3.  When an employee requests family and medical leave, the 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;

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;

c.  an explanation of the employee's right to substitute paid leave for family and medical leave including a description of when the 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 arrangements 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 District has more than 50 employees on the payroll at the time leave is requested;

2.  The employee has worked for the District for at least twelve 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.

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 thirty days notice for foreseeable leave. Failure to give the notice may result in the leave beginning thirty days after notice was received.

c.  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 District may require the employee giving notice of the need for leave to provide reasonable documentation or a statement of family relationship.

1.  Four 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.

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.

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 District may require the employee to obtain a second certification by a health care provider chosen by and paid for by the District if the District has reason to doubt the validity of the certification an employee submits. The second health care provider cannot, however, be employed by the District on a regular basis.

  (3)  If the second health care provider disagrees with the first health care provider, then the 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 District and paid for by the District. This certification or lack of certification is binding upon both the employee and the District.

c.  Medical certification will be required fifteen days after family and medical leave begins unless it is impracticable to do so. The District may request recertification every thirty days.  Recertification must be submitted within fifteen days of the District's request.

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 shall be denied until such certification is provided.

E.      Entitlement.

1.  Employees are entitled to twelve weeks unpaid family and medical leave per year. 

2.  Year is defined as:             Fiscal year

3.  If insufficient leave is available, the school district may:

a.  Deny the leave if entitlement is exhausted

b.  Award leave available

F.  Type of Leave Requested.

1.  Continuous - employee will not report to work for set number of days or weeks.

 

2.  Intermittent - employee requests family and medical leave for separate periods of time.

a.  Intermittent leave is available for:

  (1)  Birth, adoption or foster care placement of child only with the school district's agreement.

  (2)  Serious health condition of the employee, spouse, parent, or child when medically necessary without the District's agreement.

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, 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:

  (1)  Birth, adoption or foster care placement and subject to the school district's agreement.

  (2)  Serious health condition of the employee, spouse, parent, or child when medically necessary without the school district's agreement.

b.  In the case of foreseeable reduced work schedule leave, the employee must schedule the leave to minimize disruption to the school district operation.

c.  During the period of foreseeable reduced work schedule 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, do not include scheduled school breaks, such as summer, winter or spring break.

 a.  f an instructional employee begins family and medical leave for any purpose more than five weeks before the end of a semester, the 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 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 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 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 shall reimburse the school district at a time set by the Superintendent.

3.   An employee who fails to make the health care contribution payments within thirty days after they are due will be notified that their 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 an employee or family member once every thirty days and return the certification within fifteen days of the request. 

5.  The employee must notify the District of the employee's intent to return to work at least once each month during their leave and at least two weeks prior to the conclusion of 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 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, bereavement leave and professional leave. When the District determines that paid leave is being taken for an FMLA reason, the District will notify the employee within two business days that the paid leave will be counted as FMLA leave.

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.

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 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 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 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).

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 twelve months and has worked at least 1250 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-individuals who meet 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-that 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 the 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 noninstructional 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 them self 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.

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 work week, 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.

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.

See form attached 

 

 

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.

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, or child when medically necessary

                          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 school district
                                            serious health condition of myself, parent, or child when medically necessary

                          Details of the 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 shall be deducted from moneys owed me during the leave period.  If no monies are owed me, I shall 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  ________________________________________________________________________________________

 

1.  Employee's Name     ____________________________________________________

2.  Patient's Name  (if different from employee)  _________________________________

3.  The attached sheet describes what is meant by a "serious health condition" under the Family and Medical Leave Act.  Does the patient's condition, for which the
     employee is taking FMLA leave, qualify under any of the categories described?  If so, please check the applicable category.

     (1)                    (2)                   (3)                      (4)                      (5)                     (6)           

     or             None of the above

4.  Describe the medical facts which support your certification, including a brief statement as to how the medical facts meet the criteria of one of these categories:

5.  a.  State the approximate date the condition commenced, and the probable duration of the condition (and also the probable duration of the patient's present
          incapacity, i.e. inability to work, attend school or perform other regular activities due to the serious health condition, treatment therefore, or recovery therefrom, if
          different):

      b.  Will it be necessary for the employee to take work only intermittently or to work on a less than full schedule as a result of the condition (including for treatment
           described in Item 6 below)?

           If yes, give the probable duration:

      c.  If the condition is a chronic condition (condition #4) or pregnancy, state whether the patient is presently incapacitated and the likely duration and frequency of
           episodes of incapacity:

6.   a.  If additional treatments will be required for the condition, provide an estimate of the probable number of such treatments:

If the patient will be absent from work or other daily activities because of treatment on an intermittent or part-time basis, also provide an estimate of the probable number of and interval between such treatments, actual or estimated dates of treatment if known, and period required for recovery if any:

      b.  If any of these treatments will be provided by another provider of health services (e.g., physical therapist), please state the nature of the treatments:

      c.  If a regimen of continuing treatment by the patient is required under your supervision, provide a general description of such regimen (e.g. prescription drugs,
           physical therapy requiring special equipment):

7.   a.  If medical leave is required for the employee's absence from work because of the employee's own condition (including absences due to pregnancy or a chronic
           condition), is the employee unable to perform work of any kind?

      b.  If able to perform some work, is the employee unable to perform any one or more of the essential functions of the employee's job (the employee or the employer
           should supply you with information about the essential job functions)?

           If yes, please list the essential functions the employee is unable to perform.

      c.  If neither a. nor b. applies, is it necessary for the employee to be absent from work for treatment?

8.   a.  If leave is required to care for a family member of the employee with a serious health condition, does the patient require assistance for basic medical or personal
           needs or safety, or for transportation?

      b.  If no, would the employee's presence to provide psychological comfort be beneficial to the patient or assist in the patient's recovery?

      c.  If the patient will need care only intermittently or on a part-time basis, please indicate the probable duration of this need:

 

__________________________________________________________      ____________________________________________________________
(Signature of Health Care Provider)                                                                   (Type of Practice)

__________________________________________________________      ____________________________________________________________
(Address)                                                                                                            (Telephone Number)

To be completed by the employee needing family leave to care for a family member.

 

State the care you will provide and an estimate of the period during which care will be provided, including a schedule if leave is to be taken intermittently or if it will be necessary for you to work less than a full schedule:

__________________________________________________________      ____________________________________________________________
(Employee Signature)                                                                                          (Date)

 

A serious health condition means an illness, injury impairment, or physical or mental condition that involves one of the following:

1. Hospital Care - In patient care (i.e. an overnight stay) in a hospital, hospice, or residential medical care facility, including any period of incapacity or subsequent treatment in connection with or consequent to such inpatient care.

2. Absence Plus Treatment - A period of incapacity of more than three consecutive calendar days (including any subsequent treatment or period of incapacity relating to the same condition), that also involves:
   a.  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 the orders of, or on referral by, a health care provider; or
   b.  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.

3. Pregnancy - Any period of incapacity due to pregnancy or for prenatal care.

4. Chronic Conditions Requiring Treatments - A chronic condition which:
   a.  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;
   b.  continues over an extended period of time (including recurring episodes of a single underlying condition); and
   c.  may cause episodic rather than a period of incapacity (e.g. asthma, diabetes, epilepsy, etc.).

5. Permanent/Long-term Conditions Requiring Supervision - 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.

6. Multiple Treatments (Non-chronic Conditions) - Any period of absence to receive multiple treatments (including any period of recovery therefrom) 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) and kidney disease (dialysis).

 

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 employee handbook.

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;
   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;
   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 arrangements 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 twelve 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.

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 thirty days notice for foreseeable leave.  Failure to give the notice may result in the leave beginning thirty days after notice was received.
   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. Four 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.

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.
   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 fifteen days after family and medical leave begins unless it is impracticable to do so.  The school district may request recertification every thirty days.  Recertification must be submitted within fifteen days of the school district's request.

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 shall be denied until such certification is provided.

E.      Entitlement.

1. Employees are entitled to twelve weeks unpaid family and medical leave per year. 

2. Year is defined as:  Fiscal year

3. If insufficient leave is available, the school district may:
   a.  Deny the leave if entitlement is exhausted
   b.  Award leave available

F.      Type of Leave Requested.

1. Continuous - employee will not report to work for set number of days or weeks.

2. Intermittent - employee requests family and medical leave for separate periods of time.
   a.  Intermittent leave is available for:
        (1)  Birth, adoption or foster care placement of child only with the school district's agreement.
        (2)  Serious health condition of the employee, spouse, parent, or child when medically necessary without the school district's agreement.
   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:
        (1)  Birth, adoption or foster care placement and subject to the school district's agreement.
        (2)  Serious health condition of the employee, spouse, parent, or child when medically necessary without the school district's agreement.
   b.  In the case of foreseeable reduced work schedule leave, the employee must schedule the leave to minimize disruption to the school district operation.
   c.  During the period of foreseeable reduced work schedule 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, do 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 shall reimburse the school district at a time set by the superintendent.

3. An employee who fails to make the health care contribution payments within thirty days after they are due will be notified that their 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 an employee or family member once every thirty days and return the certification within fifteen 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 their leave and at least two weeks prior to the conclusion of 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, bereavement leave and professional 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.

 

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.

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 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 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 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).

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 twelve months and has worked at least 1250 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-individuals who meet 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-that 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 the 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 noninstructional 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 them self 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.

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 work week, 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.

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.

 

The undersigned licensed staff member is applying for early retirement pursuant to board policy 406, Licensed Staff - Termination of Employment.  Please complete the following information:

(Full Legal Name of Licensed Staff Member)						(Social Security Number)
(Current Job Title)				(Date of Birth)				(Years of Service)

Please specify the date desired for payment of the early retirement benefit and the reason for the date if a date other than _____________ of the year in which the undersigned licensed employee retires is desired.

 

(Date)

(Reason for date other than ______________)

 

Please attach a letter of resignation effective June thirtieth of the year in which the undersigned licensed staff member intends to retire.

The undersigned licensed staff member acknowledges that application and participation in the early retirement plan is entirely voluntary.

The undersigned licensed employee acknowledges that the District recommends that the licensed staff member contact legal counsel and the staff member’s own personal accountant regarding participation in the early retirement plan.

Should the licensed staff member die prior to full payment of an early retirement benefit, the licensed staff member designates either the following individual as beneficiary or the licensed employee’s estate.

____ Beneficiary			_____ Estate
Beneficiary
Beneficiary Address
Licensed Employee					Date
Witness					Date

The undersigned licensed staff member acknowledges receipt of the early retirement plan documents stated below, for the licensed staff member's consideration:

early retirement policy (plan description);

[early retirement insurance options]; and

early retirement application.

The undersigned licensed staff acknowledges that the application and participation in the early retirement plan is entirely voluntary.

The undersigned licensed staff acknowledges that the school district recommends the licensed staff contact legal counsel and the employee’s personal accountant regarding participation in the early retirement plan.

 

 

 

Licensed Employee		Date

The District will reimburse retirees $5.00 per day unused sick leave, to a maximum of 105 days, if the retiree meets the following criteria:

1.  Service time:  Those full-time employees who have a minimum of 15 years of continuous service to the District are eligible for application.  No more than one year of long-term disability can be part of the 15 years continuous service, and no one receiving sick leave or long-term disability payments is eligible until such payments have been phased out by use of same.

A “full-time” employee in the support positions must have been employed at least 30 hours per week for 9 months of the school year or more.  Half-time employees that are in reality considered to be “full-time half-time” shall be eligible for a retirement stipend commensurate with the amount of time their position entails, such as half-time, 3/4 time, etc.

If there are “combination” work years, the Superintendent shall compute the “pro-rata” of the employee’s final 15 years of District service. Support employees must have worked 180 days in order to be credited with a “year”. The “work year” shall be from July 1^st through the following June 30^th.

Where there are any differences of computation, the Board shall determine the employee’s District “experience”. If there is any further reorganization of the school district, those employees coming into the District via that route shall be given the same privileges and experience computations as the above.

2.  The “age” of an employee shall be that age attained during the current work year of July 1 through June 30. Any employee who attains 55 years of age during the summer prior to the start of a new school year shall be eligible for early retirement provided all other eligibility requirements have been met.

3.  Support staff must submit a written request for early retirement to the Superintendent prior to March 1^st of that year. It shall be the prerogative of the Board to determine whether each request is granted and upon what date it is to become effective.

4.  The early retirement program is not available to any employee who is under consideration of contract termination or who has been discharged, with the Board the final determiner of that status.

5.  Any decision made by the Superintendent may be appealed to the Board whose decision shall be final and is considered non-grievable in any way as a part of District policy.

6.  The Board shall be the determiner of the time and date for all employees to best accommodate the District’s mission, if the request is for a time other than the end of their contract or fiscal year.

7.  Compensation will be included in the last paycheck upon retirement termination of employment.

The undersigned support employee acknowledges receipt of the early retirement plan documents stated below, for the support employee's consideration:

• early retirement policy (plan description);
• early retirement application.

The undersigned support employee acknowledges that the application and participation in the early retirement plan is entirely voluntary.

The undersigned support employee acknowledges that the school district recommends the support employee contact legal counsel and the employee’s personal accountant regarding participation in the early retirement plan.

 

___________________________________________________   ____________________________________
Support Employee                                                                           Date

 

The undersigned support employee is applying for early retirement pursuant to board policy 413.3, Support Employee Early Retirement.  Please complete the following information:

 

_____________________________________________________   __________________________________
(Full Legal Name of Support Employee)                                               (Social Security Number)

___________________________________  _______________________  _____________________________
(Current Job)                                                   (Date of Birth)                         (Years of Service) 

Please specify the date desired for payment of the early retirement benefit and the reason for the date if a date other than _____________ of the year in which the undersigned support employee retires is desired.

_____________________     __________________________________________________________________
(Date)                                      (Reason for date other than_____________________)

Please attach a letter of resignation effective June thirtieth of the year in which the undersigned support employee intends to retire.

The undersigned support employee acknowledges that application and participation in the early retirement plan is entirely voluntary.

The undersigned support employee acknowledges that the school district recommends that the support employee contact legal counsel and the employee’s own personal accountant regarding participation in the early retirement plan.

Should the support employee die prior to full payment of an early retirement benefit, the support employee designates either the following individual as beneficiary or the support employee’s estate.

____ Beneficiary                                                                             _____ Estate

___________________________________________________________________________________________
Beneficiary

___________________________________________________________________________________________
Beneficiary Address

____________________________________________________   ______________________________________
Support Employee                                                                              Date

____________________________________________________   ______________________________________
Witness                                                                                               Date

 

See form attached 

 

 

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.

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, or child when medically necessary

                          Details of the needed internmittent 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 school district

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

                          Details of the 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 shall be deducted from moneys owed me during the leave period.  If no monies are owed me, I shall 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:  _______________________________

 

1.  Employee's Name     ____________________________________________________

2.  Patient's Name  (if different from employee)  _________________________________

3.  The attached sheet describes what is meant by a "serious health condition" under the Family and Medical Leave Act.  Does the patient's condition, for which the
     employee is taking FMLA leave, qualify under any of the categories described?  If so, please check the applicable category.

     (1)                    (2)                   (3)                      (4)                      (5)                     (6)           

     or             None of the above

4.  Describe the medical facts which support your certification, including a brief statement as to how the medical facts meet the criteria of one of these categories:

5.  a.  State the approximate date the condition commenced, and the probable duration of the condition (and also the probable duration of the patient's present
          incapacity, i.e. inability to work, attend school or perform other regular activities due to the serious health condition, treatment therefore, or recovery therefrom, if
          different):

      b.  Will it be necessary for the employee to take work only intermittently or to work on a less than full schedule as a result of the condition (including for treatment
           described in Item 6 below)?

           If yes, give the probable duration:

      c.  If the condition is a chronic condition (condition #4) or pregnancy, state whether the patient is presently incapacitated and the likely duration and frequency of
           episodes of incapacity:

6.   a.  If additional treatments will be required for the condition, provide an estimate of the probable number of such treatments:

If the patient will be absent from work or other daily activities because of treatment on an intermittent or part-time basis, also provide an estimate of the probable number of and interval between such treatments, actual or estimated dates of treatment if known, and period required for recovery if any:

      b.  If any of these treatments will be provided by another provider of health services (e.g., physical therapist), please state the nature of the treatments:

      c.  If a regimen of continuing treatment by the patient is required under your supervision, provide a general description of such regimen (e.g. prescription drugs,
           physical therapy requiring special equipment):

7.   a.  If medical leave is required for the employee's absence from work because of the employee's own condition (including absences due to pregnancy or a chronic
           condition), is the employee unable to perform work of any kind?

      b.  If able to perform some work, is the employee unable to perform any one or more of the essential functions of the employee's job (the employee or the employer
           should supply you with information about the essential job functions)?

           If yes, please list the essential functions the employee is unable to perform.

      c.  If neither a. nor b. applies, is it necessary for the employee to be absent from work for treatment?

8.   a.  If leave is required to care for a family member of the employee with a serious health condition, does the patient require assistance for basic medical or personal
           needs or safety, or for transportation?

      b.  If no, would the employee's presence to provide psychological comfort be beneficial to the patient or assist in the patient's recovery?

      c.  If the patient will need care only intermittently or on a part-time basis, please indicate the probable duration of this need:

 

__________________________________________________________      ____________________________________________________________
(Signature of Health Care Provider)                                                                   (Type of Practice)

__________________________________________________________      ____________________________________________________________
(Address)                                                                                                            (Telephone Number)

To be completed by the employee needing family leave to care for a family member.

 

State the care you will provide and an estimate of the period during which care will be provided, including a schedule if leave is to be taken intermittently or if it will be necessary for you to work less than a full schedule:

__________________________________________________________      ____________________________________________________________
(Employee Signature)                                                                                          (Date)

 

A serious health condition means an illness, injury impairment, or physical or mental condition that involves one of the following:

1. Hospital Care - In patient care (i.e. an overnight stay) in a hospital, hospice, or residential medical care facility, including any period of incapacity or subsequent treatment in connection with or consequent to such inpatient care.

2. Absence Plus Treatment - A period of incapacity of more than three consecutive calendar days (including any subsequent treatment or period of incapacity relating to the same condition), that also involves:
   a.  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 the orders of, or on referral by, a health care provider; or
   b.  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.

3. Pregnancy - Any period of incapacity due to pregnancy or for prenatal care.

4. Chronic Conditions Requiring Treatments - A chronic condition which:
   a.  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;
   b.  continues over an extended period of time (including recurring episodes of a single underlying condition); and
   c.  may cause episodic rather than a period of incapacity (e.g. asthma, diabetes, epilepsy, etc.).

5. Permanent/Long-term Conditions Requiring Supervision - 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.

6. Multiple Treatments (Non-chronic Conditions) - Any period of absence to receive multiple treatments (including any period of recovery therefrom) 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) and kidney disease (dialysis).

 

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 employee handbook.

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;
   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;
   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 arrangements 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 twelve 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.

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 thirty days notice for foreseeable leave.  Failure to give the notice may result in the leave beginning thirty days after notice was received.
   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. Four 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.

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.
   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 fifteen days after family and medical leave begins unless it is impracticable to do so.  The school district may request recertification every thirty days.  Recertification must be submitted within fifteen days of the school district's request.

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 twelve weeks unpaid family and medical leave per year. 

2. Year is defined as fiscal year

3. If insufficient leave is available, the school district may:
   a.  Deny the leave if entitlement is exhausted
   b.  Award leave available

F.     Type of Leave Requested.

1. Continuous - employee will not report to work for set number of days or weeks.

2. Intermittent - employee requests family and medical leave for separate periods of time.
   a.  Intermittent leave is available for:
        (1)  Birth, adoption or foster care placement of child only with the school district's agreement.
        (2)  Serious health condition of the employee, spouse, parent, or child when medically necessary without the school district's agreement.
   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. 

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:
        (1)  Birth, adoption or foster care placement and subject to the school district's agreement.
        (2)  Serious health condition of the employee, spouse, parent, or child when medically necessary without the school district's agreement.
   b.  In the case of foreseeable reduced work schedule leave, the employee must schedule the leave to minimize disruption to the school district operation.
   c.  During the period of foreseeable reduced work schedule leave, the school district may move the employee to an alternative position with equivalent pay
        and benefits. 

G.    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 thirty days after they are due will be notified that their 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 an employee or family member once every thirty days and return the certification within fifteen 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 their leave and at least two weeks prior to the conclusion of 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.

H.   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, bereavement leave and professional 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.

 

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.

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 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 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 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).

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 twelve months and has worked at least 1250 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-individuals who meet 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-that 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 the 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 noninstructional 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.

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.

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.

 

FMLA requires covered employers to provide up to 12 weeks of unpaid, job-protected leave to "eligible" employees for certain family and medical reasons.

Employees are eligible if they have worked for a covered employer for at least one year, and for 1,250 hours over the previous 12 months, and if there are at least 50 employees within 75 miles.  The FMLA permits employees to take leave on an intermittent basis or to work a reduced schedule under certain circumstances.

Reasons for Taking Leave:

Unpaid leave must be granted for any of the following reasons:

• 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.

At the employee's or employer's option, certain kinds of paid leave may be substituted for unpaid leave.

Advance Notice and Medical Certification:

The employee may be required to provide advance leave notice and medical certification.  Taking of leave may be denied, if requirements are not met.

• The employee ordinarily must provide 30 days advance notice when the leave is "foreseeable."

• An employer may require medical certification to support a request for leave because of a serious health condition, and may require second or third opinions (at the employer's expense) and fitness for duty report to return to work.

Job Benefits and Protection:

• For the duration of FMLA leave, the employer must maintain the employee's health coverage under any "group health plan."
• Upon return from FMLA leave, most employees must be restored to their original or equivalent positions with equivalent pay, benefits, and other employment terms.
• The use of FMLA leave cannot result in the loss of any employment benefit that accrued prior to the start of an employee's leave.

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 involvement in any proceeding under or relating to FMLA.

Enforcement:

• The U.S. Department of Labor is authorized to investigate and resolve complaints of violations.
• An eligible employee may bring a civil action against an employer for violations.

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

For Additional Information:

If you have access to the Internet visit FLMA’s website:  http://www.dol.gov/esa/whd/flma.  Or contact the nearest office of Wage and Hour Division, listed in most telephone directories under U.S. Government, Department of Labor.  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

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.

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, or child when medically necessary

 

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 school district

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

 

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 shall be deducted from moneys owed me during the leave period.  If no monies are owed me, I shall 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

1.	Employee's Name
2.	Patient's Name (if different from employee)

3.  The attached sheet describes what is meant by a "serious health condition" under the Family and Medical Leave Act.  Does the patient's condition, for which the employee is taking FMLA leave, qualify under any of the categories described?  If so, please check the applicable category.

 

         (1)                    (2)                   (3)                     (4)                     (5)                    (6)           

                                                                       

                                                                   or                                             None of the above

 

4.  Describe the medical facts which support your certification, including a brief statement as to how the medical facts meet the criteria of one of these categories:

 

5.  a.  State the approximate date the condition commenced, and the probable duration of the condition (and also the probable duration of the patient's present incapacity, i.e. inability to work, attend school or perform other regular activities due to the serious health condition, treatment therefore, or recovery therefrom, if different):

 

b.  Will it be necessary for the employee to take work only intermittently or to work on a less than full schedule as a result of the condition (including for treatment described in Item 6 below)?

                  If yes, give the probable duration:

 

 

c.  If the condition is a chronic condition (condition #4) or pregnancy, state whether the patient is presently incapacitated and the likely duration and frequency of episodes of incapacity:

 

 

6.  a.  If additional treatments will be required for the condition, provide an estimate of the probable number of such treatments:

 

If the patient will be absent from work or other daily activities because of treatment on an intermittent or part-time basis, also provide an estimate of the probable number of and interval between such treatments, actual or estimated dates of treatment if known, and period required for recovery if any:

 

b.  If any of these treatments will be provided by another provider of health services (e.g., physical therapist), please state the nature of the treatments:

 

c.  If a regimen of continuing treatment by the patient is required under your supervision, provide a general description of such regimen (e.g. prescription drugs, physical therapy requiring special equipment):

 

7.  a.  If medical leave is required for the employee's absence from work because of the employee's own condition (including absences due to pregnancy or a chronic condition), is the employee unable to perform work of any kind?

b.  If able to perform some work, is the employee unable to perform any one or more of the essential functions of the employee's job (the employee or the employer should supply you with information about the essential job functions)?

                  If yes, please list the essential functions the employee is unable to perform.

 

c.  If neither a. nor b. applies, is it necessary for the employee to be absent from work for treatment?

 

8.  a.  If leave is required to care for a family member of the employee with a serious health condition, does the patient require assistance for basic medical or personal needs or safety, or for transportation?

 

b.  If no, would the employee's presence to provide psychological comfort be beneficial to the patient or assist in the patient's recovery?

 

c.  If the patient will need care only intermittently or on a part-time basis, please indicate the probable duration of this need:

 

(Signature of Health Care Provider)		(Type of Practice)
(Address)		(Telephone Number)

To be completed by the employee needing family leave to care for a family member.

State the care you will provide and an estimate of the period during which care will be provided, including a schedule if leave is to be taken intermittently or if it will be necessary for you to work less than a full schedule:

 

 

 

 

(Employee Signature)

(Date)

A serious health condition means an illness, injury impairment, or physical or mental condition that involves one of the following:

 

1.  Hospital Care - In patient care (i.e. an overnight stay) in a hospital, hospice, or residential medical care facility, including any period of incapacity or subsequent treatment in connection with or consequent to such inpatient care.

2.  Absence Plus Treatment - A period of incapacity of more than three consecutive calendar days (including any subsequent treatment or period of incapacity relating to the same condition), that also involves:

a.  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 the orders of, or on referral by, a health care provider; or

b.  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.

3.  Pregnancy - Any period of incapacity due to pregnancy or for prenatal care.

4.  Chronic Conditions Requiring Treatments - A chronic condition which:

a.  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;

b.  continues over an extended period of time (including recurring episodes of a single underlying condition); and

c.  may cause episodic rather than a period of incapacity (e.g. asthma, diabetes, epilepsy, etc.).

5.  Permanent/Long-term Conditions Requiring Supervision - 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.

6.   Multiple Treatments (Non-chronic Conditions) - Any period of absence to receive multiple treatments (including any period of recovery therefrom) 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) and kidney disease (dialysis).

A.     District notice.

1.  The 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 employee handbook.

3.  When an employee requests family and medical leave, the 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;

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;

c.  an explanation of the employee's right to substitute paid leave for family and medical leave including a description of when the 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 arrangements 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 District has more than 50 employees on the payroll at the time leave is requested;

2.  The employee has worked for the District for at least twelve 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.

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 thirty days notice for foreseeable leave. Failure to give the notice may result in the leave beginning thirty days after notice was received.

c.  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 District may require the employee giving notice of the need for leave to provide reasonable documentation or a statement of family relationship.

1.  Four 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.

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.

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 District may require the employee to obtain a second certification by a health care provider chosen by and paid for by the District if the District has reason to doubt the validity of the certification an employee submits. The second health care provider cannot, however, be employed by the District on a regular basis.

  (3)  If the second health care provider disagrees with the first health care provider, then the 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 District and paid for by the District. This certification or lack of certification is binding upon both the employee and the District.

c.  Medical certification will be required fifteen days after family and medical leave begins unless it is impracticable to do so. The District may request recertification every thirty days.  Recertification must be submitted within fifteen days of the District's request.

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 shall be denied until such certification is provided.

E.      Entitlement.

1.  Employees are entitled to twelve weeks unpaid family and medical leave per year. 

2.  Year is defined as:             Fiscal year

3.  If insufficient leave is available, the school district may:

a.  Deny the leave if entitlement is exhausted

b.  Award leave available

F.  Type of Leave Requested.

1.  Continuous - employee will not report to work for set number of days or weeks.

 

2.  Intermittent - employee requests family and medical leave for separate periods of time.

a.  Intermittent leave is available for:

  (1)  Birth, adoption or foster care placement of child only with the school district's agreement.

  (2)  Serious health condition of the employee, spouse, parent, or child when medically necessary without the District's agreement.

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, 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:

  (1)  Birth, adoption or foster care placement and subject to the school district's agreement.

  (2)  Serious health condition of the employee, spouse, parent, or child when medically necessary without the school district's agreement.

b.  In the case of foreseeable reduced work schedule leave, the employee must schedule the leave to minimize disruption to the school district operation.

c.  During the period of foreseeable reduced work schedule 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, do not include scheduled school breaks, such as summer, winter or spring break.

 a.  f an instructional employee begins family and medical leave for any purpose more than five weeks before the end of a semester, the 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 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 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 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 shall reimburse the school district at a time set by the Superintendent.

3.   An employee who fails to make the health care contribution payments within thirty days after they are due will be notified that their 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 an employee or family member once every thirty days and return the certification within fifteen days of the request. 

5.  The employee must notify the District of the employee's intent to return to work at least once each month during their leave and at least two weeks prior to the conclusion of 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 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, bereavement leave and professional leave. When the District determines that paid leave is being taken for an FMLA reason, the District will notify the employee within two business days that the paid leave will be counted as FMLA leave.