HR Forms and Checklists

Absence Request

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Employees may use this form when requesting future time off or reporting previous time off. Remember employees can take mandatory paid sick leave upon verbal or written request. This form also gives your employees the opportunity to indicate a family and medical leave of absence, although it is not required.

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Absence Request — Spanish

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Employees may use this form when requesting future time off or reporting previous time off. Remember employees can take mandatory paid sick leave upon verbal or written request. This form also gives your employees the opportunity to indicate a family and medical leave of absence, although it is not required.

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Basic Poster and Notice Requirements Under the Family, Medical and Pregnancy Leave Laws

Review this chart to determine your responsibilities under family, medical and pregnancy leave laws.

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Basic Poster and Notice Requirements Under the Family, Medical and Pregnancy Leave Laws - Spanish

Review this chart to determine your responsibilities under family, medical and pregnancy leave laws.

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Benefits During Leaves of Absence

This chart describes leaves of absence, whether they are legally required, if state mandated wage replacement is available, whether health benefits must be continued during the leave, whether use of sick, vacation or PTO can be required and whether sick, vacation or PTO accrue during the leave.

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Bereavement Leave Checklist

Use this checklist to create and implement a bereavement leave policy that complies with California’s bereavement leave requirements for employers with five or more employees

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California and Local Paid Sick Leave Comparison

Use this chart to compare California paid sick leave requirements to various local paid sick leave requirements.

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California Family Rights Act Fact Sheet

This fact sheet outlines an employee's right for leave under the California Family Rights Act (CFRA). You may choose to give this fact sheet to each employee eligible for CFRA and/or who requests leave that qualifies as CFRA, but there's no requirement that you do so.

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California Family Rights Act Fact Sheet - Spanish

This fact sheet outlines an employee’s right for leave under the California Family Rights Act (CFRA). You may choose to give this fact sheet to each employee eligible for CFRA and/or who requests leave that qualifies as CFRA, but there's no requirement that you do so.

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Certification for Serious Injury or Illness of a Current Servicemember for Military Family Leave Under the Family and Medical Leave Act

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Use this form when an employee requests leave to care for a close family member or next of kin who has a serious injury or illness relating to current military service. California employers, note especially the stated limitations relating to medical information as this information is confidential and protected in California.

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Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave Under the Family and Medical Leave Act

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Use this form when an employee requests leave to care for a close family member or next of kin who is a veteran and who has a serious injury or illness relating to their military service. California employers, note especially the stated limitations relating to medical information as this information is confidential and protected in California.

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Certification of Health Care Provider — Employee's or Family Member's Serious Health Condition

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Have the employee's health care provider complete this medical certification as needed. This form is used for employee's taking leave under the Family and Medical Leave Act (FMLA) and California Family Rights Act (CFRA) for their own serious health condition or that of a family member.

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Certification of Health Care Provider for Employee Return to Work

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An employee may use this notice to have their health care provider certify that they may return to work.

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Certification of Health Care Provider for Employee Return to Work - Spanish

An employee may use this notice to have their health care provider certify that they may return to work.

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Certification of Health Care Provider for Pregnancy Disability Leave, Transfer And/Or Reasonable Accommodation

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Have the employee's health care provider complete this medical certification as needed. This form is used for employee's seeking reasonable accommodation, transfer or Pregnancy Disability Leave for pregnancy, childbirth or a related medical condition.

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Certification of Health Care Provider for Pregnancy Disability Leave, Transfer And/Or Reasonable Accommodation - Spanish

Have the employee's health care provider complete this medical certification as needed. This form is used for employee's seeking reasonable accommodation, transfer or Pregnancy Disability Leave for pregnancy, childbirth or a related medical condition.

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Certification of Qualifying Exigency for Military Family Leave

Use this form when an employee requests leave due to a qualifying exigency relating to a family member's military service. California employers, note especially the stated limitations relating to medical information as this information is confidential and protected in California.

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CFRA Leave Documentation Checklist (Five to 49 Employees)

Use this checklist to assist you in complying with regulations regarding California Family Rights Act leave for employers with five to 49 employees.

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CFRA Notice and CFRA/FMLA Designation (50 or More Employees)

Use this form to give employees notice of their rights under the California Family Rights Act (CFRA), and to designate leave as CFRA and/or Family and Medical Leave Act (FMLA), to provide conditional approval of the request for leave if more information is necessary or to deny the request.

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CFRA Notice and CFRA/FMLA Designation (50 or More Employees) — Spanish

Use this form to give employees notice of their rights under the California Family Rights Act (CFRA), and to designate leave as CFRA and/or Family and Medical Leave Act (FMLA), to provide conditional approval of the request for leave if more information is necessary or to deny the request.

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CFRA Notice and Designation (Five to 49 Employees)

Use this form to give employees notice of their rights under the California Family Rights Act (CFRA), and to designate leave as CFRA, to provide conditional approval of the request for CFRA leave if more information is necessary, or to deny the request.

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CFRA Sample Policy - 50 or More Employees

Use this sample to create your policy that communicates any employee requirements and gives notice to your employee of their right to California Family Rights Act (CFRA) leave. Use this version if you have 50 or more employees.

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CFRA Sample Policy - 50 or More Employees - Spanish

Use this sample to create your policy that communicates any employee requirements and gives notice to your employee of their right to California Family Rights Act (CFRA) leave. Use this version if you have 50 or more employees.

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CFRA Sample Policy - Five to 49 Employees

Use this sample to create your policy that communicates any employee requirements and gives notice to your employee of their right to California Family Rights Act (CFRA) leave. Use this version if you have five to 49 employees.

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CFRA Sample Policy - Five to 49 Employees - Spanish

Use this sample to create your policy that communicates any employee requirements and gives notice to your employee of their right to California Family Rights Act (CFRA) leave. Use this version if you have five to 49 employees.

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CFRA/FMLA - Family Member Leave for a Qualifying Exigency

This chart describes the types of events that give an eligible employee a reason for leave because of a qualifying exigency under the CFRA/FMLA arising because the spouse, son or child of the employee is on covered active duty or call to active duty.

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CFRA/FMLA - Family Member Leave for a Qualifying Exigency - Spanish

This chart describes the types of events that give an eligible employee a reason for leave because of a qualifying exigency under the CFRA/FMLA arising because the spouse, son or child of the employee is on covered active duty or call to active duty.

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Employee Letter - PDL Only

Use this letter to respond to notice of an employee’s absence due to Pregnancy Disability Leave (PDL). Respond within 10 calendar days of the request or no later than the following payday, whichever is sooner. Use this letter if you are under 50 employees and not covered by the federal Family and Medical Leave Act (FMLA) or if the employee seeking leave is not eligible for FMLA leave.

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Employee Letter - PDL Only - Spanish

Use this letter to respond to notice of an employee’s absence due to Pregnancy Disability Leave (PDL). Respond within 10 calendar days of the request or no later than the following payday, whichever is sooner. Use this letter if you are under 50 employees and not covered by the federal Family and Medical Leave Act (FMLA) or if the employee seeking leave is not eligible for FMLA leave.

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Federal Family and Medical Leave Act Poster

This poster satisfies the required federal posting notice regarding the availability of family and medical leave.

Employers should give a copy of this FMLA notice at the time of hire if they do not publish an employee handbook. Best practice is to provide the notice at time of hire regardless of whether you also include the notice in your employee handbook.

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Federal Family and Medical Leave Act Poster - Spanish

This poster satisfies the required federal posting notice regarding the availability family and medical leave.

Employers should give a copy of the FMLA notice at the time of hire if they do not publish an employee handbook. Best practice is to provide the notice at time of hire regardless of whether you also include the notice in your employee handbook.

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FMLA - Notice of Eligibility and Rights and Responsibilities

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Use this form to notify employees taking a family and medical leave only regarding their eligibility for leave and any associated rights and responsibilities.

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FMLA - Notice of Eligibility and Rights and Responsibilities - Spanish

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Use this form to notify employees taking a family and medical leave only regarding their eligibility for leave and any associated rights and responsibilities.

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FMLA Designation Notice

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Use this form to designate leave as FMLA only, to provide conditional approval of the request for leave if more information is necessary or to deny the request.

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FMLA Designation Notice - Spanish

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Use this form to designate leave as FMLA only, to provide conditional approval of the request for leave if more information is necessary or to deny the request.

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FMLA PDL Designation Notice

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Use this form to notify an employee if their leave for PDL/FMLA is approved, conditionally approved or denied.

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FMLA PDL Designation Notice - Spanish

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Use this form to notify an employee if their leave for PDL/FMLA is approved, conditionally approved or denied.

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FMLA Sample Policy — 50 or More Employees

Use this sample to create your policy that communicates any employee requirements and gives notice to your employee of their right to Family and Medical Leave Act (FMLA) leave.

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FMLA Sample Policy — 50 or More Employees — Spanish

Use this sample to create your policy that communicates any employee requirements and gives notice to your employee of their right to Family and Medical Leave Act (FMLA) leave.

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FMLA/CFRA Documentation Checklist - For Employer Use Only

Use this checklist to assist you in complying with all regulations regarding family and medical leave and California Family Rights Act (CFRA) leave.

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Lactation Accommodation Policy

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Provide this policy to employees which states your company recognizes lactating employees' rights to request lactation accommodation. A written policy is mandatory for all California employers, regardless of size. In addition to including this policy in an employee handbook or set of policies, you must provide this policy to employees upon hiring and when an employee asks about or requests parental leave. Download and read the Instructions prior to using this policy.

Instructions

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Lactation Accommodation Policy — Instructions

Download and read these instructions prior to using the Lactation Accommodation Policy.

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Leave Interaction (FMLA/CFRA/PDL)

When an employee considers a leave, use this form to determine the relationships among the various state-mandated leaves of absence and benefits during the time off. Employees also benefit from this information.

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Local Minimum Wage, Paid Sick Leave and Other Employment Ordinances

Many jurisdictions in California have passed local ordinances relating to the minimum wage and paid sick leave. Eligibility rules may vary in each jurisdiction. The minimum wage rates in these cities may change at any time, but nearly all rates are scheduled to increase every January 1 or July 1 based upon the Consumer Price Index or another index. Employers should closely monitor any ordinances that apply. Some localities also have industry-specific rates, such as specific rates for hotel workers, as well as commuter benefits ordinances. This chart is not exhaustive; an increasing number of localities have additional ordinances relating to a wide range of employment matters. Check with your local city government as to whether any other ordinances might apply to your workforce/industry.

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Military Service Checklist

Use this checklist to create and implement a military service leave policy for your company.

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Military Spouse/Registered Domestic Partner Request for Leave - 25 or More Employees

Provide this form to employees who are requesting time off when their spouse or registered domestic partner is on leave from military deployment.

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Paid Family Leave Checklist

Use this checklist when your employee notifies you that he or she needs to take Paid Family Leave.

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Paid Sick Leave Checklist

Use this checklist to develop practices for implementing the Healthy Workplaces, Healthy Families Act of 2014 and it's expanded 2024 requirements.

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PDL Checklist for Employer Compliance - 5-49 Employees

If your company has five or more employees, pregnant employees who are actually disabled by their pregnancy are eligible for as much as 17 weeks and three days of PDL. If you have 50 or more employees but an employee has not yet been employed for 12 months and 1,250 hours, the employee will not yet be eligible for FMLA, but a pregnant woman will still be eligible for a protected leave of absence under PDL. Use this checklist for each employee on a leave subject to PDL to make sure you do not miss a step. Consult with your personnel policies or employee handbook to assist you in answering some of these questions.

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PDL Documentation - For Employer Use Only - 5-49 Employees

If your company has five or more employees, pregnant employees who are actually disabled by their pregnancy are eligible for as much as 17 weeks and three days of PDL. Use this form for each employee to keep track of the variety of documentation and tracking of other time off available to the employee during such a leave of absence.

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PDL/FMLA Documentation Checklist - For Employer Use Only

Use this checklist to assist you in complying with regulations regarding Family and Medical Leave Act (FMLA) and pregnancy disability leave.

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Pregnancy Disability Leave Notice

Government

This notice must be posted and must also be given to an employee who is seeking pregnancy disability leave or reasonable accommodation/transfer for pregnancy, childbirth or related medical condition. This notice applies to California employers with five or more employees. You must post this notice in a place commonly used by employees, such as a break room. This notice is also part of the California and Federal Employment Notices Poster available at the CalChamber Store.

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Pregnancy Disability Leave Notice - Spanish

Government

This notice must be posted and must also be given to an employee who is seeking pregnancy disability leave or reasonable accommodation/transfer for pregnancy, childbirth or related medical condition. This notice applies to California employers with five or more employees. You must post this notice in a place commonly used by employees, such as a break room. This notice is also part of the California and Federal Employment Notices Poster available at the CalChamber Store.

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Pregnancy Disability Leave Sample Policy — Five or More Employees

Use this policy to satisfy the requirements regarding Pregnancy Disability Leave (PDL).

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Pregnancy Disability Leave Sample Policy — Five or More Employees — Spanish

Use this policy to satisfy the requirements regarding Pregnancy Disability Leave (PDL).

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Pregnancy Discrimination Fact Sheet

Government

Copy and distribute this sample copy of California's Civil Rights Department (CRD) informational fact sheet to employees along with the required PDL notice. There is no legal requirement to distribute these fact sheets.

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Reproductive Loss Leave Checklist

Use this checklist to create and implement a reproductive loss leave policy that complies with California’s reproductive loss leave requirements for employers with five or more employees.

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Request for Leave of Absence - FMLA/CFRA/PDL

Provide this form if you're an employer covered by the federal Family and Medical Leave Act (FMLA) or the California Family Rights Act (CFRA) and either an employee has requested a leave of absence or you recognize the need.

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Request for Leave of Absence — FMLA/CFRA/PDL — Spanish

Provide this form if you're an employer covered by the federal Family and Medical Leave Act (FMLA) or the California Family Rights Act (CFRA) and either an employee has requested a leave of absence or you recognize the need.

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School and Child Care Activities Leave Checklist

Use this checklist to create and implement a school and child care activities leave policy for your company.

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State Disability Insurance and Paid Family Leave Benefit Amounts

Government

Use this table to determine what benefits an employee is eligible for under State Disability Insurance and Paid Family Leave. For more information, go to www.edd.ca.gov.

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Summary of Family, Medical and Pregnancy Disability Leave Laws

This form summarizes employer obligations as provided in federal and state family and medical leave laws (FMLA/CFRA) and the California Pregnancy Disability Leave law. It also shows the relationship between these laws and benefits available to employees while taking these leaves.

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Victims' Leave and Accommodation Checklist

This form will help guide you through providing leave or accommodation for an employee who notifies you that they, or their family member, are a victim of an act of violence or certain crimes.

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Volunteer Civil Service Leave Checklist

Use this form to create and implement a volunteer civil service leave policy for your company.

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HR Forms and Checklists

Leave of Absence Forms