Skip to Main Content
How Do I?
The City and County of Broomfield offers a variety of leave options for eligible Full-Time and Part-Time employees.
FMLA General Notice for Employees
Leave Request Process
Employees Leave Policy
Employees (PT) Leave Policy
Part Time Non-Benefited (PP) and Temporary Employees Leave Policy
Return to Work/Modified Duty Policy
Holiday Pay Policy
Leave Request Forms
Family and Medical Leave Request
– Employee’s who are requesting leave must complete this form and give to his or her supervisor for their signature and return to Human Resources.
Certification of Health Care Provider Form
Requesting Leave for Yourself
– Must be completed by the employee’s physician and review his/her job description for an employee’s own serious health condition
Requesting Leave for a Family Member
- Must be completed by family members physician
Release to Return to Work Form
– must be completed by employee’s physician and review job description prior to returning to work.
Access to Job Descriptions
(should be reviewed by physician during completion of forms)
Certification for Care of Current Service member's Serious Injury or Illness
Certification for Care of Veteran Serious Injury or Illness
Certification for Qualified Exigency for Military Family Leave
Leave Donation Request Form
Kaiser Authorization to Disclose Health Information Form
Employee's Guide to the Family and Medical Leave Act
If you have questions on leave, please contact Human Resources at 303.438.6320 or email
Form 1095-C for Reporting Health Coverage
Safety and Workers Compensation
Slideshow Left Arrow
Slideshow Right Arrow