Workers' Compensation and Leave

Leave

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 Policies

• Full Time Employees Leave Policy
• Part Time Employees (PT) Leave Policy
• Part Time Non-Benefited (PP) and Temporary Employees Leave Policy
• Return to Work/Modified Duty Policy

Leave Request Forms

• Family and Medical Leave Request – Employees 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
• Short Term Disability eligibility is determined by Harford. Employees may call Hartford to start the application processes over the phone click here  Leave Request Forms         Leave Request Forms for details.

• 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 (must 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
• Request for Domestic Abuse Leave form