VUMC employees are not eligible for the university's COVID-19 leave bank.
Please provide documentation for the reason you are requesting COVID-19 sick leave. (Doctor’s note, other similar medical documentation, Occupational Health or PHCCC notification)
By signing below, I attest that the above statements are accurate to the best of my knowledge. I understand that providing false information may result in disqualification of COVID-19 Leave Bank pay and/or disciplinary action up to and including termination of employment.
If the employee is unable to complete this form or provide a signature please indicate the name of the person completing the form below.