G-3100 GCCG
PROFESSIONAL/SUPPORT STAFF VOLUNTARY
TRANSFER OF ACCRUED SICK LEAVE
(Voluntary Sick Leave Donation Program)
The Voluntary Sick Leave Donation Program was established to assist all district employees in dealing with catastrophic, non-job related circumstances. Catastrophic circumstances include such things as: complications from major surgery, serious injury due to accidents, and/or life threatening illnesses. The intent is to provide some measure of relief in such circumstances. For purposes of the Voluntary Sick Leave Donation, family shall include:
Spouse Grandparents
Children Grandchildren
Parents Father- and mother-in-law
Brothers and sisters Sons- and daughters-in-law
Spouse’s brothers and sisters
The following guidelines are in place for donors:
· Donors may volunteer to donate up to ten percent (10%) of available accrued leave days per year. Accrued leave days are counted at the time of donation. (One [1] day = eight [8] hours for support staff.)
· Donors must fill out the Sick Leave Donor Form.
The following guidelines are in place for the recipient:
· The recipient must have exhausted all accrued leave days before REQUESTING donation days.
· The recipient is not able to receive workman’s compensation or government disability benefits.
· The recipient (or recipient's designee) must fill out the Sick Leave Donation Request Form and provide supporting medical documentation.
The following guidelines are in place for the Voluntary Sick Leave Donation Program Committee:
· The committee will consist of three (3) Safford Unified School District (SUSD) employees from the following representative groups:
§ One (1) administrator;
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§ One (1) certified employee, and
§ One (1) support staff employee.
· All committee members will serve three-year terms after initial start-up terms.
· When a replacement member for the committee is needed, a notice will be sent out requesting a volunteer.
· If more than one (1) volunteer comes forth, the replacement will be voted upon by his/her representative group.
· The committee will keep all Sick Leave Donor Forms confidential (file to be kept at the District Office).
· The committee will keep all Sick Leave Donation Request Forms confidential (file to be kept at the District Office).
· The committee will send out the Notice of Need Form when a qualifying request for a donation has been received, reviewed and approved.
· The committee will randomly draw days from donors based on the number of days requested.
· The committee will return any unused days to donors.
· The initial committee will be comprised of volunteers from the original Voluntary Sick Leave Donation Program Committee. If there are several volunteers from a representative group(s), the original committee will vote to fill the position(s). Initial start-up terms:
§ One (1) committee member will serve a 3-year term;
§ One (1) committee member will serve a 2-year term; and
§ One committee member will serve a 1-year term (to be decided by the committee).
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The following guidelines have been set-up for the donation procedure:
Any SUSD employee may request up to one hundred twenty (120) days from the Voluntary Sick Leave Donation Program. In the event the SUSD employee is unable to make the request, a family member or someone speaking on behalf of the employee may make the request. Upon reviewing each request, the 3-person committee will notify recipient of its decision and send out the notice of need request if approved. Employees volunteering to donate days will fill out the Sick Leave Donor Form and send it to the District Office. The committee will randomly draw days from a list of employees who have volunteered to donate, based on the number of days requested. If enough donated days have not been received to fill the request, the committee may re-send the Notice for Need Form asking for additional donations from employees. The committee will return any unused donated days to donors. The payroll employee from the District Office will inform the committee when the recipient is close to exhausting donated days. Donation days will not carry-over to the next school year (July 1). A new request must be submitted for additional days.
Adopted: February 8, 2007
LEGAL REF.: A.G.O. I91-027
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EXHIBIT EXHIBIT EXHIBIT
VOLUNTARY SICK LEAVE DONATION
REQUEST FORM
The following is to be completed and submitted to the Payroll secretary prior to using any donated sick leave days. The Payroll secretary will forward the request to the Voluntary Sick Leave Donation Program Committee for their action.
Employee’s Name______
Department/School: ______
Dates and number of Donated Days Requested (cannot exceed 120 days, 8 hrs. equal one day for support staff). Dates: ______Total Days: ______
I verify I have met all of the following conditions:
· I have exhausted all of my accrued sick leave days.
· I will not have used more than 120 donated sick leave days for the fiscal year.
· I am not entitled to receive workmen’s compensation or government disability benefits.
· Days requested will be used in compliance with District Sick Leave Policy.
· Give permission for this information to be submitted to staff to seek donors.
______
Employee’s Signature Date
______
Witness’s Signature Date
………………………………………………………………………………………………………
Total Number of Days Donated: ______
Committee Approval: ______
Date
Payroll Approval: ______
Date
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EXHIBIT EXHIBIT EXHIBIT
VOLUNTARY SICK LEAVE DONATION
DONOR FORM
Please complete the following information and submit it to the Payroll secretary who will confirm available days for donation. She will then forward it to the Voluntary Sick Leave Donation Program Committee for their action.
______
Name of Donor Department/School
I am a: (check one)
_____ Certificated Employee
_____ Support Staff Employee
I offer to donate ______days (for support staff, 8 hours equals one day, total number of days may not exceed 10% of accrued sick leave) to:
______
Name of person to whom you wish to donate sick leave days Department/School
I understand that if more days are offered for donation than are needed, a drawing will be conducted to randomly select whose days will be used for donation. Any of my days not selected will be returned to my sick leave account.
______
Signature of Employee Making Donation Date
______
Witness Date
………………………………………………………………………………………………………
Number of Days Donated: ______
Number of Days Returned to Employee’s Sick Leave Account: ______
Committee Approval: ______
Payroll Approval: ______
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