New 2022 CA COVID-19 Sick Leave

Employees are entitled to up to 80 hours of 2022 COVID-19 related paid sick leave from January 1, 2022, through December 31, 2022, immediately upon request to their employer, with up to 40 of those hours available only when an employee or family member tests positive for COVID-19.

Haga clic aquí para el formulario en español https://www.tfaforms.com/4967659.

IMPORTANT: Please note that this form AND a corresponding ADP Time Off Request are required for processing of your claim.

Name:

Department:

Select Status Full-Time or Non Full-Time (includes part-time, seasonal, on-call; amount of time will vary by each person)

What dates are you requesting this leave for?

Retro claim January 1 – February 19*Current claim February 20 – December 31**

*If you were already paid for this time off via Sick or Vacation these accounts will be credited, and you will see on your pay statement X CA SPSL USED once approved. If you were NOT paid please submit the Time Off Request via www.workforcenow.adp.com for the actual days you were scheduled and NOT paid by Boisset or SDI.

**Submit Time Off Request via www.workforcenow.adp.com using Time Off Policy - CA FT or PT Supplemental PSL 22 AND Reason Code. All requests will be finalized with HR/Payroll once received.

WHAT TYPE OF COVID-19 SICK LEAVE ARE YOU REQUESTING?

California Supplemental Paid Sick Leave (ADP Reason Code - CA SPSL 2022):

Vaccine-Related - SELFVaccine-Related - FAMILY MEMBER* Caring for Yourself - Subject to Quarantine or IsolationCaring for Yourself - Symptoms and seeking a medical diagnosisCaring for a Family Member* - Subject to Quarantine or IsolationCaring for a Family Member* - Symptoms and seeking a medical diagnosisCaring for a Family Member* - Caring for child whose school or place of care is closedN/A

California Supplemental Paid Sick Leave ADDITIONAL Leave (ADP Reason Code - CA SPSL 2022 Addl Leave):

Positive - SELFPositive - FAMILY MEMBER* N/A

*A family member includes a child, parent, spouse, registered domestic partner, grandparent, grandchild, or sibling.

Hint: Select the N/A option for the sick leave category that does not apply to you. The form requires a selection to be made on both categories.

Provide dates and hours relevant to your request as well as any additional supporting information:

Be prepared to provide clarification to HR upon request.

Please provide your cell phone:

Please provide your email:

Thank you! Remember, if you experience COVID-19 symptoms, OR have close contact with an individual who has COVID symptoms, please call in sick to your supervisor and contact your HR representatives.

Sandi Weimer: 707.963.6913
Eduardo Hernandez: 707.967.7607
Joy Murphy: 707.963.6919

Email: hr@boisset.com