Resolution No. 78491
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RESOLUTION NO. 7849
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
VERNON AMENDING THE CITY OF VERNON FAMILY AND
MEDICAL LEAVE POLICY
WHEREAS, on October 17, 1995, the City Council of the City of
Vernon adopted Resolution No. 6696 approving and adopting a Family and
Medical Leave Policy, as amended by Resolution Nos. 7295, 7344 and 7406
adopted on March 16, 1999, June 1, 1999 and August 17, 1999,
respectively; and
WHEREAS, by letter dated October 10, 2001, Bruce V.
Malkenhorst, City Administrator/City Clerk, has recommended that
Section XI of the Family and Medical Leave Policy dealing with Short -
Term Disability be amended.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF VERNON AS FOLLOWS:
SECTION 1: The City Council of the City of Vernon hereby
finds and determines that the recitals contained hereinabove are true
and correct.
SECTION 2: The City Council of the City of Vernon hereby
approves and adopts the Amended City of Vernon Family and Medical
Leave Policy, a copy of which is attached hereto as Exhibit "A" and
made a part hereof.
SECTION 3: The City Council of the City of Vernon hereby
authorizes the City Clerk to inform City employees about the
provisions of said Amended Policy.
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SECTION 4: The City Clerk of the City of Vernon shall
certify to the passage of this resolution, and thereupon and
thereafter the same shall be in full force and effect.
APPROVED AND ADOPTED this 17th day of October, 2001.
ATTEST:
BRUCE V. MALKENHORST, City Clerk
LEONIS C. MALE RG, Ma or
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STATE OF CALIFORNIA )
) ss
COUNTY OF LOS ANGELES )
I, BRUCE V. MALKENHORST, City -Clerk of the City of Vernon, do
hereby certify that the foregoing Resolution, being Resolution No.
7849, was duly adopted by the City Council of the City of Vernon at a
regular meeting of the City Council duly held on Wednesday, October 17,
2001, and thereafter was duly signed by the Mayor of the City of
Vernon.
(SEAL)
BRUCE V. MALKENHORST, City Clerk
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EXHIBIT
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CITY OF VERNON
FAMILY AND MEDICAL LEAVE POLICY
(Amended October 17, 2001)
I. STATEMENT OF POLICY
In accordance with the California Family Rights Act (Government Code Section 12945.2) and
the Federal Family and Medical Leave Act of 1993 (Title 29 U.S. Code, Sections 2601 et
seq.), the City of Vernon will grant job protected unpaid family and medical leave to eligible
employees for up to 12 weeks per 12-month period for any one or more of the following
reasons:
A. The birth of a child and in order to care for such child or the placement of a child with
the employee for adoption or foster care (leave for this reason must be taken within the
12-month period following the child's birth or placement with the employee); or
B. In order to care for an immediate family member (spouse, child, or parent) of the
employee if such immediate family member has a serious health condition; or
C. The employee's own serious health condition that makes the employee unable to
perform the functions of his/her position.
H. DEFINITIONS
A. "12-Month Period" - means a rolling 12-month period measured backward from the
date leave is taken and continuous with each additional leave day taken.
B. "Spouse" - does not include unmarried domestic partners. If both spouses work for the
City of Vernon their total leave in any 12-month period may be limited to an aggregate
of 12 weeks if the leave is taken for either the birth or placement for adoption or foster
care of a child or to care for a sick parent.
C. Child" - means a child either under 18 years of age, or 18 years of age or older who is
incapable of self -care because of a mental or physical disability. An Employee's
"child" is one for whom the employee has actual day-to-day responsibility for care and
includes a biological, adopted, foster or step -child.
D. "Parent" - means the biological parent of an employee or an individual who stands or
stood in loco am entis to the employee when the employee was a child.
E. "Serious Health Condition" - means an illness, injury, impairment, or a physical or
mental condition that involves:
1. Inpatient care; or
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2. Any period of incapacity requiring absence from work for more than three
calendar days AND involves continuing treatment by a health care provider; or
3. Continuing treatment by a health care provider for a chronic or long-term health
condition that is incurable or which, if left untreated, would likely result in a
period of incapacity of more than three calendar days; or
4. Prenatal care by a health care provider.
F. "Continuing Treatment" -means:
1. Two or more visits to a health care provider; or
2. Two or more treatments by a health care practitioner on referral from, or under
the direction of, a health care provider; or
3. A single visit to a health care provider that results in a regimen of continuing
treatment; or
4. In the case of a serious, long-term or chronic condition or disability that cannot
be cured, being under the continuing supervision of, but not necessarily being
actively treated by, a health care provider.
III. COVERAGE AND ELIGIBILITY
A. To be eligible for family/medical leave an employee must:
1. Have worked for the City of Vernon for at least 12 months, which need not be
consecutive months; and
2. Have worked at least 1250 hours over the previous 12 month period.
3. Determinations of whether an employee meets the requirements of 1 & 2 above
will be made as of the date leave commences.
IV. INTERMITTENT OR REDUCED LEAVE
A. An employee may take leave intermittently (a few days or a few hours at a time) or on
a reduced leave schedule to care for an immediate family member with a serious health
condition or because of a serious health condition of the employee when "medically
necessary."
1. "Medically necessary" means there must be a medical need for the leave and
that the leave can be best accomplished through an intermittent or reduced leave
schedule.
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2. The employee may be required to transfer temporarily to a position with
equivalent pay and benefits that better accommodates recurring periods of leave
when the leave is planned based on scheduled medical treatment.
B. For part-time employees who are eligible and those employees who work variable hours
and are eligible, the family and medical leave entitlement is calculated on a pro rata
basis. A weekly average of the hours worked over the 12 weeks prior to the beginning
of the leave should be used for calculating the employee's normal workweek.
V. SUBSTITUTION OF PAID VACATION TIME
Employees are required to use accrued paid vacation time for any part of a family/medical
leave taken for any reason. The accrued paid vacation runs concurrently with the family and
medical leave. Employees may, at their discretion, use accrued compensatory time
concurrently with the family and medical leave.
VI. EMPLOYEE NOTICE OF LEAVE
Although the City of Vernon recognizes that emergencies arise which may require employees
to request immediate leave, employees are required to give as much notice as possible of their
need for leave. If leave is foreseeable, at least 30 days notice is required. In addition, if an
employee knows that he/she will need leave in the future, but does not know the exact date(s)
(e.g. for the birth of a child or to take care of a newborn), the employee shall inform his/her
supervisor as soon as possible that such leave will be needed. If the City of Vernon determines
that an employee's notice is inadequate or the employee knew about the requested leave in
advance of the request, the City of Vernon may delay the granting of the leave until it can, in
its discretion, adequately cover the position with a substitute.
VII. MEDICAL CERTIFICATION
Employees who request leave for their own serious health condition or to care for a child,
parent or a spouse who has a serious health condition must provide written certification from
the health care provider of the individual requiring care. If the leave is requested because of
the employee's own serious health condition, the certification must include a statement that the
employee is unable to perform the essential functions of his/her position.
If the City of Vernon has reason to doubt the validity of a certification regarding the
employee's serious health condition, the City of Vernon may require a medical opinion of a
second health care provider chosen by the City of Vernon. If the second opinion is different
from the first, the City of Vernon may require the opinion of a third provider jointly approved
by the City of Vernon and the employee. The opinion of the third provider will be binding.
If an employee requests leave intermittently (a few days or a few hours at a time) or on a
reduced leave schedule to care for an immediate family member with a serious health
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condition, the employee must provide medical certification that such leave is medically
necessary. "Medically necessary" means there must be a medical need for the leave and that
the leave can best be accomplished through an intermittent or reduced leave schedule.
VIII. AFFECT ON BENEFITS
An employee granted a leave under this policy will continue to be covered under the City of
Vernon group medical/dental insurance plan and life insurance plan under the same conditions
as coverage would have been provided if they had been continuously employed during the
leave period.
If an employee fails to return from unpaid family/medical leave for reasons other than (1) the
continuation of a serious health condition of the employee or a covered family member or (2)
circumstances beyond the employee's control (certification required within 30 days of failure to
return for either reason), the City of Vernon may seek reimbursement from the employee for
the premiums paid by the City of Vernon on behalf of that employee during the leave.
An employee does not accrue seniority and is not entitled to employment benefit accrual during
periods of unpaid leave; this includes longevity, annual merit increase consideration and
vacation. However, the employee will not lose any seniority or benefits which were accrued
prior to the unpaid family/medical leave.
IX. JOB PROTECTION
If an employee returns to work within the time permitted by this policy following the
commencement of family/medical leave, he/she will be reinstated to his/her former position or
an equivalent position with equivalent pay, benefits, status and authority.
Employee's restoration rights are the same as they would have been had the employee not been
on leave. Thus, if an employee's position would have been eliminated or the employee would
have been terminated but for the leave, the employee would not have the right to be reinstated
upon return from leave.
If an employee fails to return within the time permitted by this policy following a
family/medical leave the employee will be reinstated to his/her same or similar position, only
if available. If the employee's same or similar position is not available, the employee may be
terminated.
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X. REQUIRED FORMS
1. "Request for Family or Medical Leave Form" prepared by the City of Vernon to be
eligible for leave;
2. Medical certification - either for the employee's own serious health condition or for the
serious health condition of a child, parent or spouse;
3. Fitness for duty to return from leave form.
XI. SHORT-TERM DISABILITY
The City of Vernon may provide to certain City employees paid short-term disability benefits
which are not required by the California Family Rights Act or the Family Medical Leave Act
of 1993. Such short-term disability benefits will be available only as follows:
1. Full time miscellaneous employees with ten (10) years of continuous service
shall receive up to three (3) weeks of paid disability; and
2. Full time miscellaneous employees with fifteen (15) years of continuous service
shall receive up to six (6) weeks of paid disability.
The short-term disability benefits provided herein shall not be in addition to the leave required
by the California Family Rights Act or the Family Medical Leave Act of 1993. Such benefits
shall only be made available if the qualified employee chooses to use all other accrued paid
time off including, but not limited to, vacation, compensatory time, perfect attendance, and in -
lieu holiday time concurrently with any family or medical leave provided by this Policy. If the
employee does not choose to take all other accrued time off to run concurrently with his or her
leave, he or she will still be entitled to take all other leave provided by this Policy, but shall
not be entitled to the short-term disability benefits provided by this section. The short-term
disability benefits provided by this section are not intended to extend the maximum amount of
family and medical leave of twelve (12) weeks which is provided by the City's Family and
Medical Leave Policy.
Short-term disability benefits do not apply to intermittent leave taken under the California
Family Rights Act or the Family Medical Leave Act of 1993.
PHYSICIAN OR PRACTITIONER CERTIFICATION
FAMILY MEMBER - SERIOUS HEALTH CONDITION
1. Employee's Name:
2. Patient's Name
3. Does the employee's child, parent, or spouse have an illness, injury,
impairment, or physical or mental condition which constitutes a "serious health
condition." A "serious health condition" is described on the attached sheet
(attachment "A"). Does the patient's condition qualify under any of the
categories described? If so, please check the applicable category.
(1)_(2)_(3)_(4)_(5)_(6)—, or None of the above_.
4. Date medical condition or need for treatment commenced:
5. Probable duration of medical condition or need for treatment:
6. Regimen of treatment to be prescribed (indicate number of visits, general nature and
duration of treatment, including referral to other provider of health services. Include
schedule of visits or treatment if it is medically necessary for the employee to be off
work on an intermittent basis or to work less than the employee's normal schedule of
hours per day or days per week):
A. By Physician or Practitioner:
B. By other provider of health services, if referred by Physician or Practitioner: _
E.
Check Yes or No in the space below, as appropriate.
7. Yes —
No _ Is inpatient hospitalization of the family member (patient)
required?
8. Yes
No — Does (or will) the patient require assistance for basic
_
medical, hygiene, nutritional needs, safety or
transportation?
9. Yes
No _ After review of the employee's signed statement (see
—
Item 11 below), is the employee's presence necessary or
would it be beneficial for the care of the patient? (This
may include psychological comfort and/or the arranging
for third -party care for the family member.)
10. Estimate the
period of time care that is needed or the employee's presence would be
beneficial:
ITEM 11
TO BE COMPLETED BY THE EMPLOYEE REQUESTING
FAMILY LEAVE
11. When Family Leave is needed to care for a seriously ill family member, the employee
shall state the care he or she will provide and an estimate of the time period during
which this care will be provided, including a schedule if leave is to be taken
intermittently or on a reduced leave schedule:
Employee Signature: Date:
12.
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14.
Signature of Physician or Practitioner:
Date:
Type of Practice (Field of Specialization, if any):
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PHYSICIAN OR PRACTITIONER CERTIFICATION
EMPLOYEE SERIOUS HEALTH CONDITION
1. Employee's Name:
2. Patient's Name:
3. Does the employee have an illness, injury, impairment, or physical or mental
condition which constitutes a "serious health condition." A "serious health condition"
is described on the attached sheet (attachment "A"). Does the employee's condition
qualify under any of the categories described? If so, please check the applicable
category.
(1)_(2)_(3)_(4_(5)_(6)_, None of the above_.
4. Date medical condition or date for treatment commenced:
5. Probable duration of medical condition or need for treatment:
6. Regimen of treatment to be prescribed (indicate number of visits, general nature and
duration of treatment, including referral to other provider of health services. Include
schedule of visits or treatment if it is medically necessary for the employee to be off
work on an intermittent basis or to work less than the employee's normal schedule of
hours per day or days per week):
A. By Physician or Practitioner:
B. By other provider of health services, if referred by Physician or Practitioner: _
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Check Yes or No in the space below, as appropriate.
7. Yes _ No _. Is inpatient hospitalization of the employee required?
7. Yes _ No — Is employee able to perform work of any kind? (If
"No", skip to Item 9.)
8. Yes _ No _ Is employee able to perform the functions of employee's
position? (Answer after reviewing job description from
employer describing essential functions of employee's
position, or, if none provided, after discussing with
employee.)
9. Signature of Physician or Practitioner:
10. Date:
11. Type of Practice (Field of Specialization, if any):
12 Signature of Employee: Date:
E
Employee Name:
REQUEST FOR FAMELY/MEDICAL LEAVE
Date of Request:
Department: Position Title:
Hire Date:
I request a Family/Medical Leave for the following reason (check one):
A. The birth of a child and/or in order to care for such child.
B. The placement of a child for adoption or foster care.
C. In order to care for an immediate family member because such family
member has a serious health condition. Circle one: CHILD -
SPOUSE - PARENT (Must submit "Physician Certification" within
15 days)
METHOD OF LEAVE REQUESTED
A. Consecutive Leave
B. Intermittent or Reduced Leave Schedule (Specify Schedule Below):
Date leave is to begin:
Expected duration of leave:
If the duration of my family/medical leave (total of paid and unpaid time) does not exceed 12
weeks, I will be returned to my same, equivalent or comparable position. I understand that
if my family/medical leave should exceed 12 weeks I will be returned to my same, equivalent
or comparable position, only if available. If my same, equivalent or comparable position is
not available, I understand that I may be terminated.
Date: Employee.
Signature:
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FITNESS FOR DUTY TO RETURN FROM EMPLOYEE'S
MEDICAL LEAVE CERTIFICATION
date employee commenced leave for serious health condition, employee's name,
began a period of medical care leave from
name of agency employer
for
diagnosis
Based on my examination of on
employee's name
, I certify that he/she is medically/psychologically fit to return to
date of medical examination of employee
with the following limitations:
employee's Job - list limitations if applicable
Date Signature of Physician or Practitioner
Type of Practice (Field or
Specialization, if any):
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SERIOUS HEALTH CONDITION
A "Serious Health Condition" means an illness, injury, impairment, or physical or mental condition that involves one of the following:
1. Hospital Care
Inpatient can (i.e., an overnight stay) in a hospital, hospice, or residential medical care facility, including any period of incapacity or subsequent treatment
in connection with or consequent to such inpatient care.
2. Absence Plus Treatment
(a) A period of incapacity of mom than three consecutive calendar days (including any subsequent treatment or period of incapacity relating to the same
condition), that also involves:
(1) Treatmentl two or more times by a health care provider, by a nurse or physician's assistant under direct supervision of a health care provider, or
by a provider of health can services (e.g., physical therapist) under orders of, or on referral by, a health cam provider, or
(2) Treatment by a health care provider on at leant one occasion which results in a regimen of continuing treatment2 under the supervision of the health
care provider.
3. ftgnancy
Any period of incapacity due to pregnancy, or for prenatal care.
4. Chronic Conditions Reauldne Treatments
A chronic condition which:
(1) Requires periodic visit* for treatment by a health cam provider, or by a nurse physician's assistant under direct supervision of a health can
provider,
(2) Continues over an extended period of time (mcluding recurring episodes of a single underlying condition); and
(3) May cause episodic rather than a continuing period of incapacity (e.g., asthma, diabetes, epilepsy, etc).
S. Permanent/Long term Conditions Reauirine Supervision
A period of incapacity which is permanent or long-term due to a condition for which treatment may not be effective. The employee or family member
must be under the continuing supervision of, but need not be receiving active treatment by, a health care provider. Examples include Alzbeimer's, a severe
stroke, or terminal stages of a disease.
6. Multiple Treatments (Non -Chronic Conditions)
Any period of absence to receive multiple treatments (including any period of recovery therefrom) by a health care provider or by a provider of health
care services under orders, of, or any referral by, a health care provider, either for restorative surgery after an accident or other injury, of for a condition
that would Nicely result in a period of incapacity of more than three consecutive calendar days in the absence of medical intervention or treatment, such as
cancer (chemotherapy, radiation, etc), severe arthritis (physical therapy), kidney disease (dialysis).
LN,piw6 10110N5
(Treatment includes examination to determine if a serious
condition exists and evaluations of the condition. Treatment does
not include routine physical examinations, eye examinations, or
dental examinations.
2A regimen of continuing treatment includes, for example, a course of prescription medication (e.g. an antibiotic) or therapy requiring special equipment
to resolve or alleviate the health condition. A regimen of treatment does not include the taking of over-the-counter medications such as aspirin, antihistamines,
or salves; or bed -rest, drinking fluids, exercise, and other similar activities that can be initiated without a visit to a health care provider.
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