Families First Corona Virus Response Act (FFCRA) COVID19 Leave Request

  • Families First Corona Virus Response Act (FFCRA) COVID19 Leave Request


    Please see this form to request a leave of absence related to a COVID19-related absence.

    Completed forms should be submitted to:  emp.services@fwisd.org


    Employees who are absent for any reasons listed on the request form should enter an absence in the District’s absence reporting system at 817-814-7827 as “sick leave self” or “sick leave-family member.”  HCM staff will amend the absence reason accordingly in the absence reporting system once the leave request form is processed.  For questions about leave related to an illness/absence qualifying under the FFCRA, please communicate with HCM staff through emp.services@fwisd.org, and 817-814-2790 when the District offices are open for regular business.

Leaves of Absences


    Employee Leave Request Instructions

    When an employee has been absent or anticipates being absent ten (10) or more consecutive workdays, Fort Worth ISD requires an application for a District leave.

     Employee Request for Leave Steps:

    1. An employee shall obtain Form 100 via the Employee Relations Department (Section A or online). 
    2. The employee completes and signs Form 100
    3. The employee has the attending physician complete and sign a medical certification form and submits it to the Employee Relations Department. (Forms not signed by the physician will be returned to the employee.)
    4. Form 100 and the applicable medical certification form can be submitted in person to the Employee Relations Department Section-A or via email at emp.relations@fwisd.org

     *Leaves are processed as quickly as possible. However, please note we cannot process a leave without all required documents.


    Click on the link below for the appropriate medical certification form:

    a.) Employee's Serious Health Condition (Form WH-380-E) (includes maternity)

    b.) Family Member's Serious Health Condition (Form WH-380-F)

    c.) Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave (Form WH-385)

    d.) Certification of Qualifying Exigency for Military Family Leave (Form WH- 384) (This form does not need to be completed by a healthcare provider)


     Reporting Leaves and Absences

    Employees must follow District and department/campus procedures to report/request any leave and as appropriate complete the leave request Form 100.  Employees must report all leaves and absences on the automated absence reporting system. Please do not automatically request a substitute.  Check with your supervisor to see if a substitute is required for your position. In addition to calling the automated absence reporting system, you must also notify your immediate supervisor of the absence on the day of the absence.