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Letter of Critical Illness Leave - Template Form

✓ Designed for use in Canada

Create your Letter of Critical Illness Leave for use in Canada. Answer a few plain-English questions and the document fills in automatically as you go - then download it in Word and PDF, ready to sign or share.

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Below you can preview the Letter of Critical Illness Leave, complete it by answering a few plain-English questions, and download a ready-to-sign copy in Word and PDF - tailored for use in Canada.

What the Letter of Critical Illness Leave includes

This template is organised into the following sections:

Frequently asked questions

What is a Letter of Critical Illness Leave?

A Letter of Critical Illness Leave is a ready-to-use legal template for Canada. You complete it by answering a few plain-English questions, then download the finished document in Word and PDF.

What does the Letter of Critical Illness Leave cover?

The Letter of Critical Illness Leave is organised into sections covering Purpose of Notice, Reason for Leave, Commencement of Leave, Medical Certificate, Statutory Entitlement, so the important points are captured in a clear, consistent structure.

What formats can I download?

You can download your completed Letter of Critical Illness Leave as an editable Microsoft Word (.docx) file and as a PDF.

Can I edit the document later?

Yes - save it to your account and you can re-open, edit and re-download it at any time.

Is a Letter of Critical Illness Leave legally binding?

Once it is properly completed and signed by everyone involved, a Letter of Critical Illness Leave is generally legally binding in Canada, provided it meets the legal requirements that apply to this type of document.

What laws apply to a Letter of Critical Illness Leave in Canada?

A Letter of Critical Illness Leave should comply with the laws in force in Canada. This template is built around the provisions such situations commonly require, but the rules can vary by region and change over time, so check the current requirements for your case.

Do I need a lawyer to use a Letter of Critical Illness Leave?

For most standard situations you can complete the Letter of Critical Illness Leave yourself using the guided questionnaire. For high-value, unusual or high-risk matters, it is sensible to have a qualified lawyer review the finished document.

How do I sign the Letter of Critical Illness Leave?

Download the completed Letter of Critical Illness Leave as Word or PDF and sign it as required in Canada. Depending on the document this may involve a handwritten or electronic signature, and some documents also need witnesses.

Is the Letter of Critical Illness Leave free?

You can preview the Letter of Critical Illness Leave and fill it in for free. A one-time fee applies only when you download the finished, ready-to-sign document in Word and PDF.

How long does it take to complete a Letter of Critical Illness Leave?

Most people finish the Letter of Critical Illness Leave in just a few minutes by answering the plain-English questions. You can save your progress and come back to it at any time.

Prepared and reviewed by the LegalDocs team.

Document preview

PRIVATE AND CONFIDENTIAL

________
________
Telephone: ________
Email: ________
Employee Number: ________

________

________
Attention: ________, ________
________

Re: Notice of Critical Illness Leave under the Employment Standards Act, 2000

Dear ________:

§ 1. Purpose of Notice. Please accept this letter as my formal written notice of my intention to take Critical Illness Leave pursuant to sections 49.4 and 50.2 of the Employment Standards Act, 2000, SO 2000, c 41 (the "ESA"), as amended, and the regulations made thereunder.

§ 2. Reason for Leave. I require this leave to provide care or support to my ________, namely ________, who is a critically ill family member within the meaning of section 49.4 of the ESA. The said family member is an ________ for the purposes of determining my statutory entitlement.

§ 3. Commencement of Leave. I intend that my leave of absence commence on ________.

§ 4. Medical Certificate. A certificate issued by a qualified health practitioner, as required under subsection 49.4(3) of the ESA, was obtained on ________. The certificate states that the family member is a critically ill person who requires the care or support of one or more family members, and sets out the period during which such care or support is required. A copy of the said certificate is enclosed with this letter to establish my entitlement, and the original will be provided to you upon request as soon as is reasonably practicable.

§ 6. Duration Requested. Based on the period set out in the medical certificate, I anticipate requiring ________ weeks of leave. Should this duration exceed the minimum statutory entitlement applicable to my circumstances, I respectfully request your agreement to such extension in the form of an unpaid leave or other accommodation, and I trust that you will give this request your favourable consideration in light of my circumstances.

§ 8. Transition of Duties. I will make every reasonable effort to ensure an orderly transition of my responsibilities prior to the commencement of my leave, and I am pleased to assist with such arrangements as may be reasonably required.

§ 9. Documentation. I request that this notice and the enclosed certificate be forwarded to the appropriate department to be documented and placed in my employee file.

§ 10. Anticipated Return. I anticipate returning to work on ________. Should the circumstances giving rise to this leave change, or should I be required to end or extend my leave, I will provide you with reasonable written notice in accordance with the ESA.

§ 11. Contact During Leave. Should any further information regarding my leave be required, please contact me by telephone or email at the particulars set out above, and I will respond as soon as is reasonably practicable.

I thank you for your understanding and cooperation in this matter.

Yours sincerely,




______________________
________

Enclosure: Certificate of qualified health practitioner

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Fields you complete are inserted into the document live. This template is general guidance only - not legal advice.