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Notice of Sick Leave - Template, Sample Form Online Pro · EN-CA-law

✓ Valid in Canada (English) · drafted to comply with local law

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Notice of Sick Leave - Template, Sample Form Online
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Employee Identification No.: ________


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Attention: ________


RE: NOTICE OF SICK LEAVE / MEDICAL LEAVE OF ABSENCE

Dear ________,

§ 1. Purpose of Notice. Please accept this letter as my formal written notice of my intention to take a medical (sick) leave of absence from my employment with ________ (the “Employer”), in respect of which I currently hold the position of ________ in the ________ department.

§ 2. Commencement of Leave. I intend for my leave of absence to commence on ________, and I anticipate that the leave will continue for a period of ________ day(s), subject to any extension that may be medically required.

§ 3. Statutory and Contractual Entitlement.

  1. This notice is provided in accordance with my entitlement to leave under the applicable employment standards legislation governing my employment, namely the ________.
  2. Where my employment is subject to federal jurisdiction, this leave is taken pursuant to the medical leave and personal leave provisions of the Canada Labour Code, R.S.C. 1985, c. L-2, including, where applicable, the entitlement to paid medical leave under section 239 thereof.
  3. Where my employment is subject to provincial jurisdiction, this leave is taken pursuant to the sick leave, medical leave and/or personal emergency leave provisions of the applicable provincial employment standards statute identified above.
  4. This notice is given without prejudice to, and in addition to, any greater rights or benefits to which I may be entitled under my employment agreement, any applicable collective agreement, or any workplace policy of the Employer (including any short-term or long-term disability benefit plan).

§ 6. Transition of Duties. I appreciate your understanding and cooperation in this matter, and I will make every effort to ensure a smooth transition of my responsibilities during my absence. Please let me know if there is any additional documentation or information you require to process this request.

§ 7. Anticipated Return. Should I not be in touch during my leave, I plan on returning to work on ________, and I would be pleased to discuss any outstanding matters with you upon my return. I will provide reasonable notice of any change to this anticipated return date.

§ 8. Contact. During my absence I may be reached, for non-urgent matters only, at ________.

Sincerely,




______________________
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Date: ________

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