HomeMy WebLinkAbout*Other - BOCC (002)GRANT COUNTY
BOARD OF COUNTY COMMISSIONERS
T _ �
To: Elected Officials and Department Heads
From: Board of County Commissioners
Dabn August 24, 2021
Re: Sick Leave Donation Request
The Board of County Commissioners has received and approved a request to
initiate the Sick Leave Donation Policy.
Ronald Coombs (ID #21-03) of Grant County Public Works is suffering from an
illness, injury, impairment or physical or mental condition which is extraordinary
in nature (life threatening or causing long term or permanent damage) and has
or will soon exhaust all leave balances.
Any County employee who is interested in donating a portion of their own sick
leave to this employee may do so by submitting the attached, completed form to
the Payroll Administrator, Rachel Jorgensen via interoffice mail or emailed to
riorgensen@.grantcount)Ma.gov. The deadline for sick leave donation forms to
be received in Accounting is Friday, September 17, 2021.
Employees who are eligible to accrue sick leave, may donate sick leave,
according to the following criteria:
• Sick leave may not be donated in less than two (2) hour increments.
• Employees must retain at least 10 (ten) days or eighty (80) hours in their
own sick leave balance after the donation.
Cc: Public Works
Accounting
Human Resources
"To meet current and future needs, serving together with public and private entities, while
fostering a respectful and successful work environment."
Grant County
..Sick Leave Donation Form
Donor Certification
CONFIDENTIAL
To: Accounting
From: (name)
Uawfful
Data
Re: Request to Donate Sick Leave
STATEMENT OF DONATION: I hereby voluntarily agree to donate a portion of my accrued sick
leave in response to the request to donate sick leave to an employee in the
department/office.
understand this donation is irrevocable. I understand that Accounting will take from my
donation, in two (2) hour increments, the whole or a portion of my donated leave that will assist in
meeting the requested leave, or the maximum allowed leave, whichever comes first.
Should all or part of my intended donation not be needed to meet the request, it shall not be taken
from my balance.
I am donating a maximum of hours (2 hour minimum increment) to be
deducted from my sick leave balance to Requestor No. (See announcement)
Print Name: Signature:
Department Date
Accounting Certification
STATEMENT OF CERTIFICATION: I hereby certify that the above employee will, after the
donation is made, retain a sick leave balance of at least eighty (80) hours.
Name Title
Accounting Date
N:\Staff\BVasquez\BOCC Correspondance\Sick Leave Donation Request Public Works #21-03 Coombs
08242021.docx