CHO3

Force Majeure Leave Notification Form – HR108(f)

This form must be completed by an employee who takes Force Majeure Leave as soon as reasonably practicable after the leave is taken.

Under the Parental Leave Act, an employee is entitled to force majeure leave where for urgent family reasons, owing to an injury to or the illness of a person referred to in section 13(2) of the Act, the employee's immediate presence is indispensable at the place where the person is.

The persons referred to in section 13(2) of the Act are:

a person of whom the employee is the parent or adoptive parent;
the spouse of the employee or a person with whom the employee is living as husband and wife;
a person to whom the employee is in loco parentis;
a brother or sister of the employee; and
a parent or grandparent of the employee.

Force majeure leave must not exceed 3 working days in any period of 12 consecutive months or 5 working days in any period of 36 consecutive months.

Section 1

Name *

Grade *

Personnel Number *

Location *

PPS Number *

Names injured/ill person *

Address of injured/ill person *

Relationship to employee *

Nature of injury/illness *

No of days applied for *

From *

Date(s) of force majeure leave

To *

Date(s) of force majeure leave

Agree