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  • COVID-19 PTO Request Form

  • We are excited to share that, once again, Carewell SEIU 503 is offering COVID-19 Paid Time Off benefits to workers impacted by the pandemic.

    You can receive up to 40 hours of paid time off benefits if:

    • you lose hours after January 1, 2021 for one of the five qualifying reasons below, and
    • you worked at least 40 hours in one of the three months before the time period in which you lost those hours. For example, if you lose hours in February, you would need to have worked 40 hours in either January 2021, December 2020, or November 2020 to be eligible.

    The five qualifying reasons for lost hours are:

    1. You had a confirmed case of COVID-19;
    2. You were advised by a qualified medical professional to self-quarantine due to potential exposure to COVID-19;
    3. You have symptoms of COVID-19 and are actively seeking a medical diagnosis by a qualified medical professional;
    4. You are providing care for an individual, who you are legally responsible for or live with, and who is subject to a quarantine or isolation order by a qualified medical professional; and/or        
    5. You are caring for a child who you are legally responsible for whose school or childcare facility has been closed due to COVID-19 precautions and no other qualified individuals are available to care for your child(ren).

    Complete this form to apply for the COVID-19 PTO benefit.

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  • *In order to qualify for this benefit, “advice or an order to quarantine due to COVID-19” must have been issued by a qualified medical professional.

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