Request a leave of absence for my own injury or illness

Macomb County employees who would like to request a leave of absence for their own injury or illness should follow the instructions below.

I want to:

1

Complete section 1, 2 and 3 of the Leave of Absence Request form

2

Complete section I of the Department of Labor (DOL) Health Care Certification form

3

Provide the DOL Healthcare Certification form to your health care provider, who must complete all of section II (including A, B and C).

4

Submit all completed forms via email to benefits@macombgov.org or via fax to 586-469-6974

Helpful tips:

  • Employees who are requesting a medical leave of absence for themselves are required to use their sick leave or comp time. The use of PTO for a medical leave of absence for yourself is optional. Once approved, this option cannot be changed unless there is a change or alteration of the leave.
  • Provide your personal phone number and email address. If you are out on leave, you may not have access to your desk phone and work email address.
  • Section 4 of the Leave of Absence Request Form can be signed by the department head before it is submitted to Human Resources and Labor Relations.