Request a leave of absence to care for my sick or injured family member

Macomb County employees who would like to request a leave of absence to care for their sick or injured family member 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 and II of the Department of Labor (DOL) Healthcare Certification form

3

Provide the DOL Healthcare Certification form to your family member's healthcare provider, who must complete all of section III (including A and B).

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 to care for a family member are required to use their sick leave or comp time. The use of PTO for this type of leave 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.