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2016 CBA Tentative Agreement Page 189 of 217 Appendix Article 25 - 1 Sick Leave Restriction Template This letter concerns your use of sick leave or other leave (i.e. annual, LWOP) in lieu of sick leave. For the purpose of this letter, a reference to 'leave' applies only to absences utilizing sick le ave or other leave in lieu of sick leave . T h is is follow up to the recent leave counseling that took place on [INSERT DATE(S) OF EMPLOYEE LEAVE COUNSELING HERE] regarding your potential abuse of leave. This is to inform you that my carefu l review of y our leave usage has revealed a pattern that I consider to be an abuse of leave. In view of your overa ll use of leave since [INSERT DATE] , I have observed a patte rn of l eave usage that in cludes: [PROVIDE THE SPECIFIC REASONS FOR THE ISSUANCE OF THE LEAVE RE STRICTION LETTER HERE] . Following the review of your leave usage for the period spec ifi ed above , I have determined t here i s a reasonab l e belief you may be abusing sick leave or leave in lieu of sick leave. T h erefore , in accordance with Article 25 , Sectio n 7 , effective the date of rece ipt of this letter and for a period of time, not to exceed six (6) m onths , you will be required to provide a medical certificate, to substantiate the request that covers the period of each subsequent absence for which you req uest sick leave or other leave in lieu of sick leave. A registered physician or other health practitioner must sign the medical certificate. Failure to comply with the provisions of this leave restriction letter ma y result in charge to absence without leav e (AWOL). AWOL is non - disciplinary but may form the basis for disciplinary action. This written instruction to provide a medical certificate applies to all absences utilizing sick leave or other leave in lieu of sick leave , except in the instance that bec ause of illne ss you are released from dut y, you may be r eq uir e d to furnish a medical certificate for that day . Requests for FMLA and LWOP may be subject to approval based on separate and distinct documentation and notification requirements. In the even t that you may ha ve a personal or health problem, which is adversely affecting your ability to maintain a regular and reliable attendance record , assistance i s available through the Employee Assistance program (EAP). This is a free and confidential serv ice and I strongly encourage you to take advantage of this assistance if needed. Assistance is available through the EA P Hotlin e at 1 - 800 - 23 4 - 1 EA P or visiting the EAP website at: www.magellanhealth.com .

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