This form is used by all pedagogues to apply for medical certification for absence up to 20 consecutive school days, for requests to borrow sick days, for excuse of absence due to children’s diseases, and for injury in the line of duty claims. Rules...

The following is a list of the most commonly prescribed drugs. It represents an abbreviated version of the drug list (formulary) that is at the core of our prescription drug benefit.

Form and instructions from the DOE Science Safety Manual.

This form for Lab Specialists is taken from the DOE Science Safety Manual.

If there is equipment in your school that is unrepairable, not cost-effective to repair, educationally inappropriate, or a safety hazard, complete this form to have the equipment removed.

Use this form to document a hazardous chemical exposure incident in your school. Parts I, II, and III of the form are included.

Especially for Lab Specialists. Use Page 1 to document the presence of mercury in a science room.

Extended Session Teacher/Student Ration Fact Sheet

This form details the nature of your injuries. It should be turned in to your principal within 24 hours of your accident or illness.

Use this confidential form to notify the UFT School Safety Department if you have been the victim of an incident and/or injury. Or fill out the online incident report form.

The DOE will reimburse you up to $500 per school year for stolen or destroyed property such as loss or damage to personal clothing and personal accessories. For reimbursement of eyeglasses damaged in assault cases, use form OP 505G.

Once line-of-duty status has been approved, you can use this form to request reimbursement for out-of-pocket medical expenses to a maximum of $1,500.

Workers’ compensation intake form for Paraprofessionals, School Nurses, Occupational and Physical Therapists:

The employer is required to fill out this report within 10 days to notify the Workers’ Compensation Board of your work-related injury or illness. You should not participate in filling out this form. See the C-2: Employer's Report - Filing Procedure...

You must fill out this form to initiate your Workers’ Compensation claim. You should retain one copy, file a second with the Board, and provide a third to your legal representative.

Your doctor must fill out this form at regular intervals — usually every 4-6 weeks — during your convalescence. It is used to determine your level of benefits — so it is very important that your doctor fills it out carefully.

Change in employment status includes return to work, discontinuance of work, increase or decrease of regular hours of work and increase or reduction of wages.

Use this form to claim out-of-pocket expenses related to your injury or illness.

Complete this form to claim disability benefits only if your Workers’ Compensation claim has been rejected.

Here is the form for an attending doctor to obtain medical authorization:

Complete this form and file it with your school payroll secretary within 10 days.

All pedagogues and paraprofessionals may use this form to donate sick time to a colleague. The recipient receives one day for every two days donated. Sick leave transfer rules are on page 2 of the form.

All pedagogical personnel may apply for a medical leave of absence without pay only when they have exhausted all of their Cumulative Absence Reserve (CAR) days. This application must be completed, signed and submitted to HR Connect for approval...

Upon an employee’s return from a leave of absence without pay, the payroll secretary must submit an OP 255 form to the Bureau of Salary Differentials and Status.

Pedagogues and paraprofessionals use this form to apply for a retirement leave of absence. For every two days in the employee’s sick bank, one day of terminal leave is granted. The form must be filed 30 days in advance of the leave. The leave can...

Upon resignation, termination or retirement, pedagogues are entitled to receive half of their sick leave balance (up to 100 days).

For pedagogues and administrative staff. You must provide acceptable certification by a physician or other health care provider for your own serious health condition or the serious health condition of a covered family member within fifteen (15)...

Must be filed along with a FMLA request.

Authorization for voluntary deduction.