Building 16A

F&S Human Resources
and Payroll
Building 16A

Worker's Compensation Forms


Form Name Purpose Link
UCF Report of Accident-Near Miss Form     Complete this form when an employee has an accident at work.     Accident-Incident Report

Workers' Compensation - New Claim Reporting Worksheet for Amerisys     Complete this form when an employee is injured on the job.     First Report of Injury or Illness

The MiniER Information Sheet     Information regarding the MiniER service.     The MiniER Information Sheet

Worker’s Compensation Pay/Leave Information Sheet     Document explaining leave usage when on an approved leave of absence in relation to a worker’s compensation case.     Workers Compensation Pay/Leave Information Sheet

Leave of Absence Forms


Form Name Purpose Link
Certification of Health Care Provider Form (CHCP) for Employee’s Serious Health Condition   Document for the employee's physician to complete when he/she requests an FMLA or Non-FMLA Leave of Absence     UCF Certification of Health Care Provider Form for Employee Serious Health Condition

Certification of Health Care Provider Form (CHCP) for Family Member’s Serious Health Condition   Document for the employee's family member's physician to complete when he/she requests an FMLA or Non_FMLA Leave of Absence.     Certification of Health Care Provider Form for Family Member’s Serious Health Condition

Intent to Return To Work and Medical Release Form     Documentation completed by a physician releasing an employee to return to work.     Intent to Return To Work and Medical Release Form

Intent to Return To Work Form (Non-Medical)     Documentation for employee to submit when returning from a personal, intermittent, or family member’s illness leave request.     Intent to Return To Work Form (Non-Medical)

Medical Leave Request Form     Form to request FMLA for medical leave of absence.     Medical Leave Request Form

Military Leave Request Form     Form to request FMLA for military leave of absence.     Military Leave Request Form

Parental Leave Request Form     Form to request FMLA for parental leave of absence.     Parental Leave Request Form

Personal Leave Request Form     Form to request a leave of absence for personal reasons.     Personal Leave Request Form

Sick Leave Pool Open Enrollment Application for USPS and A&P     Form required for faculty, A&P, and USPS staff to enroll in the Sick Leave Pool. Open Enrollment takes place twice a year in March and September.     Faculty/A&P Sick Leave Pool Open Enrollment Application

Sick Leave Pool Request Form (USPS)     Complete this form to request Sick Leave Pool hours when on an approved leave of absence (for Employee’s own health condition only) and all accruals are exhausted.     USPS Sick Leave Pool Request Form



 

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University of Central Florida
Resource Management - Building 16A
PO Box 163630
Orlando, FL 32816-3630