0 m
Z
0 >-F-
b
g
Q
$
G
SanPablo
CITY.rSAN PABLO 2014
City agnew Directions
l
MEMO RAN D U M
CITY MANAGER'S OFFICE
1000 Gateway Avenue
San Pablo, CA 94806
DATE
TO:
FROM
RE:
April 1 2, 2022
ALL CITY EMPLOYEES, CITY CONTRACTORS AND THE PUBLIC
Matt Rodriguez, City Manager / Director of Emergency
CORONAVIRUS COVID-19 UPDATE AND VERSION
OPERATIONS PLAN
DIFIED
IMPORTANT-PLEASEREAD
The City of San Pablo (City) remains committed to the health and safety of its employees and the San Pablo community throughout this COVID-1 9 pandemic.
After the onslaught of the Omicron variant of COVID-19, active positive cases and acute hospitalizations are stabilizing and the State of CA Department of Public Health (DPH), and Contra Costa County Health Services (CCCHS) announced recent measures to "reopen" certain business sectors, including lifting restrictions for indoor and outdoorevents.
Effective March 1 , 2022, the State has revised some masking requirements, but with the strong recommendation that all persons, regardless of vaccine status, continue indoor masking, with some universal masking required in specific high-risk settings, such as on public transit. The Governor has also lifted all but approximately 30 Of the 561 Executive Orders issued during COVID-191 although, the State of Emergency continues to exist.
Following State guidance, Contra Costa lifted indoor mask mandate on February 1 6, 2022 for vaccinated individuals with unvaccinated individuals over the age of 2 years still required to wear a mask. The Contra Costa County Health Department still recommends masks to prevent the spread under certain circumstances and willallow businesses and "hosts" to decide whether to mandate masks:
1 000 Gateway Avenue © San Pablo, CA 94806
Main: 5 1 0-2 1 5-3000 © Direct 5 /0-2 /5-300 / e Fax: 5 1 0-2 1 5-30 1 1 www.SanPabloCA.gov
TO: ALLCITYEMPLOYEES
Re: CORONAVIRUS COVID-19 UPDATE AND MODIFIED OPERATIONS PLAN V.20
"Continuing to mask in indoor public settings, especially crowded or poorly ventilated spaces, remains the safest choice for an individualand protects those who are medically vulnerable or are not able to get vaccinated, like our youngest children. As evidence continues to show. vaccinations and boosters remain the best defense against the virus."
As of the County's website on April11, 2022, Contra Costa County had 998 confirmed COVID-1 9 cases in the past 1 4 days, with an average number of new cases per day of 74, which shows a decreasing trend of -1 .3% over the past week, with 21 people hospitalized (9% decrease in hospitalizations).
As of April 1 1 , 2022, Countywide, 81 .2% of the population is vaccinated. However, only 51 .65% of the eligible population have received a booster shot. Over 90% of residents in San Pablo are fully vaccinated, but only 47% of the eligible population have received the boostershot.
San Pablo continues to have the highest per capita rate of COVID-19 cases in the County. Overall, San Pablo has the fifth highest total number of COVID-1 9 cases in the County. According to the County's website, there have been 70 COVID-related deaths in San Pablo. See below link for more information:
htt psl#www .coron avirus. cchealth . Q rq/Qve rview
The County Public Health Department continues to recommend getting the COVID- 1 9 vaccine (and booster shot if the appropriate time has passed) as the best defense to serious illness if infected and all employees are strongly encouraged to get fully vaccinated.
NEW OPERATIONAL REQUIREMENTS FOR CITY DEPARTMENT OPERATIONS Under the direction of the City Manager / Director of Emergency Services, the following updates are being implemented by the City under the Modified Operations Plan Version 20 (Plan), effecliyQ Mav 2, 2022 (unless another date iSiIQtQd General Rules applicable to all
Comply with the Contra Costa County Health Department requirements. Do NOT enter a City facility or worksite if you are experiencing any of the following symptoms:
Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
TO: ALL CI'TY EMPLOYEES
Re: CORONAVIRUS COVID-19 UPDATE AND MODIFIED OPERATIONS PLAN V.20
Muscle or body aches
Headache
New loss of taste or smell
Sore th roat
Congestion or runny nose
Nausea or vomiting
Diarrhea
Definitions
Fully vaccinated
eligible.
2 weeks have passed acer final vaccine including boosters if Proof of vaccination: documentation of vaccination record Public Meetings:
Starting May 2, 2022, all meetings of San Pablo Brown Act bodies - including the City Council, City Council Standing Committees, Planning Commission, Youth Commission and Public Safety Commission -- will be held in-person but with phone- in option for participation under Assembly Bil1361 findings to be made every 30 days.
Non-Brown Act bodies and other city meetings may be held live and in-person, or using other means as deemed appropriate and effective by the meeting organizers.
City HallPublic Service Counter Hours:
Starting May 2, 2022, City Hall Public Works and Community Development counter hours will be expanded to Monday to Thursday from 7:30 AM to 4:00 PM. City Hall business hours continue to be Monday to Thursday, 7:30 AM to 6:00 PM, and Closed t-naays
City Staff
l Maskina at work. All City staff will continue to mask in common areas including work cubicles and vehicles (if other people are in the vehicle). Staff will be allowed to eat and drink in common areas as long as properly distanced (i.e. 6 feet apart). Staff who are working outdoors and properly distanced are encouraged to wear a mask but not required to.
2 3
Use of Conference Rooms. Virtual meetings are encouraged but conference rooms can be used by City staff. All meeting attendees must be masked.
Supplemental Paid Sick Leave (SPSL). On April 7, 2022, the City issued a Temporary Administrative Policy (Policy) regarding Supplemental Paid Sick Leave which provides supplemental leave for specific reasons related to COVID-1 9. The Policy is attached.
TO: ALL CITY EMPLOYEES
Re: CORONAVIRUS COVID-19 UPDATE AND MODIFIED OPERATIONS PLAN V.20
4. 5
Telecommute. Telecommuting for staff IS NOT permitted unless approved by the Department Head and Human Resources.
Quarantine. The City continues to follow the State of California's COVID-19 Prevention Emergency Temporary Standards recommended guidelines for returning to work after getting sick or exposed to COVID-1 9. As of the date of this Plan, the guidelines are as follows:
If you were exposed to someone with COVID-19 and you have COVID-19 symptoms, you can return to work when all of these are true:
e
©
e
©
Your fever is gone, and you have no other symptoms
You get a negative result from a COVID-19 test on Day 5 0r later from when your symptoms began.
Regardless of vaccination status or City masking rules, you wear a well- fitting mask for a total of 1 0 days.
You continue to have no symptoms during the 1 0 days.
Otherwise, you cannot return to work until all of these are true . At least 1 0 days have passed since your symptoms began . Your fever is gone for 24 hours and other symptoms continuously improving.
If you were exposed to someone with COVID-19, but you do not have symptoms, you must get tested (PCR or antigen test) on Day 5. You can continue to go to work if all of these are true:
©
©
©
©
You're fully vaccinated.
You continue not to have COVID-1 9 symptoms.
You wear a well-fitting mask for a total of 10 days regardless of City masking policy.
STOP coming to work if COVID-1 9 test on day 5 comes back positive.
If you test positive for COVID-19 but do not have symptoms, you can return to work when all of these are true:
©
©
e
You have isolated at home for 5 days and never developed symptoms.
You get a negative result from a COVID-1 9 test on Day 5 0r later from yourlast exposure.
You wear a well-fitting mask for a total of 10 days regardless of City masking policy.
Otherwise, you cannot return to work for at least 1 0 days after you first tested positive.
TO: ALL CI'TY EMPLOYEES
Re: CORONAVIRUS COVID-19 UPDATE AND MODIFIED OPERATIONS PLAN V.20
If you have symptoms and test negative for COVID-19, you can return to work when all of these are true:
©
©
All symptoms are gone.
You get a negative result from a COVID-19 test on Day 5 0r later from when your symptoms began.
Otherwise, you cannot return to work until after 10 days if fever is resolved and other remaining symptoms are continuing to resolve.
Specific Categories and Rules for those entering City Facilities l Attending Public Meetings and ConductillQ Busirless: Members of the public including elected and appointed officials entering City facilities and worksites to attend public meetings and/or conduct business are required to wear a face mask properly covering the nose and mouth, social distance, follow screening protocols and submission of voluntary attendance sheet. The City will provide a face mask to any member of the public who does not have one or if the individual's face mask does not meet the requirements of federal, state or local public health requirements. Eating or drinking will not be allowed inside any City facility by members of the public. The City continues to encourage doing business virtually or setting appointments bef ore coming into any City facility. 2 Renting a city Facility: All members of the public are required to wear face masks unless actively consuming food or drinking. The renter/event organizer will be responsible for all contact tracing if an attendee subsequently tests positive for COVID-19 0r shows symptoms, including notifying the City if City staffis present atthe event.
3 E?erlicipglirlg iQitv f?rQgrQ $: Members of the public participating in any City voluntary City Programs (i.e. Senior Center Programs, Paratransit, Community Center Programs, Police Programs) whether indoors or outdoors and instructors must be fully vaccinated and show proof of vaccination to City staff before attending a City program.
Youth under 5 years of age (or minimum age for vaccinations) and those with a validated medical or religious exemption from the COVID-1 9 vaccination are exempted from this requirement.
All instructors and program participants are required to wear masks unless actively consuming food or drink whether the program is indoors or outdoors. 4 Citv Volunteers: City Volunteers will need to show proof of being fully vaccinated for COVID-19, unless other arrangements are made through the Department Head and Human Resources Manager.
TO: ALLCI'TYEMPLOYEES
Re: CORONAVIRUS COVID-19 UPDATE AND MODIFIED OPERATIONS PLAN V.20 Page6
5 Q!!v.Q91)!raQIQn: City Contractors (including instructors) will need to show proof of being fully vaccinated to City staff bef ore entering any City Facility or worksite. Contractors will be required to be properly masked (covering the face and nose with a face covering approved by federal, state or local health requirements) at all times in the City facility. Eating or drinking by Contractors will not be allowed inside any City facility.
6 Lessees/Recurrent Users of City Facilities (e.a. Holy Ghost Association and San Pablo Economic Development Corooration and collectively carted "Lessees"): Anyone at a City facility shall be properly masked (covering the face and nose with a face covering approved by federal, state or local health requirements) unless actively eating or drinking or alone in an enclosed room.
Lessee shall be responsible for contact tracing if someone subsequently tests positive for COVID-1 9 0r shows symptoms, including notifying the City if City staff had any contact with the individual.
7 Outdoor Recreation (Adi:iltarldYolJtl$: All Participants, Coaches, Referees and spectators at any outdoor City facility authorized by the City of San Pablo are STRONGLY ENCOURAGED but NOT be required to wear a mask.
Non City Sponsored Special Events within City Limits (>75 0r more people) Starting April 1 , 2022, all large-scale, non-City sponsored Special Events that result in the use of any public property with potential attendance that exceeds 75 0r more persons are subject to the City's Special Event Permit requirements, which may include additional COVID-1 9 precautions. For additional information, please contact the San Pablo Police Department/Support Services Division at:
httos://www.sanpabloca.qov/DocumentCQoter/View/11436/Special Event Pe!.!!)l! Final-Draft-2-28-1 9
Should you have any concerns or questions regarding this information, please contact Assistant City Manager Charles Ching at (510) 215-3031, or via email at:
TO: ALL CI'TY EMPLOYEES
Re: CORONAVIRUS COVID-19 UPDATE AND MODIFIED OPERATIONS PLAN V.20
The City's prior Revised Modified Operations Plans are
superseded by a later Revised Modified Operations Plan. still in effect unless
As approved
Date '?'-/'- - &''''"
Matt Rodrigue:
of Emergency
City Manager/Director.ervices
Attachment:
(1) Temporary Administrative Policy on Supplemental Paid Sick Leave (Issued: 04/7/22) cc San Pablo City Council
Executive Leadership Group
CITY OF SAN PABLO
1000 Gateway Avenue
San Pablo, CA 94806
www.SanPabloCA.gov 04/07/2022
CITY OF SAN PABLO TEMPORARY ADMINISTRATIVE POLICY – Coronavirus (COVID-19) SENATE BILL 114 (SB114) SUPPLEMENTAL PAID SICK LEAVE (SPSL) under LABOR CODE SECTION § 248.6 and 248.7.
PURPOSE
On February 9, 2022 , the State of California adopted SB114 codifying at Labor Code § § 248.6 and 248.7 providing Supplemental Paid Sick Leave (SPSL) for specific reasons related to COVID-19 to be retro-actively effective January 1, 2022 through September 30, 2022.
The City adopted this temporary policy in order to comply will all relevant and applicable requirements provided under Labor Code §§ 248.6 and 248.7.
This policy provide s paid leave to employees experiencing symptoms of COVID-19 or have a potential exposure to COVID -19 (or who have a family member who has tested positive or who is experiencing symptoms), or for any other COVID-19 related reasons allowed by this Policy between January 1, 2022 and September 30, 2022. The existing FMLA leave policy still applies to all other reasons for leave outside of this temporary policy, and all other applicable leave policies still apply.
This policy also provides for retroactive application of paid leave pursuant to SB 114. This policy may be updated based on additional guidance from the Department of Labor (“DOL”) or other regulatory bodies and shall apply toward any benefit mandated by such bodies.
DEFINITIONS:
“Child” means a biological, adopted, or foster child, stepchild, legal ward, or a child to whom the employee stands in loco parentis. This definition of a child is applicable regardless of age or dependency status.
“Covered Employee” means any City employee who is unable to work or telework for the City for one or more of the reasons related to COVID-19 as set forth in this policy.
“COVID-19 Supplemental Paid Sick Leave” or “SPSL” means paid sick leave pursuant to Labor Code § 248.6 and 248.7.
“Family Member” means any of the following:
(i) A “child”, as defined above
1 CITY OF SAN PABLO
1000 Gateway Avenue
San Pablo, CA 94806
www.SanPabloCA.gov 04/07/2022
(ii) A biological, adoptive, or foster parent, stepparent, or legal guardian of an employee or the employee’s spouse or registered domestic partner, or a person who stood in loco parentis when the employee was a minor child (iii) A spouse
(iv) A registered domestic partner
(v) A grandparent
(vi) A parent-in-law
(vii) A grandchild
(viii) A sibling
EFFECTIVE DATES:
The policy is effective immediately upon adoption, and the paid leave benefits provided herein shall be retroactive to January 1, 2022.
Within this policy there are two types of exclusion leave being discussed:
Supplemental Paid Sick Leave (SPSL), in accordance with SB114 , for reason number s 1 through 7 as described in this policy, under the Eligibility section. Supplemental Paid Sick Leave (SPSL), in accordance with SB114 , for reason number 8 as described in this policy, under the Eligibility section.
All SPSL leave banks will be available upon adoption of this policy and made retroactive to January 1, 2022. Unless the underlying law is extended, this policy will expire at the end o f the day o n September 30, 2022. SPSL benefits will likewise expire on September 30, 2022, except that the City will provide a Covered Employee who is on SPSL at the time of the expiration of such benefits the full amount of SPSL to which the Covered Employee would otherwise be entitled. The leaves in this policy are designed to supplement exi sting leaves, and not run concurrent to other sick leave entitlements provided to employees, including the Paid Sick Leave Law.
ELIGIBILITY:
SPSL granted to eligible employees who are unable to work or telework for the reasons below will be based on the employee’s regular rate of pay for the workweek in which the SPSL was used (not less than state and local minimum wage) but shall not exceed $511 per day or $5,110 in the aggregate:
1) The covered employee is subject to a quarantine or isolation period related to COVID-19 as defined by an order or guidance of the California Department of Public Health (“CDPH”), the
2 CITY OF SAN PABLO
1000 Gateway Avenue
San Pablo, CA 94806
www.SanPabloCA.gov 04/07/2022
federal Centers for Disease Control and Prevention (“CDC”), or a local public health officer who has jurisdiction over the workplace.
2) The covered employee has been advised by a health care provider to isolate or quarantine due to COVID-19.
3) The covered employee is attending an appointment for themselves or a family member to receive a vaccine or a vaccine booster for protection against COVID-19. 4) The covered employee is experiencing symptoms, or caring for a family member experiencing symptoms, related to a COVID-19 vaccine or vaccine booster that prevent the employee from being able to work or telework.
5) The covered employee is experiencing symptoms of COVID -19 and seeking a medical diagnosis.
6) The covered employee is caring for a family member who:
A. Is s ubject to a CDPH, CDC, or local health officer order or guidance to isolate or quarantine, OR
B. Has been advised by a health care provider to isolate or quarantine. 7) The covered employee is caring for a child whose school or place of care is closed or otherwise unavailable for reasons related to COVID-19 on the premises. 8) The covered employee, or a family member for whom the covered employee is providing care, tests positive for COVID-19.
RESPONSIBILITY:
Employee. It is the responsibility of the employee to determine their own need for leave under this policy and to request the need for the leave orally or in writing to their immediate supervisor.
Human Resources will provide leave forms which will be available on the City’s SharePoint intranet page at http://covid.sanpabloca.gov. Completed forms shall be submitted to the employee’s supervisor for approval, then directly to Human Resources prio r to initiating leave when possible.
In the event that the employee makes an oral/verbal request or there is a medical emergency where the employee is unable to provide the form prior to initiating leave , such leave shall be requested as soon as possible in the same manner as a regular sick leave request.
For use of SPSL, employee needs to request verbally or in writing through a City form entitled Employee Certification of Need for Supplemental Paid Sick Leave and send it to the employee’s Supervisor and Human Resources (Attachment A).
3 CITY OF SAN PABLO
1000 Gateway Avenue
San Pablo, CA 94806
www.SanPabloCA.gov 04/07/2022
For use of retroactive SPSL, employee needs to complete a City form entitled Employee Certification of Need for Retroactive Supplemental Paid Sick Leave and send it to the employee’s Supervisor, Payroll and Human Resources at ([email protected]) (Attachment B).
A City form entitled Employee Certification to Return to Work after Exhibiting Symptoms of COVID- 19 or Suspicion of Having or Being Exposed to COVID-19 (Attachment C) must be used to return to work when an employee is out under any COVID-19 public health related quarantine.
Employee’s Supervisor. It is the responsibility of the employee’s supervisor to review and approve the request form and s ubmit to Human Resources in a timely manner or contact the Department Head and Human Resources to discuss concerns about approval.
In circumstances where the employee makes an oral/verbal request for SPSL the Supervisor should fill out, sign, and date the form to create a record of the provision of such leave.
REQUIREMENTS:
SB114 provides two leave banks with up to 40 hours (or whatever work schedule to which the employee is regularly assigned in a two -week period) of SPSL in each bank, as described above for full-time employees and prorated for eligible part-time employees as follows:
Employees may use this leave continually or intermittently in full or partial days, as needed, until leave is exhausted or the employee no longer has a qualifying reason to use the leave. The SPSL is available for immediate use regardless of how long the employee has been employed by the City.
After SPSL is exhausted, employees may use their sick leave or other applicable leave for COVID-related health issues.
Should an employee also exhaust their sick leave bank and continue to have COVID -related issues, the City shall work with the employee to determine eligibility for other applicable leaves or benefits.
To use SPSL the employee will select Supplemental Paid Sick Leave (COR-SPSL) rather than regular Sick Leave in InTime (and use regular time on the paper timesheet including typing the dates of the leave in the comments section). Use of this time will not take away from other existing leave balances, unless supplementing the leave as discussed below. If needed, employees may supplement the SPSL with any accrued sick leave or other leaves rather than having any unpaid leave due to the dollar amount caps described above.
4 CITY OF SAN PABLO
1000 Gateway Avenue
San Pablo, CA 94806
www.SanPabloCA.gov 04/07/2022
Approved retroactive payments will be paid on the payday for the next full pay period after the oral or written request of the covered employee.
Paid leave under this policy is separate from any other leave bank the employee currently has. These hours shall be pa id in the same manner and at the same rate as sick leave. These hours are not a vested property right and cannot be cashed out.
April 7, 2022
Matt Rodriguez Date
City Manager
FORMS ATTACHED:
A. EMPLOYEE CERTIFICATION OF NEED FOR SUPPLEMENTAL PAID SICK LEAVE (SPSL) B. EMPLOYEE CERTIFICATION OF NEED FOR RETROACTIVE SUPPLEMENTAL PAID SICK LEAVE C. EMPLOYEE CERTIFICATION TO RETURN TO WORK AFTER EXHIBITING SYMPTOMS OF COVID -19 OR SUSPICION OF HAVING OR BEING EXPOSED TO COVID-19
R:\2022\Coronavirus\SPSL
5 CITY OF SAN PABLO
1000 Gateway Avenue
San Pablo, CA 94806
www.SanPabloCA.gov 04/07/2022
Employee Certification of Need for SUPPLEMENTAL PAID Sick Leave (SPSL)
I, ___________________________ (print name), certify that I am unable to work (or telework) for one of the following reasons: (If your reason for absence qualifies under multiple reasons, check the one reason code for which you wish to use SPSL).
1 I am subject to a quarantine or isolation period related to COVID-19 2 I have been advised by a health care provider to isolate or quarantine due to COVID-19. 3 I am attending an appointment for myself or a family member to receive a vaccine or a vaccine booster for protection against COVID-19.1
4 I am experiencing symptoms, or caring for a family member experiencing symptoms, related to a COVID-19 vaccine or vaccine booster that prevent the employee from being able to work or telework.1
5 I am experiencing symptoms of COVID-19 and I am seeking a medical diagnosis.
6 I am caring for a family member who is subject to a Federal, State, or local quarantine or isolation order related to COVID-19 or who has been advised by a health care provider to self-quarantine due to concerns related to COVID-19. Relationship to Employee:
7 I am caring for a child whose school or place of care is closed or otherwise unavailable for reasons related to COVID-19 on the premises.
8 I have tested positive, or a family member for whom I am providing care, has tested positive for COVID-19.*
*I have attached a copy of positive test result per law.
If family member: Relationship to Employee:
DATE(s) of absence: ____________________________________________________________
Wage Replacement: Employees are compensated based on their normal hourly rate, excluding overtime, and are subject to a maximum payment cap of $511/ day. Employees may supplement with other leaves to reach full pay.
I understand that if my circumstances change, I must immediately inform my supervisor and Human Resources. I may be directed t o report back to work (or telework). I further understand that any misrepresentation of facts could warrant disciplinary action, up to and including termination.
(A) 1
CITY OF SAN PABLO
1000 Gateway Avenue
San Pablo, CA 94806
www.SanPabloCA.gov 04/07/2022
_____________________________________________________________ Employee Signature
_____________________________________________________________ LaTanya Fisher, HR Management Analyst
Date Request Received by Human Resources: ________________________
(A) 2
CITY OF SAN PABLO
1000 Gateway Avenue
San Pablo, CA 94806
www.SanPabloCA.gov 04/07/2022
EMPLOYEE CERTIFICATION OF NEED FOR RETROACTIVE COVID-19 SUPPLEMENTAL
PAID SICK LEAVE
Please complete and return the following form to your immediate supervisor if you are requesting COVID-19 Supplemental Paid Sick Leave (“SPSL”) retroactively for leave taken on or after January 1, 2022 and prior to March 16, 2022.
Employee Name: ______________________________________________________
Date of Request: ______________________________________________________
I am requesting payment for SPSL that I took for this qualifying reason beginning on ______________________, 2022 and ending on _____________________, 2022.
I am requesting retroactive payments for SPSL because I was previously unable to work or telework for the following reason(s) on or after January 1, 2022 and prior to March 16, 2022:
1 I am subject to a quarantine or isolation period related to COVID-19 2 I have been advised by a health care provider to isolate or quarantine due to COVID-19. 3 I am attending an appointment for myself or a family member to receive a vaccine or a vaccine booster for protection against COVID-19.1
4 I am experiencing symptoms, or caring for a family member experiencing symptoms, related to a COVID-19 vaccine or vaccine booster that prevent the employee from being able to work or telework.1
5 I am experiencing symptoms of COVID-19 and I am seeking a medical diagnosis.
6 I am caring for a family member who is subject to a Federal, State, or local quarantine or isolation order related to COVID-19 or who has been advised by a health care provider to self-quarantine due to concerns related to COVID-19.
Relationship to Employee:
7 I am caring for a child whose school or place of care is closed or otherwise unavailable for reasons related to COVID-19 on the premises.
8 I have tested positive, or a family member for whom I am providing care, has tested positive for COVID-19.*
*I have attached a copy of positive test result per law.
If family member: Relationship to Employee:
(B) 1
CITY OF SAN PABLO
1000 Gateway Avenue
San Pablo, CA 94806
www.SanPabloCA.gov 04/07/2022
DATE(s) of absence: ___________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________
The dates listed above must lie between January 1, 2022 and March 16, 2022. If the dates you are requesting SPSL is after this date, please fill out the form title “Employee Certification of Need for S upplemental paid Sick Leave (SPSL)”.
Once paid for such leave (if such the leave was unpaid) or reimbursed for other paid leaves used, I will hereby waive my right to seek further retroactive payments for unpa id SPSL on or after January 1, 2022 and on or before March 16, 2022. If I have not exhausted my SPSL balance as a result of the above retroactive payment request, I understand that I may still qualify for SPSL in the future.
_____________________________________________________________ Employee Signature
_____________________________________________________________ LaTanya Fisher, HR Management Analyst
Date Received by Human Resources: _______________________________
(B) 2
CITY OF SAN PABLO
1000 Gateway Avenue
San Pablo, CA 94806
www.SanPabloCA.gov 04/07/2022
EMPLOYEE CERTIFICATION TO RETURN TO WORK AFTER EXHIBITING SYMPTOMS OF COVID-19 OR SUSPICION OF HAVING OR BEING EXPOSED TO COVID-19
I, ___________________________, certify that I have returned to work from:
1) COVID-19, or
2) Being exposed to COVID-19, or
3) Was subject to a Federal, State, or local quarantine or isolation order.
I certify that I have been:
free of a fever of 100.4 degrees Fahrenheit or higher for at least 24 hours without the use of fever - reducing medications; and
COVID-19 symptoms have improved; and
A diagnostic specimen collected on day 5, or later , tests negative (antigen test preferred). If unable to test (or choosing not to test), and symptoms are not present or are resolving, isolation can end after day 10. and
At least 5 days have passed since the date of your positive COVID-19 test, if asymptomatic or 5 days from when your symptoms first appeared. and
I will wear a well-fitting mask around others for a total of 10 days after I return to work. and
The City’s Return to Work form has been completed.
I understand that if I do show further signs of having COVID -19 (e.g., fever, cough, or shortness of breath), I must inform my supervisor immediately and the City of San Pablo may either direct me to stay away from work or may require me to undergo a fitness for duty examination at the City of San Pablo’s expense and according to the City of San Pablo’s policy regarding fitness for duty examinations.
Employee Signature Date
Supervisor’s Signature Date
Human Resources Signature Date
(C) 1