Extended Illness Absence Card (Form SEH-3)
Form SEH-3 must be completed by the employee and his/her doctor any time an employee takes more than three consecutive sick days.
One card must be submitted for each pay period during which an absence falls. (See the school district's pay schedule below to be sure you are entering the correct dates on the SEH-3 card.)
Note: If you print the form from this web site, you must mail it in a separate envelope to the following address:
Payroll Schedule 2014 - 2017
School Personnel Health Record
All School District employees must have current health records on file with EHS. If you are about to go through the pre-employment process, or if you need to update your record with our office, please have your doctor complete the following:
Please Note: To meet the legal requirements of the Commonwealth of Pennsylvania, your tuberculosis/PPD results must be read within a 48-72 hour window of the date applied. Be sure your healthcare provider fills in this section of the form completely and accurately, and that he/she signs next to the results of the PPD skin test.
If you do not have a personal physician, see the link below for a list of local clinics in Philadelphia.
Family & Medical Leave Act of 1993 (FMLA)
The following are Department of Labor postings about the FMLA that you should review:
Please submit a completed SDP FMLA cover sheet for a determination of your FMLA eligibility. If you are eligible, you will receive a FMLA Eligibility Notice and the appropriate FMLA certification for completion. After the submission of your completed FMLA certification, a determination of the designation of your leave as FMLA protected will be made and you will then receive a FMLA Designation Notice.
The completed SDP FMLA cover sheet can be sent via: FAX: (215) 400-4661; EMAIL: firstname.lastname@example.org or MAIL: 440 N Broad St, Ste 134, Phila., PA 19130
*If you are requesting FMLA protection for leave to care for a child age 18 and older, please review the following Department of Labor fact sheet for additional information:
Below are the FMLA certification forms for your convenience. However we ask that you submit the FMLA certification after you have been notified of your FMLA eligibility.
REASONABLE SUSPICION FORMReasonable Suspicion Form
©School District of Philadelphia|
440 N. Broad Street Suite 134 - Philadelphia, PA 19130
Phone: 215-400-4660 Fax: 215-400-4661