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.)

• REQUEST FOR EXTENDED PERSONAL ILLNESS-FORM SEH-3.

Note: If you print the form from this web site, you must mail it in a separate envelope to the following address:

School District of Philadelphia
Employee Health Services-Suite 134
440 N. Broad. St.
Philadelphia, PA   19130

Payroll Schedule 09 - 12

Payroll Schedule 09-10

Payroll Schedule 10-11

Payroll Schedule 11-12

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:

School District Personnel Health Record

 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)

Please submit the completed cover sheet & corresponding application for review of FMLA eligibility.  Completed applications may be mailed or faxed directly to Employee Health Services at (215) 400-4661.

SDP FMLA COVER SHEET

FMLA APPLICATION FOR PERSONAL ILLNESS

FMLA APPLICATION FOR ILLNESS IN FAMILY

REASONABLE SUSPICION FORM

Employee Health Services Contact form

If you have any questions or need assistance, please complete the following form and we will get back to you as soon as possible.