Forms

REQUEST ABSENCE FOR PERSONAL ILLNESS/ILLNESS IN FAMILY – Form# SEH-3

Form SEH-3 must be completed by the employee and his/her doctor then submitted to the EHS office after an absence of more than three (3) consecutive personal illness (sick) days.

If you are out on an extended personal illness or illness in family leave, you must submit one SEH-3 form at the end of each pay period during your absence.  If the doctor is willing to complete more than one SEH-3 form at a time, you may submit the forms to EHS ahead of the pay period ending dates. Please review the School District of Philadelphia’s Payroll Schedule below for the pay period beginning and ending dates.

The SEH-3 form must be mailed to EHS or dropped off at our office. Faxed or emailed copies are not acceptable.

REQUEST ABSENCE FOR PERSONAL ILLNESS/ILLNESS IN FAMILY (SEH-3)

PAYROLL SCHEDULE 2020 – 2021

PAYROLL SCHEDULE 2020 – 2021

RECORD OF PERSONNEL ABSENCES – Form# SEH-90

RECORD OF PERSONNEL ABSENCES (SEH-90)

SCHOOL PERSONNEL HEALTH RECORD FORM (PHYSICAL)

All School District of Philadelphia employees must have current health records on file with EHS. During your pre-employment process, you must have your doctor complete the School Personnel Health Record form and submit the completed document to EHS.

PHYSICAL FORM

Please Note: Pennsylvania law requires that your tuberculosis/PPD results 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.

CITY OF PHILADELPHIA HEALTH CENTERS

REASONABLE SUSPICION FORM

If you suspect a colleague is under the influence, immediately report your suspicions to a school or office administrator, complete a Reasonable Suspicion Observation form, and fax the completed form to EHS: 215-400-4661. Your administrator will be contacted by EHS with further instructions.

REASONABLE SUSPICION FORM