Sick & Family Leave Credit Due Diligence Form

Sick & Family Leave Credit Due Diligence Form
Please complete the form below for days missed in 2021 due to Covid-19.
Enter the number of missed days from 01/01/2021 through 03/31/2021
Rows Days you cared for yourself Days you cared for someone else Days you cared for your son or daughter
Enter the days
Enter the number of missed days from 04/01/2021 through 09/30/2021
Rows Days you cared for yourself Days you cared for someone else Days you cared for your son or daughter
Enter the days
Please add any additional notes if applicable.
By signing this form, I attest, that these are the correct number of days missed due to Covid-19.
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Rows	Days you cared for yourself	Days you cared for someone else	Days you cared for your son or daughter
Enter the days