Attendance and Leave Forms


Attendance and Leave

If you would like more information, please contact Consultation & Accountability:

Carrie Hughes, Personnel Analyst; cphughes@admin.nv.gov or (775) 684-0111

    Form Title  Word  PDF Revision Date
    Sick Leave Documentation- GINA Warning  NPD-82 NPD-82 7/2011
    FMLA Leave of Absence Form  NPD-60 NPD-60 6/2023
    FMLA Notice of Eligibility and Rights & Responsibilities  NPD-62 NPD-62 9/2018
    FMLA Designation Form  NPD-63 NPD-63 9/2018
    FMLA Medical Release  NPD-81 NPD-81 7/2015
    FMLA Medical Certification for Employee    WH-380-E 1/2011
    FMLA Medical Certification for Family Member    WH-380-F 5/2015
    FMLA Certification of Qualifying Exigency for Military Family Leave   WH-384 2/2013
    FMLA Certification for Serious Injury or Illness of a VETERAN for Military Caregiver Leave   WH-385-V 5/2015
    FMLA Certification for Serious Injury or Illness of a CURRENT service member for Military Family Leave   WH-385 5/2015
    FMLA Help for Health Care Providers flyer   FMLA HCP flyer 8/1/2023
    Request to Receive Catastrophic Leave Donations PAY-23 PAY-23 1/2016
    Notification of Agency's Payroll Center (Regarding a Request to
    Use Catastrophic Leave) 
    PAY-23A PAY-23A 6/8/2010
    (Catastrophic) Notice of Intent to Donate/Request to Transfer Leave/Return of Excess Donated Leave NPD-25 NPD-25 11/2012
    Physician's Certification for Catastrophic Leave Request - EMPLOYEE  PAY-23CE PAY-23CE 1/2016
    Physician's Certification for Catastrophic Leave Request - IMMEDIATE FAMILY MEMBER  PAY-23CF PAY-23CF 1/2016
    Formal Appeal to Committee on Catastrophic Leave PAY-23B PAY-23B 1/2015
    Voluntary Leave Without Pay Authorized Pursuant to NAC 284.580 TS-12 TS-12 2/2013
    Differential Pay for Active Military Duty Policy & Procedures ML-1-3 ML-1-3 11/2012
    Calculation of Military Differential Pay ML-4 ML-4 3/2011
    Shift Trade Agreement  TS-133 TS-133 8/2002