Attendance and Leave Forms

Attendance and Leave

If you would like more information, please email Consultation & Accountability at consultationar@admin.nv.gov.

Form Title	Revision Date
Sick Leave Documentation- GINA Warning NPD-82 (Word) Sick Leave Documentation- GINA Warning NPD-82 (PDF)	7/2011
FMLA Leave of Absence Form HR-60 (current version on DHRM SharePoint)	-
FMLA Notice of Eligibility and Rights & Responsibilities HR-62 (current version on DHRM SharePoint)	-
FMLA Designation Form HR-63 (current version on DHRM SharePoint)	-
Medical Release HR-81 (current version on DHRM SharePoint)	-
FMLA Medical Certification for Employee WH-380-E (PDF)	1/2011
FMLA Medical Certification for Family Member WH-380-F (PDF)	5/2015
FMLA Certification of Qualifying Exigency for Military Family Leave WH-384 (PDF)	2/2013
FMLA Certification for Serious Injury or Illness of a VETERAN for Military Caregiver Leave WH-385-V (PDF)	5/2015
FMLA Certification for Serious Injury or Illness of a CURRENT service member for Military Family Leave WH-385 (PDF)	5/2015
FMLA Help for Health Care Providers flyer (PDF)	8/1/2023
Request to Receive Catastrophic Leave Donations PAY-23 (Word) Request to Receive Catastrophic Leave Donations PAY-23 (PDF)	1/2016
Notification of Agency's Payroll Center (Regarding a Request to Use Catastrophic Leave) PAY-23A (Word) Notification of Agency's Payroll Center (Regarding a Request to Use Catastrophic Leave) PAY-23A (PDF)	6/8/2010
(Catastrophic) Notice of Intent to Donate/Request to Transfer Leave/Return of Excess Donated Leave NPD-25 (Word) (Catastrophic) Notice of Intent to Donate/Request to Transfer Leave/Return of Excess Donated Leave NPD-25 (PDF)	11/2012
Physician's Certification for Catastrophic Leave Request - EMPLOYEE PAY-23CE (Word) Physician's Certification for Catastrophic Leave Request - EMPLOYEE PAY-23CE (PDF)	1/2016
Physician's Certification for Catastrophic Leave Request - IMMEDIATE FAMILY MEMBER PAY-23CF (Word) Physician's Certification for Catastrophic Leave Request - IMMEDIATE FAMILY MEMBER PAY-23CF (PDF)	1/2016
Formal Appeal to Committee on Catastrophic Leave PAY-23B (Word) Formal Appeal to Committee on Catastrophic Leave PAY-23B (PDF)	1/2015
Voluntary Leave Without Pay Authorized Pursuant to NAC 284.580 HR-12 (current version on DHRM SharePoint)	-
Differential Pay for Active Military Duty Policy & Procedures ML-1-3 (Word) Differential Pay for Active Military Duty Policy & Procedures ML-1-3 (PDF)	11/2012
Calculation of Military Differential Pay ML-4 (Word) Calculation of Military Differential Pay ML-4 (PDF)	3/2011
Shift Trade Agreement TS-133 (Word) Shift Trade Agreement TS-133 (PDF)	8/2002
Paid Family Leave - Request HR-16 (Word) Paid Family Leave - Request HR-16 (PDF)	1/2024
Paid Family Leave - Immediate Family Medical Certificate HR-17 (Word) Paid Family Leave - Immediate Family Medical Certificate HR-17 (PDF)	1/2024
Paid Family Leave - Employee Medical Certificate HR-18 (Word) Paid Family Leave - Employee Medical Certificate HR-18 (PDF)	1/2024