Disability Management Forms & Templates

What's on this Page

• • Lactation Accommodation Request Form
  • Medical Leaves
  • Temporary Transitional Duty
  • Permanent Restrictions -Reasonable Accommodation
  • Military Leave
  • Workers' Compensation
  • Catastrophic Leave
  • Pre-Employment Self Disclosure
  • Reproductive Loss Leave Accommodation Form
  • Reproductive Loss Leave Letter Template

Lactation Accommodation Request Form
(PDF: 175.81 kB)

Back to top

Medical leave provides eligible employees up to 12 weeks of job protected unpaid leave.

Learn more about Medical Leave

For Employees

• Medical Certification Form Self-Caregiver
  (PDF: 2.34 MB)
• Request for Leave of Absence Form
  (PDF: 206 kB)
• Employee Medical Leave Checklist
  (PDF: 152 kB)

Back to top

The purpose of the Temporary Transitional Duty Program (TTrD) is to provide early intervention for those injured or ill employees who are expected to return to full duty. 

Learn more about Temporary Transitional Duty

• Accommodation Request / Certification Form
  (PDF: 1.35 MB)

Back to top

A reasonable accommodation is any modification or adjustment to a job or the work environment that will enable a qualified applicant or employee with a disability to participate in the application process or to perform essential job functions.

Learn more about Reasonable Accommodation

• Accommodation Request / Certification Form
  (PDF: 1.35 MB)

Back to top

Military Leave is available to all County employees including Extra Help employees who perform service in the uniformed services. Military Leave may be covered under FMLA/CFRA and administered accordingly. Please reach out to your Disability Management Analyst for guidance.

• Disability Management Analyst Assignment Chart
  (PDF: 178.52 kB)

Learn more about Military Leave

• Medical Certification for Covered Service Member 
  (PDF: 184 kB)
• Certification for Qualifying Exigency for Military FMLA
  (PDF: 145 kB)

Back to top

The County of Sonoma's Workers’ Compensation Program compensates employees for disability leave and medical treatment as a result of a work-related injury or illness.

Learn more about Workers' Compensation

For Employees

• Workers' Compensation Claim Form DWC1 & Notice of Potential Eligibility
  

Back to top

Self-Disclosure of Restrictions and/or Need for Accommodation Form
(PDF: 101 kB)

Back to top

Reproductive Loss Leave Accommodation Form
(PDF: 225.78 kB)

Back to top

Catastrophic Leave Request Form
(PDF: 32.31 kB)

Decedent's Leave Benefit Request Form
(PDF: 27.08 kB)

Back to top