How does an employee apply for donated sick leave?

To apply, the employee must submit both of the following forms:

1. Request for Donated Sick Leave (PR-0472)
2. Medical Statement for the Transfer of Donated Sick Leave (PR-0471)

The medical statement must be completed by the employee’s current doctor, surgeon, nurse practitioner, or physician assistant working directly under the doctor’s supervision.
It must be sent directly from the medical provider’s office to the Department of Human Resources. Forms sent by anyone else will not be accepted.

Each new request for donated leave requires both forms to be resubmitted with updated medical certification based on a follow-up visit related to the same illness or injury.

For more information, visit the State of Tennessee Attendance and Leave Manual.