You must submit one or both of the following forms if:

  • you have been absent from work for more than 10 consecutive days, OR
  • you became ill at work and EMS was called, OR
  • you are returning from any period of absence with restrictions in your ability to perform your duties.
  1. MENTAL HEALTH CONDITION ABSENCE FORM
  2. PHYSICAL HEALTH CONDITION ABSENCE FORM

Submit the following forms if it’s anticipated that you will be absent for an extended period of time (either continuously or intermittently), due to:

  • pregnancy
  • paternity, your own serious illness
  • or a family member’s serious illness.

You should submit the forms as soon as you are aware that you might need leave, regardless of whether you have paid leave available to you.

Please contact the IDLM Office regarding leave of absence requests before submitting the following form:

If you have a disability, and require a modification to your work environment or duties in order to perform the essential functions of your position, you must complete the following forms:

Trouble Accessing Forms?

If you have difficulty accessing or completing any of the forms below, please contact the IDLM office at 410.222.5090, for assistance.