Paid Sick Time

Please use this form to request use of your accrued paid sick time under Nebraska law (effective October 1, 2025). Requests should be submitted as soon as possible.

Requests are made in accordance with the Nebraska Healthy Families and Workplaces Act (Neb. Rev. Stat. §§ 48-3801 to 48-3811). For an overview of your rights and responsibilities under this Act, you may view the official poster here: https://dol.nebraska.gov/webdocs/Resources/Items/Poster%20Paid%20Sick%20Time.pdf.

(Please note: The poster is an informational summary and is not the complete text of the law. For the full language of the law, you may review Neb. Rev. Stat. §§ 48‑3801 to 48‑3811.)

Important: This form may only be used to request one (1) day at a time. If you need multiple days of sick leave, please submit a separate request for each day.

Information collected will only be used to administer sick leave benefits and will remain confidential.