NYC Commission on Human Rights
Bill de Blasio, Mayor | Carmelyn P. Malalis, Commissioner/Chair
NYC.gov/HumanRights | @NYCCHR
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Sample Letter to Employee on Leave
[Date]
[Addressee]
Re: Leave of Absence
Dear [Employee],
I write regarding your leave of absence from [employer]. When
we last spoke on [date], you informed me that you would be visiting
your doctor on [date] and would be able to update me as to your
ability to return to work following that appointment.
As you know, [employer] has a policy of allowing employees up
to [xx] weeks of disability-related leave from work. According to our
records, you have now been on leave since [date]. Therefore, your
available leave will expire on [date]. In order to maintain your status
as an employee, we need to hear from you regarding your plans and
ability to return to work. If you need a modification of your job duties
or workspace in order to return to work, or if you need an extension of
your leave beyond the [xx] weeks allowed by our policy, please
contact me at [phone] or [email] to discuss a possible reasonable
accommodation. We may ask that you submit a note from your
medical provider specifying what accommodations you need and/or
when you will be able to return to work.
If we do not hear from you at all by [date], we will unfortunately
be left with no option but to terminate your employment. When you
