Bereavement Leave Policy

BEREAVEMENT LEAVE POLICY

Policy Name: Bereavement Leave Policy

Effective Date: [__/__/____]

Policy Owner: Human Resources / [________________________________]

Applies To: ☐ All full-time employees ☐ All full-time and part-time employees ☐ All employees (including temporary and seasonal) ☐ Employees in the following states: [________________________________]

1. PURPOSE

[COMPANY NAME] ("Company") recognizes that the death of a family member or loved one is a difficult time for employees. This policy provides paid bereavement leave to allow employees to grieve, attend funeral services, handle estate matters, and attend to family needs following a loss.

2. ELIGIBILITY

The following employees are eligible for bereavement leave under this policy:

☐ All full-time employees (regularly scheduled [____]+ hours per week) who have completed [____] days of employment.

☐ All part-time employees (regularly scheduled [____]+ hours per week) on a pro-rated basis as described in Section 4.

☐ Temporary, seasonal, and on-call employees: ☐ Eligible ☐ Not eligible (confirm applicable state and local requirements before selecting).

3. QUALIFYING RELATIONSHIPS

3.1 Immediate Family (Tier 1)

Employees are entitled to leave under Section 4.1 for the death of an immediate family member, which includes:

☐ Spouse or domestic partner (registered or unregistered, as recognized under applicable state law)

☐ Child (biological, adopted, step-child, foster child, legal ward, or child for whom the employee stands in loco parentis), regardless of age

☐ Parent (biological, adoptive, step-parent, or person who stood in loco parentis to the employee)

☐ Sibling (biological, adopted, step-sibling, or half-sibling)

☐ Grandchild

☐ Grandparent

☐ Parent-in-law / Parent of domestic partner

☐ Sibling-in-law (brother- or sister-in-law)

3.2 Extended Family (Tier 2)

Employees may take leave under Section 4.2 for the death of an extended family member, which includes:

☐ Aunt or uncle

☐ Niece or nephew

☐ First cousin

☐ Child-in-law (son-in-law, daughter-in-law)

☐ Domestic partner of a child or sibling

☐ Grandparent-in-law

☐ Step-grandparent or step-grandchild

3.3 Other Relationships

Employees may request up to [____] day(s) unpaid leave (or paid at manager discretion) for the death of a close friend, colleague, or other person not listed above. Such leave is subject to management approval.

3.4 Pregnancy Loss

Employees are entitled to bereavement leave under Section 4.1 for the following qualifying pregnancy or infant loss events:

☐ Miscarriage (applies to the pregnant employee or their partner)

☐ Failed adoption or failed surrogacy (embryo/fetus loss)

☐ Stillbirth

☐ Death of a child within the first [____] days following birth (neonatal death)

☐ Unsuccessful in vitro fertilization procedure resulting in loss of embryo

Employee privacy regarding pregnancy loss events shall be protected; under this Company policy, no medical documentation beyond self-certification will be requested for pregnancy loss events. This does not change documentation rules for a separate statutory leave claim.

4. LEAVE DURATION AND PAY

4.1 Immediate Family Leave (Tier 1)

Paid Leave Duration:

Additional Unpaid Leave:

Employees may request up to [____] additional calendar days of unpaid leave following exhaustion of paid bereavement leave. Such requests must be submitted to Human Resources and are subject to manager approval based on business needs.

4.2 Extended Family Leave (Tier 2)

Employees are entitled to [____] day(s) of paid leave for the death of an extended family member listed in Section 3.2.

4.3 Travel Distance Allowance

If the employee must travel more than [____] miles (one way) to attend funeral services or make arrangements, the employee is entitled to [____] additional paid day(s) for travel, per qualifying event. Employee must notify HR of the travel requirement when requesting leave.

4.4 Pay During Bereavement Leave

Paid bereavement leave shall be compensated at the employee's regular base rate of pay. Any treatment of overtime, commissions, bonuses, or shift differentials will follow the written compensation plan and applicable pay law.

4.5 Part-Time Employee Pro-Ration

Part-time employees working less than [____] hours per week are entitled to bereavement leave as follows:

☐ The same number of days as full-time employees, but calculated based on their scheduled hours per day.

☐ Pro-rated: [(regularly scheduled hours per week ÷ [____] hours) × full-time leave days].

5. INTERACTION WITH OTHER LEAVE

5.1 Holidays and Weekends

If a company-recognized holiday or weekend falls during a bereavement leave period, such day(s) shall ☐ extend the bereavement leave period ☐ count against the bereavement leave days.

5.2 Interaction with Other Leave Laws

Bereavement leave is separate from leave under other applicable laws. HR will review any request that may also qualify under another leave law and provide the notices and designations required by that law.

5.3 Interaction with PTO / Vacation

Bereavement leave is separate from the employee's accrued PTO or vacation balance. Employees shall not be required to use accrued PTO for paid bereavement leave.

5.4 State and Local Requirements

Before adopting this policy for employees in [STATES AND LOCALITIES], HR will check each location's current bereavement, pregnancy-loss, paid-leave, wage-payment, and documentation rules and record any required supplement in [STATE/LOCAL ADDENDUM]. Where a mandatory rule provides a greater benefit or different process, the Company will follow that rule.

6. REQUESTING BEREAVEMENT LEAVE

6.1 Notice Requirements

Employees should notify their manager and Human Resources as soon as practicable after learning of the qualifying death, or before the employee's next scheduled shift when possible.

Notification Method: ☐ Manager and HR via email ☐ HR online portal ☐ Phone call to supervisor

HR Contact for Leave Requests: [________________________________]

6.2 Documentation

The Company may request documentation to support a bereavement leave request. Documentation may include:

☐ Death certificate (a copy, not the original)

☐ Obituary

☐ Memorial service program or funeral notice

☐ Written statement from funeral home

☐ For pregnancy loss: a self-certification statement from the employee (no medical documentation beyond self-certification will be required)

Timing for Documentation: Documentation may be requested at any time but must be provided within [____] calendar days of the employee's return to work.

Confidentiality: All documentation related to bereavement leave shall be maintained in a confidential personnel file separate from the employee's primary personnel file.

7. RETURN TO WORK

Employees are expected to return to work on the scheduled return date. If additional time is needed, the employee must contact HR to request unpaid leave or use accrued PTO, subject to business needs.

8. NON-DISCRIMINATION AND NON-RETALIATION

The Company shall administer this policy in a non-discriminatory manner. Employees shall not be retaliated against, disciplined, or penalized for taking leave under this policy or for requesting leave to which they are entitled under applicable law. Any supervisor who retaliates against an employee for taking bereavement leave is subject to disciplinary action, up to and including termination.

9. MANAGER RESPONSIBILITIES

Managers are responsible for:

☐ Responding compassionately and promptly to bereavement leave requests

☐ Notifying HR of any bereavement leave request received directly from an employee

☐ Not requiring detailed personal disclosures about the relationship or circumstances of the death beyond what is necessary to administer this policy

☐ Facilitating a smooth workload transition during the employee's absence

10. POLICY ADMINISTRATION AND AMENDMENTS

Human Resources is responsible for administering this policy and ensuring compliance with applicable laws. This policy is subject to amendment at any time by the Company. In the event of a conflict between this policy and applicable state law, the applicable state law shall control.

Questions: Contact Human Resources at [________________________________].

EMPLOYEE ACKNOWLEDGMENT

By signing below, I acknowledge that I have received and read the Company's Bereavement Leave Policy and understand my rights and responsibilities thereunder.

Employee Name (Print): [________________________________]

Employee Signature: [________________________________]

Date: [__/__/____]

Department: [________________________________]

SOURCES AND REFERENCES

• 29 U.S.C. § 206(d) (Equal Pay Act): https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section206&num=0&edition=prelim
• 42 U.S.C. § 2000e (Title VII): https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section2000e-2&num=0&edition=prelim