DR. JOHN WARNER HOSPITAL
CLINTON, ILLINOIS 61727
POLICY AND PROCEDURE
TITLE
BLOOD DONATION LEAVE REQUEST
PAGE 1 OF 2
ISSUING DEPARTMENT
HUMAN RESOURCES
EFFECTIVE DATE
11/01/10
PREPARED BY
BELINDA RITTENHOUSE
REVISED DATE
10/22/10
POLICY #: HR-2552
ORIGINAL DATE
02/25/10
REVISES AND SUPERSEDES: Employee Blood Donation Leave with an original date of 02/25/10,
prepared by Belinda Rittenhouse.
POLICY:
It is the policy of the Dr. John Warner Hospital to comply with the Illinois Employee Blood Donation
Leave Act (820 ILCS 149/), which allows eligible full-time and part-time employees to use paid leave
for up to one (1) hour every 56 days to donate blood or to attempt to donate blood.
This policy applies to non-bargaining unit employees only. Bargaining Unit employees need to refer to
the Labor Agreement.
STAFF: All Departments
EQUIPMENT, FORMS & LOCATIONS: Blood Donation Leave Request, Form #462 available on
the intranet or through the Human Resource Department.
PROCEDURE:
Notice, Approval and Verification Requirements
An eligible employee is required to give no less than 24 hours notice to their department manager in the
event the employee chooses to use paid leave under this policy. The request for leave under this policy
must be in writing and on the Employee Blood Donation Leave Request, Form # 999.
Upon the employee’s return from an approved leave, the employee will be required to submit a copy of
the post donation and call back instructions or other verification provided by the blood donation center
verifying the employee donated blood or attempted to donate blood. The verification must be submitted
to the Human Resource Office by the end of the pay period in which the leave was taken. Failure to
submit verification will result in either the docking of pay for the time or a deduction from the
employee’s accrued ETO bank.
To receive pay for this leave, the employee must clock in code 014 (hour type for other pay) in the time
clock system.
-2POLICY AND PROCEDURE – BLOOD DONATION LEAVE REQUEST
DEFINITIONS:
“Eligible employee” means a full-time employee who has been employed for at least six (6) months and
donates blood or attempts to donate blood.
“Blood Donation” means the act of donating blood in accordance with appropriate medical standards
established by the American Red Cross, America’s Blood Centers, the American Association of Blood
Banks, or other nationally recognized standards.
DOCUMENTATION: Appropriate documentation is provided on the Blood Donation Leave Request,
Form #462
COPIES SENT TO:
Administration – Original
All Departments
February 25, 2010 – Original
October 22, 2010 – Revised
______________________________________
DIRECTOR
DATE
______________________________________
CEO
DATE
INITIAL
AND DATE
REVIEWED ________
________
________
________
________
________
________