San Francisco Paid Parental Leave Form

Entity Mandating Form: San Francisco's Office of Labor Standards Enforcement (OLSE).

Applicability: San Francisco's Paid Parental Leave Ordinance (PPLO) applies to employers with 50 or more employees beginning January 1, 2017; to employers with 35 or more employees beginning July 1, 2017; and to employers with 20 or more employees beginning January 1, 2018. An employee must complete this form in order to receive supplemental compensation under the PPLO.

Distribution Specifications: An employer must provide this form to employees in San Francisco within a reasonable time after the employee discloses that he or she is expecting a newborn, adopted or foster child, or sooner if the employee inquires about paid parental leave. The OLSE also encourages employers to provide this form to current and new employees.

Obtaining This Form: An employer may obtain this form by visiting the OLSE's website.

Additional Resources

San Francisco's Office of Labor Standards Enforcement (OLSE) Website

City and County of San Francisco Website