Employee Bereavement Policy Form

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Employee Bereavement Policy Form

An employee bereavement policy form outlines a company’s rules regarding time off following the death of a family member or relative. This document ensures employees are notified of their right to take leave in such an event and the protocol they should follow.

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Last updated July 13th, 2025

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An employee bereavement policy form outlines a company’s rules regarding time off following the death of a family member or relative. This document ensures employees are notified of their right to take leave in such an event and the protocol they should follow.

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Bereavement Leave States
State Details Statute
California
  • Required for employers with 5 or more employees
  • Up to 5 work days unpaid leave
  • Employees eligible after 30 days of employment
 § 12945.7
Colorado
  • Employees may use paid sick leave for bereavement
 § 8-13.3-404
Illinois
  • Required for employers with 50 or more employees
  • Up to 10 work days unpaid leave
  • Employees eligible after 12 months
 820 ILCS 154/10, IL Dept. of Labor, 29 U.S. Code § 2611
Maryland
  • Required for employers with 15 or more employees
  • Employees can use any paid leave for bereavement
 § 3-802, § 17.04.11.06
Minnesota
  • Employees may use paid sick leave for bereavement
  • Employees eligible
 § 181.9447
Oregon
  • Required for employers with 25 or more employees
  • Up to 2 weeks leave (per family member death, 12 weeks max)
  • Employees eligible after 180 days
 § 659A.153, § 659A.162, § 659A.156, § 659A.159
Washington
  • Up to 7 paid calendar days following the death of a child
  • Employees are eligible after 820 hours
 § 50A.05.010, § 50A.15.010

Sample

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[EMPLOYER NAME]
BEREAVEMENT POLICY
1. BACKGROUND. The purpose of this policy is to provide employees with the time and space to manage immediate needs following the loss of a loved one. [EMPLOYER NAME] (the “Company”) recognizes that each situation comes with unique challenges. Employees are encouraged to communicate with supervisors to ensure their needs are met as they utilize bereavement leave and transition back to work.

2. ELIGIBILITY. This policy applies to Company employees who have completed a minimum probationary period of [#] days of employment with the Company. Contract and temporary employees are not eligible for paid leave under this policy.

3. RELATIONSHIP TO DECEASED. Eligible employees are entitled to take bereavement leave in the event of the death of an immediate family member (spouse, domestic partner, child, parent, or sibling) or a close relative (grandparent, aunt/uncle, niece/nephew, cousin, or in-law).

4. DURATION OF LEAVE. In the event of the death of an immediate family member, eligible employees may take up to [#] working days of leave to attend services, manage affairs, and for personal space. The entitlement in the event of the passing of a close relative is [#] working days. Employees may elect to use accrued paid time off if additional time is needed. Additional leave may be granted at the discretion of human resources or the relevant supervisor (“management”).

5. NOTICE AND DOCUMENTATION. Employees should inform management of their intent to take bereavement leave at the earliest opportunity and no later than the day on which leave is to begin. On a case-by-case basis, the Company may request documentation such as a funeral program, obituary, and/or written verification of the employee’s relationship to the deceased.

6. CONFIDENTIALITY. The Company will maintain the utmost discretion and sensitivity in supporting employees through the process of bereavement leave. Information will only be shared with relevant personnel on a need-to-know basis.

EMPLOYEE ACKNOWLEDGEMENT

I, [EMPLOYEE NAME], acknowledge that on [MM/DD/YYYY], I received a copy of [EMPLOYER NAME]‘s Bereavement Policy and that I read it, understood it, and agree to comply with it. I understand that [EMPLOYER NAME] has the maximum discretion permitted by law to interpret, administer, change, modify, or delete this policy at any time, with or without notice.

Employee Signature:                                                               Date: ______________
Print Name: [EMPLOYEE NAME]