Routine and Preventative Care Layoffs

*** for reference only ***

Here is a copy of System General Notice 255. Please keep up with your general notices for any changes to this policy. The form in step two is posted for your convenience and may update at anytime.

                              December 29, 2022
BNSF Railway Co.

                            SYSTEM GENERAL NOTICE NO. 255


SUBJECT: Routine and Preventive Care Layoffs


Employees working in unassigned service (including those with earned
rest), will be allowed unpaid scheduled day(s) off that are necessary to
attend up to three (3) routine and preventive medical care visits per
calendar year, without being assessed any points under BNSF's Hi-Viz
Attendance Program.  The following conditions apply:

   * Employee must be in unassigned service (including pools with earned
   * Exams must be scheduled on a Tuesday, Wednesday, or Thursday,
     excluding holidays.
   * Employee must provide BNSF at least 30 days' advance notice.
   * Documentation verifying the routine or preventative service took
     place will be required.

1. Lay Off Process - "LDR"
   Employees may enter a pre-approval layoff request for a single day or
   multiple days up to 90 days in advance using layoff code "LDR".  If a
   multiple day request is entered, the request cannot be submitted until
   the whole request is within the request window.  For example:  an
   employee makes a two-day request for LDR. Both days have to be within
   the 90-day window before the request can be entered into the system.
   The LDR layoff will be approved 30-days in advance.

2. What Documentation is Required?
   Employees must have their health care provider fill out and sign the
   Routine/Preventive Care Appointment Validation Form - no other
   documentation will be accepted.

   The Routine/Preventive Care Appointment Validation Form can be found
   on the LR website or in the Workforce Hub.

   LR website:

   To access the PDF/Link via the Hub please follow these instructions:

     * Expand the Time Off drop-down menu on the home page.
     * Select the "Prev Appt Form" link.
     * Once selected a PDF/Link will pop-up.
     * From there you can print, send, save, etc. this form.

   Completed forms should be emailed to or faxed to
   817-352-3310 and must be received by BNSF no later than 7 calendar
   days following the appointment.  The LDR layoff will be converted to
   LOP in Hi-Viz if a completed validation form is not received within 7
   calendar days following the appointment.  Use of the code without
   support documentation may subject an employee to discipline.

   If a routine or preventive visit is cancelled and/or rescheduled by an
   employee's provider after the employee has laid off to attend the
   visit, documentation verifying the visit was scheduled and then
   cancelled by the provider after the layoff will be required.
   Documentation can be emailed to or faxed to 817-352-3310.

3. What is the Definition of Routine and Preventive Medical Care?
   Routine services are defined as services that are not urgent or
   emergent in nature.  They include identifying or evaluating a new
   condition or illness, routinely monitoring an already known condition,
   or providing treatment for a condition or illness.  Routine care
   commonly referred to as preventive services include regular checkups,
   physicals, screenings, and other services designed to prevent an
   illness or condition from developing.  This includes, but is not
   limited to, ACA Preventive Health Services.

4. What if the Routine or Preventive Service Needed Falls Outside of the
   Conditions Listed Above?
   If an employee has a request that does not meet the criteria above,
   they should email their request to for
   consideration.  Examples may include:

    * Employee does not have 30 days' advance notice.
    * Healthcare provider only offers certain routine and preventive
      services on a Monday or Friday.
    * Employee schedules an appointment 30 or more days in advance, but
      their provider reschedules the appointment to an earlier date.
    * An employee would like to use these days for a family member who
      requires assistance attending routine and preventive visits.
    * A nationally recognized holiday precedes or follows the date of a
      scheduled routine or preventive visit and the employee is required
      to lay off (either for medical necessity or availability purposes).

   Appropriate documentation substantiating the request may be required;
   please allow up to 72 hours for a response.  Employees who lay off
   without prior approval may have the LDR converted to LOP in Hi-Viz
   and/or may be subject to discipline.

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