Family Medical Leave Act (FMLA)

Information and Procedures

Last Updated September 2019

FMLA is 12 weeks of job protection after 1250 hours of work in the past 12 months. FMLA can be taken for your own serious illness, an immediate family member along with military family leave.

When the employee notifies HR or their supervisor that they have need of FMLA verbally or in writing, form WH-381 Notice of Eligibility and Rights & Responsibilities (FMLA) should be sent to the employee with the Family and Medical Leave Act (FMLA) Request Form. Employee has 15 days to respond with the form.

Once the form has been returned the employee is then provided with these forms:

The Certification of Health Care provider form should be returned to Human Resources within 15 days. Within 5 days of receipt a decision for approval or denial must be mailed to the employee by certified mail using form WH-382 Designation Notice.

Upon receipt of the Certification of Health Care Provider a memo will be sent from HR to the employee and supervisor. The memo will include the dates that the employee will be out and the return to work strategies, insurance premiums detail, including any payments with timeline and return to work documentation.

HR is responsible for all the required tracking and documentation.

An employee does not have to share medical information with their supervisor.

HR will not share medical information unless permission is provided by the employee.

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