FMLA Leave

FMLA Leave image


The FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave.

Eligible employees are entitled to:

Twelve workweeks of leave in a 12-month 'rolling' period for:

  • the birth of a child and to care for the newborn child within one year of birth;
  • the placement with the employee of a child for adoption or foster care and to care for the newly placed child within one year of placement;
  • to care for the employee’s spouse, child, or parent who has a serious health condition;
  • a serious health condition that makes the employee unable to perform the essential functions of his or her job;
  • any qualifying exigency arising out of the fact that the employee’s spouse, son, daughter, or parent is a covered military member on “covered active duty;

Pursuant to DOL 29 C.F.R. § 825.220(d), as your employer we are prohibited from delaying the designation of FMLA – qualifying leave as FMLA leave.  Once an eligible employee communicates a need to take leave for an FMLA qualifying reason, neither the employee nor the employer may decline FMLA protection for that leave.

You will be provided with critical notices about the FMLA so that both the employees and the employer have a shared understanding of the terms of the FMLA leave.

Notice Forms:

  1. Eligibility Notice, form WH-381 – informs the employee of his or her eligibility for FMLA leave or at least one reason why the employee is not eligible.
  2. Rights and Responsibilities Notice, form WH-381 (combined with the Eligibility Notice) – informs the employee of the specific expectations and obligations associated with the FMLA leave request and the consequences of failure to meet those obligations.
  3. Designation Notice, form WH-382 – informs the employee whether the FMLA leave request is approved; also informs the employee of the amount of leave that is designated and counted against the employee’s FMLA entitlement. An employer may also use this form to inform the employee that the certification is incomplete or insufficient and additional information is needed.

Certification of Healthcare Provider for a Serious Health Condition Forms:

  1. Employee’s serious health condition, form WH-380-E – use when a leave request is due to the medical condition of the employee.
  2. Family member’s serious health condition, form WH-380-F – use when a leave request is due to the medical condition of the employee’s family member.


FMLA Fact Sheets HERE