Request for Family or Medical Leave - to be completed by employee and returned to supervisor to request consideration for FMLA leave.

Notice of Eligibility and Rights and Responsibilities – to be given to employee within five business days after employee requests leave or supervisor becomes aware that employee’s leave may qualify under FMLA. Supervisors may also send a cover memo with this Notice.

Certification Forms: appropriate form to be given to employee with the Notice of Eligibility and Rights and Responsibilities form for completion by appropriate party and for return to supervisor.

• Certification of Health Care Provider for Employee’s Serious Health Condition - to be completed by health care provider, signed by employee and returned to supervisor.
• Certification of Health Care Provider for Family Member’s Serious Health Condition -to be completed by employee’s family member’s health care provider, signed by employee and returned to supervisor.
• Certification of Qualifying Exigency for Military Family Leave - to be completed by employee and returned to supervisor.
• Certification for Serious Injury or Illness of Covered Service member - to be completed by employee or employee’s covered servicemember for whom the employee is requesting leave and a United States Department of Defense health care provider and returned to supervisor.

Designation Notice - to be given to employee within five business days of receiving the completed certification form. Supervisors may also send a cover letter with this memo.

Certification of Fitness for Duty - to be completed by health care provider and returned to supervisor upon return to work.

Time Log - to be maintained by department timekeeper.