For companies with 50 or more employees that are responsible for complying with the federal Family & Medical Leave Act (FMLA) law or similar state legislation, our Member-Partners will assist clients in the completion of the following forms as part of the process for ensuring your regulatory compliance.
1) FMLA Checklist
This is an invaluable checklist kept in an employee’s file to ensure that the company completes its legal and administrative obligations when an employee requests an FMLA leave. This checklist becomes the proof of a company’s compliance with the FMLA in the event of a legal challenge. This form is to be completed for each FMLA leave requested.
2) FMLA Letter to Employee
This is a letter to be sent to an employee who is seeking a FMLA leave which provides a check-off of the forms that a company is required to provide to the employee. This document would be mailed or handed to an employee with a copy filed in the employee’s personnel folder. It becomes additional proof of your compliance with the FMLA in the event of a legal challenge.
3) FMLA Poster
This is the most recent FMLA poster on standard letter format that must be provided to an employee to ensure that the employee is fully advised of his/her FMLA rights.
4) FMLA Leave Request
This is the form an employee completes when requesting a FMLA leave. When this form is completed and returned to the company, the company must respond within the required time limits as noted on the “FMLA Checklist.”
5) FMLA DOL Fact Sheet (Non-Military)
For non-servicemember FMLA leave requests, a company must provide this Department of Labor (DOL) fact sheet to an employee.
6) FMLA DOL Fact Sheet Military
For servicemember or military FMLA leave requests, a company must provide this DOL fact sheet to an employee.
7) FMLA Notice of Eligibility & Rights
This is a company’s notice to an employee of his/her eligibility for a FMLA leave, as well as his/her rights relative to amount of time available, the use of accrued paid days such as sick days, and other factors that an employee needs to know.
8 ) FMLA Certification of Health Care Provider – Employee
This document is to be used by an employee’s physician to document an employee’s serious health condition when an employee is seeking a FMLA leave for his/her personal serious health condition under the FMLA medical guidelines.
9) FMLA Certification of Health Care Provider – Family Member
This document is to be used by the physician of an employee’s family member to document the serious health condition of the family member when an employee is seeking a FMLA leave to assist a family member in need.
10) Medical Certification Release Authorization
Whenever an employee is seeking an FMLA leave for his/her serious health condition or the serious health condition of a family, the company should also give the employee this form. This form authorizes the employee’s or a family member’s physician to release the completed “FMLA Certification of Health Care Provider” to the company in order that the company may verify the reason for the FMLA leave.
11) Certification of Qualifying Exigency for Military FMLA
This is the certification form that an employee should complete when requesting a FMLA leave under the exigency provisions for military personnel in the Reserves or National Guard.
12) Certification for Military Caregiver Leave
This is a certification form that an employee should complete when requesting a FMLA leave under the military caregiver provisions.
13) FMLA Designation Notice
This form is the company’s official notice of approval or denial of a FMLA leave request.
14) FMLA Days Off Worksheet
This worksheet takes the guess work out of how many FMLA days an employee has remaining and eliminates having to count calendar days to determine when the 12-week (or 26-week in certain cases) FMLA leave will end. This Excel spreadsheet automatically computes the 12-week (or 26-week in certain cases) FMLA period from first day to last day and also automatically tracks Intermittent and Non-Intermittent time used to show the balance of time remaining.
To receive information about our FMLA Administration, contact a Member-Partner in your area or our corporate offices.