Family Medical Leave Act

FMLA Forms

Your Own Condition

Family Medical Leave Policy (3-0708) - (to be given to employee with a copy of the rights/responsibilities document (WH381) and the appropriate certification document (WH380E, WH380F, WH384, WH385)

WH381-Notice of Eligibility and Rights and Responsibilities form - (give to the employee when notice is received of the need for the leave; also provide the appropriate certification document WH380E, WH380F, WH384, WH385 and a copy of the FMLA policy)

WH380E-Certification of Health Care Provider form for Employee’s Serious Health Condition - (use for employee only leave; provide a copy of FMLA policy & form WH381)

Care for a Family Member

WH380F-Certification of Health Care Provider form for Family Member’s Serious Health Condition - (use for family member only; provide a copy of FMLA policy & form WH381)

Bonding with a Child

 

Military

WH384-Certification of Qualifying Exigency for Military Family Leave - (to be used for exigency leave for a qualifying family member; exigency is defined as short-term deployment, military events/activities; childcare/school activities or financial/legal arrangements-non routine, counseling, rest & recuperation, post-deployment activities, or other additional activities; provide a copy of FMLA policy & form WH381)

WH385-Certification for Serious Injury or Illness of Covered Service Member for Military Family Leave - (use for care of a family member who became ill or injured while serving in the military; provide a copy of FMLA policy & form WH381)

WH385V- Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave - (to be used for an employee seeking military caregiver leave under the FMLA leave due to a serious injury or illness of a covered veteran; provide a copy of the FMLA policy & form WH 381)

FMLA Tools

FMLA Why Centralize FMLA Supervisor FAQ’s
FMLA FAQ’s FMLA Declaration of Relation Form
FMLA Overview FMLA Declaration of Relation Form
FMLA Tracking Form FMLA Measurement Tool
FMLA Leave of Absence Form FMLA Minute
HIPAA Privacy Regulations FMLA for Care of Servicemember: FAQ
FMLA for Qualifying Exigency Leave: FAQ  

Important Links

FMLA Notice - (post with Labor Law poster; copy to new hires-include in Payroll Sign-up)
ComPsych Link:  http://hr.okstate.edu/benefits/hrEAP
Department of Labor FMLA Poster:  http://www.dol.gov/whd/regs/compliance/posters/fmla.htm
Department of Labor FMLA Test:  http://webapps.dol.gov/elaws/whd/fmla/10.aspx
Department of Labor Guide Link:  Dept of Labor (DOL) Employee Information Guide
DOL Qualifying Reasons Fact Sheet:  http://www.dol.gov/whd/regs/compliance/whdfs28f.pdf
Long-Term Disability Insurance Procedures for Employees (pdf)
Long-Term Disability Benefit