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Leave of absence request form: This form documents the employee’s request for FML and notifies the University that leave is needed.

• Whose responsibility? The employee must submit this request 30 days before the leave is needed when the leave is known or otherwise foreseeable. If the leave is not known or foreseeable, the employee shall submit the request as soon as possible. For most medical leaves a doctor’s note is required and it should state the effective date and the possible return-to-work date. A verbal request may suffice for unforeseeable situations but the employee should try to make it clear that leave is needed for a covered reason. An unreasonable delay in requesting leave may result in a delay of approving the time off.

Notice of Employee Eligibility and Rights and Responsibilities (1st letter): This letter notifies an employee whether he or she is eligible for FML and also explains the employee’s rights and responsibilities when taking such leave.

• Whose responsibility? The University will provide this letter to the employee at the home address on record. The University will include with this letter the Certification of Health Care Provider.

Certification of Health Care Provider: This form documents the serious health condition of the employee or family member to determine whether FML is warranted.

• Whose responsibility? The employee must return the certification to Human Resources within 15 calendar days. The medical certification must be complete and sufficient for the University to determine if FML is warranted. If any section of the certification is incomplete or insufficient, it will be necessary for the employee to obtain more information before FML leave can be approved. In most circumstances, an additional 7 days may be granted while the employee works to obtain the certification from the healthcare provider.

Certification of Qualifying Exigency or Serious Illness or Injury of Covered Service member: This form documents the reason for and amount of leave needed for an exigency due to a family member’s call to covered active duty. The form may also document the reason for and amount of leave needed to care for a family member or veteran who is injured or ill due to covered active duty.

• Whose responsibility? The employee must return this form to Human Resources within 15 calendar days.

Designation Notice (2nd letter): This letter documents whether FML leave has been granted.

• Whose responsibility? The University will provide this letter to the employee at the home address on record as soon as possible after the need for FML leave is determined based on the documentation received.

Recertification: This medical certification is often used to update an employee’s chronic or ongoing condition. The University may request recertification every 30 days unless the original certification specified a certain date when the condition would improve; however, in all cases the University may request recertification at least annually, or may choose to seek recertification every 6 months even if the certification includes a certain date when the condition will improve. If the supervisor learns of new developments that cause him/her to question the employee’s need for leave or question the accuracy of the original certification, the University may seek recertification in those situations.

• Whose responsibility? It is the University’s responsibility to request the recertification. It is the employee’s responsibility to return the recertification within 15 calendar days.

Release to Return to Work: If an employee has taken continuous FML leave for his or her own serious health condition, a return-to-work form from their physician is required prior to returning to work. The employee must be able to perform all the essential functions of their job with or without an accommodation. 

• Whose responsibility? It is the employee’s responsibility to provide the return-to-work form from their physician prior to returning to work.

If you fail to request FML leave in advance and you knew you would need the time off, the University may delay the start of your FML leave for 30 days. If you fail to submit the required certification documentation, your FML leave may be delayed or even denied. If you fail to submit requested Recertification, future FML leave may be delayed or denied. If you fail to submit the return-to-work form from your physician, you will not be able to return to work from continuous leave taken for your own serious health condition.

The employee must be able to perform all the essential functions of their job with or without an accommodation. 

 

The Human Resources office is the central storage location for your FML and medical information. The information will be kept confidential.