Family Medical Leave
Family Medical Leave of Absence Documents
FMLA Basic Leave Entitlement
FMLA requires covered employers to provide up to 12 weeks of unpaid, job-protected leave to eligible employees.
Employees are eligible if they have worked for a covered employer for at least 12 months, have 1,250 hours of service in the previous 12 months, and if at least 50 employees are employed by the employer within 75 miles.
Employees must provide 30 days advance notice of the need to take FMLA leave when the need is foreseeable. When 30 days notice is not possible, the employee must provide notice as soon as practicable and generally must comply with an employer’s normal call-in procedures.
Step 1: Employer, school or department designee, will provide to the employee, upon notice, the following:
Step 2: Employer, school or department designee, will provide the appropriate federal form, as listed below, to the Employee. Employee should have the appropriate form completed by their physician and returned to their Supervisor/Designee.
Step 3: Employer will provide the employee a designation notice once appropriate documentation has been received in order for a determination to be made:
Step 4: Return to Work (WH-380E leave). The employee must provide the employer/designee a release to return to work with No Restrictions, unless modified work duty can be assigned, prior to returning the work.
Contact Dr. Michelle Griffith 706-602-6628 regarding questions.
- FMLA Rights & Responsibilities
- WH-381 Notice of Eligibility
- FMLA Leave for the employee should complete the following form: WH-380 FMLA Employee
- FMLA Leave for a family member should complete the following form: WH-380F FMLA Family Member
- FMLA Leave for military should complete the following form: WH-384 FMLA Military
- FMLA Leave for Military Illness/Injury should complete the following form: WH-385 Serious Illness Military
- FMLA Leave for Military Illness/Injury Caregiver should complete the following form: WH-385V Serious Illness Military Caregiver
- WH-382 Designation Notice
- Note: All leave should be entered in Frontlint in weekly increments.