This packet was designed to assist employers with maintaining compliance with the Federal Family and Medical Leave Act (FMLA). Compliance with FMLA requires that an employer understand the notification and timing requirements associated with an employee’s federally protected right to take time off for a “qualifying” medical condition. This FMLA Employer Checklist walks an employer through the numerous notices and deadlines associated with each employee request. Employers can follow the checklist and document their management of each employee request to ensure that they meet with requirements under the law.
The United States Department of Labor (US DOL) has numerous forms and resources that employers can utilize in their management of FMLA requests. However, the US DOL has not published an FMLA Request Form for use by covered employers. These forms can be utilized in conjunction with the forms previously supplied by the US DOL to comprehensively document an employer’s compliance with the law.
• Federal Family and Medical Leave Act (FMLA) Request Form
• Family & Medical Leave Act (FMLA) Employer Checklist
USDOL FMLA Standard Forms for download on U.S. D.O.L. website
- WH-380-E Certification of Health Care Provider for Employee’s Serious Health Condition (PDF)
- WH-380-F Certification of Health Care Provider for Family Member’s Serious Health Condition (PDF)
- WH-381 Notice of Eligibility and Rights & Responsibilities (PDF)
- WH-382 Designation Notice (PDF)
- WH-384 Certification of Qualifying Exigency for Military Family Leave (PDF)
- WH-385 Certification for Serious Injury or Illness of Covered Servicemember — for Military Family Leave (PDF)
- WH-385-V Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave (PDF)