Number 06.02.04 Division Human Resources Date April, 2013 Purpose This policy provides employees with a consistent and uniform process for medical leaves of absence as required of the Family and Medical Leave Act of 1993, as amended January 2008, and its implementing regulations effective January 16, 2009. Policy The Family and Medical Leave Act (FMLA) provides an entitlement of up to 12 weeks of job-protected, unpaid leave during any 12-month period to eligible, covered employees for the following reasons: 1) birth and care of the eligible employee's child, or placement for adoption or foster care of a child with the employee; 2) care of an immediate family member (spouse, child, parent) who has a serious health condition; or 3) care of the employee's own serious health condition. It also requires that employee's group health benefits be maintained during the leave. For more information regarding your rights under FMLA, please review the links below Procedure Forms FMLA Request for Leave Form FMLA Health Care Provider Certification Forms Employee Serious Health Condition Physician Certification Form. Family Member's Serious Health Condition Physician Certification Form. FMLA Intermittent Timesheet FMLA Intermittent Timesheet. Return to Work Form Fitness-For-Duty Form. (This form must be completed by your physician prior to your return to work). Review The Human Resources Office is responsible for the review of this policy every five years (or whenever circumstances require). Family and Medical Leave of Absence Policy
