Human Resource Services
Family Medical Leave Responsibilities Checklist
- Discuss your Leave with your Supervisor
- Contact The Office of Human Resources
- Request your physician to complete the Certification of Health Care Provider form and
submit to The Office of Human Resources (within15 days from notification of eligibility)
- Commence Leave
- Contact your supervisor with any changes in leave status/duration/or date of return
- Within ten (10) business days prior to the expiration of your leave you must submit
a FMLA Return to Work Authorization Form
- OR submit a new Employee Leave Request Form and a FMLA Return to Work Authorization
(a Certification of Health Care Provider form may be requested) to request an extension.
If you fail to notify us of your intention, and you do not return to work on the date
specified on your Designation Letter you jeopardize your pay status.
- You cannot return to work without a FMLA Return to Work Authorization Form accepted and
approved by a member of The Office of Human Resources.
- The Supervisor must notify Human Resources within twenty - four (24) hours, via email or
phone call, of having any knowledge that an employee may be out for more than three (3) business days due to a medical
condition or injury.
- The time sheet will be completed on the employee’s behalf while on approved leave.
The employee will complete timesheet when FMLA time is used intermittently.
- You may not let an employee return to work without mutual agreement between yourself and
The Office of Human Resources on workplace restrictions (if any). Formal clearance on return
to work will be emailed to the supervisor by The Office of Human Resources.
Human Resources Responsibility
- To review, approve or deny the Medical Leave Request Form for all employees.
- Upon notification of a medical illness or injury, Human Resources will notify the employee
of their FMLA Rights and Responsibilities via letter.
- To review the medical documentation and designate or deny the requested leave.
- Send the employee a letter to his/her home address advising of approval or denial
of the request for leave.
- Consult with the supervisor on the contents of the return to work