FMLA Request Form
FMLA Medical Certification Form
What is FMLA?
A federal mandate that grants up to 12 weeks off in a 12-month period to an eligible employee for certifiable medical reasons, the birth of and to care for a newborn child, and/or the placement of an adoptive or foster child. FMLA provides protection of an employee's current or equivalent position while away from work and assures continuation of provided insurance coverage. To remain in pay status, appropriate use of sick leave, vacation leave, comp time or personal holiday must be requested and approved.
Who Can Take FMLA?
An employee who, on the date on which any FMLA leave is to commence:
- Has been employed for a total of at least 12 months by the employer (need not be consecutive), and
- Has been employed for at least 1250 hours of service during the previous 12 months.
When Can FMLA Be Taken?
An eligible employee is entitled to a total of 12 workweeks of leave during a 12-month period for:
- The birth of and care for a child or placement of a child for adoption or foster care. (Entitlement of leave for the birth or placement of a child shall expire at the end of the 12-month period beginning on the date of birth or placement.) FMLA will begin after any leave for disability due to pregnancy or childbirth.
- The care of the employee's spouse, child or parent with a serious health condition
- The employee's serious health condition that makes the employee unable to perform the functions of his or her position.
What Are My Responsibilities?
- Notify HR and supervisor of need for time away from work. Provide 30-day advance notice if the leave is foreseeable and such notice is practicable.
- Submit FMLA Request form to HR
- Submit the FMLA Medical Certification form
- Meet with HR Leave Administrator to determine appropriate use of leave, if necessary.
- Submit time and leave online via MyCWU to cover time away from work.
- While on leave, notify supervisor of change in return to work date.
- While on leave, notify HR of change in medical condition, change of address, and date of baby's birth (or placement) for parental leaves.
- Provide release to return to work to HR when returning from leave (if leave was for your medical condition).
- Ensure appropriate time and leave is submitted via MyCWU.
- Stay in contact with employee regarding return to work date.
- Notify HR of employee's return to work date.
Human Resources Leave Administrator:
- Designate leave as covered by Family and Medical Leave if appropriate.
- Answer FMLA questions for employee and supervisor and ensure completion of applicable forms.
- Review and evaluate medical recommendations from health care provider(s) and coordinate with supervisor prior to returning employee to work.
- Make appropriate adjustments to employee's service date and accrual balances.
- Ensure health insurance coverage continues during leave.
- Provide information and assistance regarding retirement programs as applicable.
- Medical insurance coverage continues for 90 days. However, self-pay of employee monthly premium may be required.
- Vacation (annual leave) or sick leave will NOT accrue during a month in which an employee is in leave without pay status for more than ten days.
Return to Work Provisions
- The department that granted the leave is responsible for ensuring that timely placement occurs when leave is completed.
- The employee will normally be returned to the last job held or, if necessary, to an equivalent position, unless one of the following conditions applies:
- Employee's return creates or is affected by a layoff situation.
- Medical restriction precludes placement.
Serious Health Condition:
- An illness, injury, impairment, or physical or mental condition that involves:
- Inpatient care (i.e., an overnight stay) in a hospital or residential medical care facility.
- Continuing treatment by a health care provider.
- Ordinarily, unless complications arise, the common cold, the flu, upset stomach, headaches other than migraine, routine dental or orthodontia problems, etc., are examples of conditions that DO NOT meet the definition of a serious health condition and DO NOT qualify for FMLA leave.
A serious health condition involving continuing treatment by a health care provider and includes any one or more of the following:
- Incapacity for more than three consecutive calendar days.
- Any incapacity due to pregnancy or for prenatal care.
- Any period of absence to receive multiple treatments.
- Intermittent Leave: Leave taken in separate periods of time due to a single illness or injury may include leave of periods from an hour or more to several weeks. Examples may include medical appointments and/or recovery from a serious health condition.
Any rolling 12-month period in which an eligible employee is entitled to 12 weeks of leave.
A husband or wife as defined or recognized under State law.
Biological, adopted, or foster child; a stepchild, a legal ward, or a child of a person standing in loco parentis, who is under 18 years of age or 18 years of age or older and incapable of self-care because of a mental or physical disability.
Biological, adoptive, stepparent or an individual who stands/stood in loco parentis to an employee.
This information is intended as a general overview of Central Washington University's FMLA procedure.
For more information please view the FMLA in the CWU Policies Manual. Classified and exempt staff can also contact Human Resources at 963-1202. Faculty should contact the appropriate Dean's Office.