Family and Medical Leave Forms

The Family and Medical Leave Act (FMLA) allows eligible employees who work for covered employers up to 12 weeks of unpaid, job-protected leave during any 12-month period for specific family or medical reasons. In addition, most state and local laws offer protected leave to qualified employees. Under FMLA, both employers and employees are covered by certain rights and responsibilities. This collection of attorney-reviewed, digital forms includes notices and information required under federal, state, and local laws.

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  • Employee Family Relationship Statement Form (FMLA) – WorkWise Compliance
    Employee Statement of Family Relationship Under the FMLA Form - Digital

    An attorney-reviewed digital form to confirm a covered employee’s relationship to their family member when they are requesting FMLA leave to care for the family member.

    $4.99
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  • WorkWise Compliance FMLA Notice of Eligibility and Rights Form WH-381
    Notice of Eligibility & Rights and Responsibilities Under the Family and Medical Leave Act (Form WH-381) - Digital

    An attorney-reviewed digital form to inform an employee of their eligibility for FMLA leave or at least one reason why they are not eligible, as well as additional required information.

    $4.99
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  • FMLA Designation Notice Form WH-382 – WorkWise Compliance
    Designation Notice Under the Family and Medical Leave Act (Form WH-382) - Digital

    A digital, attorney-reviewed form to inform an eligible employee of the outcome of their family and medical leave request and the amount of leave that will be designated.

    $4.99
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  • WorkWise Compliance Employee Coverage Discontinuation Form
    Discontinuation of Coverage Form - Digital | WWC

    An attorney-reviewed digital form to notify an employee that their 12 weeks of job-protected family- or medical-related leave has expired.

    $4.99
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  • Clarification from Health Care Provider Form – WorkWise Compliance
    Clarification from Health Care Provider Form - Digital | WWC

    A digital, attorney-reviewed form to request clarification and authentication from a health care provider in response to a request for family- or medical-related leave.

    $4.99
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FAQs

What is the Family and Medical Leave Act (FMLA) and who is eligible for it?

The Family and Medical Leave Act (FMLA) is a federal law that provides eligible employees with up to 12 weeks of unpaid, job-protected leave for specific family and medical reasons. To qualify, an employee must have worked for a covered employer for at least 12 months, completed at least 1,250 hours of service during the previous 12 months, and work at a location where the employer has 50 or more employees within 75 miles.

Which employers are required to comply with FMLA?

Covered employers include private-sector companies with 50 or more employees in 20 or more workweeks during the current or previous calendar year, public agencies at the state or local level, and all public and private elementary or secondary schools. These employers must provide eligible employees with FMLA leave and comply with notice, recordkeeping, and benefit continuation requirements.

How many weeks of leave does FMLA provide, and can it be taken intermittently or on a reduced schedule?

Eligible employees may take up to 12 workweeks of unpaid leave in a 12-month period for qualifying reasons. They may take up to 26 workweeks of leave to care for a covered service member with a serious injury or illness. Leave may be taken intermittently or on a reduced schedule when medically necessary.

What reasons qualify for leave under FMLA, including caring for a family member or personal medical needs?

Employees may take FMLA leave for several reasons, including:

  • The birth of a child or placement of a child for adoption or foster care
  • Bonding with a newborn or newly placed child
  • Caring for a spouse, child, or parent with a serious health condition
  • The employee’s own serious health condition that prevents them from working
  • Certain qualifying military family needs, including caring for a covered service member
Can FMLA leave be used to bond with a newborn, newly adopted, or foster child?

Yes. Eligible employees may use FMLA leave for the birth or placement of a child and to bond with that child within one year of birth or placement. Bonding leave may be taken intermittently only with the employer’s approval.

How do employees maintain health insurance and other benefits during FMLA leave?

Employers must continue group health insurance coverage during FMLA leave under the same terms as if the employee were still working. Employees may need to continue paying their share of health premiums. Other benefits, such as paid time off or retirement contributions, are handled according to company policy and may be paused during unpaid leave.

What rights do employees have while on FMLA leave, including job protection?

Employees taking FMLA leave are entitled to return to the same or an equivalent position with the same pay, benefits, and conditions. Employers are prohibited from interfering with, restraining, or retaliating against employees for using their FMLA rights. Health coverage continues during leave, and employees keep their seniority and accrued benefits in line with company policies.

What documentation is required to request FMLA leave, and is there a waiting period to access benefits?

Employees must provide at least 30 days’ notice if the need for leave is foreseeable. If the need is unexpected, notice should be given as soon as possible. Employers may request medical certification to support the need for leave and must give employees at least 15 days to submit the form. There is no waiting period to access FMLA leave once eligibility requirements are met.

What notice must an employee give their employer before taking FMLA leave?

Employees should provide 30 days’ advance notice whenever the need for leave is known in advance. When advance notice is not possible, employees must notify their employer as soon as practicable. Employers must display an FMLA rights poster and give written notice of rights and responsibilities to any employee requesting leave.

How do federal FMLA rules interact with state paid family and medical leave laws?

The FMLA does not override state laws that provide greater employee rights. If an employee qualifies for both federal and state leave, the leaves may run at the same time. Employers must comply with both laws and clearly explain how they coordinate federal and state benefits to employees.

Does FMLA cover all employers and employees, or are there exceptions?

Small private employers with fewer than 50 employees within a 75-mile radius are generally not covered by the FMLA. Employees who have not yet met the 12-month service or 1,250-hour work requirement are also ineligible. Certain flight crew employees have separate eligibility standards under the Airline Flight Crew Technical Corrections Act.

What are employer obligations related to FMLA and family and medical leave?

Employers must:

  • Post notices explaining FMLA rights
  • Provide written information about eligibility and responsibilities
  • Designate qualifying absences as FMLA leave
  • Maintain health benefits during leave
  • Restore employees to their positions after leave ends
  • Keep accurate records and avoid any interference or retaliation against employees using FMLA leave
  • Failure to meet these obligations can result in penalties or legal action
How does FMLA leave apply to serious health conditions, including mental health or routine medical appointments?

A serious health condition includes any illness, injury, impairment, or physical or mental condition that requires inpatient care or continuing treatment by a healthcare provider. Mental health conditions can qualify if they require ongoing care. Employees may also use intermittent leave for medical appointments or treatment related to such conditions. Routine checkups generally do not qualify unless they are part of ongoing treatment for a serious condition.