• Utilize one of the following templates to submit your letter requesting FMLA to your site supervisor:

         FMLA Absence - 
    Employee's Serious Health Condition
         FMLA Absence - 
    Family Member's Serious Health Condition

  • Site Supervisor will submit Letters for FMLA Leave to Human Resources

  • Human Resources will provide "Eligibility and Rights & Responsibilities Notice" (ERRN) to employee

  • The employee must submit the completed ERRN and Certification of Health Care Provider forms (see above) to Human Resources. The FMLA permits an employer to require that you submit a timely, complete, and sufficient medical certification to support a request for FMLA leave due to your own serious health condition.  You have 15 calendar days to return these forms to the Department of Human Resources.

  • Employee will receive a Designation Notice.


Advanced Leave

An employee must give at least 30 days advance notice of the need to take FMLA leave when he or she knows about the need for the leave in advance and it is possible and practical to do so.  

If 30 days advance notice is not possible because the foreseeable situation has changed or the employee does not know exactly when leave will be required, the employee must provide notice of the need for leave as soon as possible and practical.

For planned medical treatment, the employee must consult with his or her employer and try to schedule the treatment at a time that minimizes the disruption to site operations.  The employee should consult with the employer prior to scheduling the treatment in order to arrange a schedule that best suits the needs of both the employee and the employer.  Any schedule of treatment is subject to the approval of the treating health care provider.


When the need for leave is unexpected, the employee must provide notice as soon as possible and practical.  It should usually be reasonable for the employee to provide notice of leave that is unforeseeable by the next business day.  Whether the employee's notice of unforeseeable leave is timely will depend upon the facts of the particular case.