ACD 702–03 Table

Medical Leave

The chair, director, or supervisor:

1. determines in consultation with Human Resources (HR) whether the employee meets the requirements to qualify for the Family Medical Leave Act (FMLA).
2. if the employee qualifies for FMLA:
   
   
   1. informs the employee that the leave (up to 12 weeks) will be designated as FMLA

      and

   2. provides the employee with the following forms within two business days: a Leave Request form and a certification of Health Care Provider form with a copy of the employee’s job description attached.

If the request for leave is due to the employee’s own serious health condition, the chair, director, or supervisor:

1. notifies the employee in writing within two business days of the following information:
   
   
   1. eligibility for FMLA
   2. leave designation
   3. benefits options
   4. sick and/or vacation options
   5. requirement for medical reports every two weeks
   6. requirement for recertification at 30-day intervals

      and

   7. requirement for a return-to-work slip before returning to work

   and

2. records sick/vacation leave, as applicable.

   Note: Keeping a log of each employee’s leave designation assists in determining future eligibility.

The employee:

1. completes and returns the Leave Request form along with the Certification of Health Care Provider form from the physician for self, spouse, member of the employee’s established household, child, or parent, as applicable
2. contacts HR regarding options
3. contacts the department every two weeks to provide an update on the leave
4. submits to the department every 30 days a new Certification of Health Care Provider form completed and signed by the physician

   and

5. obtains a return-to-work slip from the doctor to present to the department before returning to work.

Child Care Leave

Follow the Medical Leave procedure above, but do not attach a copy of the employee’s job description to the Certification of Health Care Provider form.

Return to ACD 702–03.