Set of FMLA Forms

For companies with 50 or more employees who are responsible for complying with the federal Family Medical Leave Act (FMLA) law, the following forms will assist you in meeting your regulatory deadlines when administering FMLA leaves of absence.

FMLA Checklist – This is an invaluable checklist for you to use and keep in an employee’s file to ensure that you complete your legal and administrative obligations when an employee requests an FMLA leave. This checklist allows you to record your compliance with the FMLA guidelines regarding an employee’s FMLA leave. This checklist becomes your proof of compliance with the FMLA in the event of a legal challenge. This form is to be completed for each FMLA leave requested.
FMLA Letter to Employee – This is a letter to be sent to an employee who is seeking a FMLA leave which provides a check-off of the forms that you are required to provide to the employee. This document would be mailed or handed to an employee with a copy filed in the employee’s personnel folder. It becomes your proof of compliance with the FMLA in the event of a legal challenge.
FMLA Poster – This is the most recent (1/09) FMLA poster on standard letter format that must be sent to the employee to fully advise the employee of his/her FMLA rights.
FMLA Sample Policy – This is a sample FMLA policy for you to include in your Employee Manual.
FMLA Leave Request – This is the form an employee completes when requesting a FMLA leave. When this form is completed and returned to you, you must respond within the required time limits as noted on the “FMLA Checklist.”
FMLA DOL Fact Sheet (Non-Military) – For non-servicemember FMLA leave requests, you are to provide this Department of Labor (DOL) fact to an employee.
FMLA DOL Fact Sheet Military – For servicemember or military FMLA leave requests, you are to provide this DOL fact to an employee.
FMLA Notice of Eligibility & Rights – This is your company’s notice to an employee of his/her eligibility for a FMLA leave as well as his/her rights relative to amount of time, use of accrued paid days such as sick days, etc.
Medical Certification Release Authorization – Whenever you require an employee to submit a “FMLA Certification of Health Care Provider” form, you must also give the employee this form. This form authorizes the employee’s or a family member’s physician to release the completed Certification to the employer.
FMLA Certification of Health Care Provider Employee – This document is to be used by an employee’s physician to document the employee’s personal illness when an employee is seeking a FMLA leave under the medical guidelines.
FMLA Certification of Health Care Provider Family Member – This document is to be used by the physician of an employee’s family member to document the illness of the family member when an employee is seeking a FMLA leave under the medical guidelines.
Certification of Qualifying Exigency for Military FMLA – This is the certification form that an employee must complete when requesting a FMLA leave under the exigency provisions for military personnel in the reserves or national guard.
Certification for Military Caregiver Leave – This is a certification form that an employee must complete when requesting a FMLA leave under the military caregiver provisions.
FMLA Designation Notice – This form is your company’s official notice of approval or denial of a FMLA leave request.
FMLA Days Off Worksheet: – This worksheet takes the guess work out of how many FMLA days an employee has remaining and eliminates having to count calendar days to determine when the 12-week FMLA leave will end. This Excel spreadsheet automatically computes the 12-week FMLA period from first day to last day and also automatically tracks Intermittent and Non-Intermittent time used to show the balance of time remaining.
FMLA Days Off Worksheet SAMPLE – This is a filled out sample of the “FMLA Days Off Worksheet” to show you how easy it is to maintain.

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