FMLA Information Letter to Employee
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FAQ
The FMLA entitles eligible employees of covered employers to take unpaid, job-protected leave for specified family and medical reasons with continuation of group health insurance coverage under the same terms and conditions as if the employee had not taken leave.
Dear (Supervisor / HR Manager): Please be advised that I hereby request an FMLA leave for a period of (number of weeks) in connection with my serious health condition. The leave is to start on (date). Attached is my medical note reflecting the need for FMLA leave.
The FMLA permits employers to request a doctor's note or medical certification when an employee first requests leave under the FMLA. If the employee is on extended leave, a doctor's note can be requested every 30 days.
You need leave under the Family & Medical Leave Act (FMLA). Your employer gives you a form to have your doctor fill out certifying your need for leave under the FMLA.Under the FMLA, an employer can request that you have your doctor complete a form certifying your need for leave under the FMLA.
Understand your legal rights regarding time off and pay. Make the request in person. Give sufficient advance notice. If possible, work with your boss to develop an agreeable plan. Keep track of relevant paperwork.
Employers may use Form WH-381, which is available at no cost from the WHD website at www.dol.gov/agencies/whd/fmla, to provide notice of eligibility and rights and responsibilities. Employers must be responsive to answer questions from employees concerning their FMLA leave.
When an employee requests FMLA to care for a family member with a serious health condition, the same documents are mailed to the employee -- leave of absence request form, certification for the doctor to complete and the official notice that contains the rights and responsibilities of the employee and the employer.
Provide complete employee contact information, which includes name, address, and phone number. Include the date you will submit the letter. Include the supervisor or manager's name. Include supervisor or manager's title. Add the company name. Include the company's location.
In order to determine your eligibility for FMLA leave, however, your employer does need to know the reason you need the time away. So if you are staying out due to a medical condition, you are obligated to disclose it if the employer asks.