1. Complete FMLA request form, clearly stating how they wish to charge their time.
Include any request for sick at ½ pay or additional sick leave. Employee must complete
accrual summary section.
2. Provide doctor's note with request to supervisor.
3. Provide "Return to Work" doctor's note to supervisor.
1. Sign request
2. Verify documentation.
3. Send forms to Office Staff charged with completing the appointment form(s).
(Do not keep copy of medical documentation).
4. Repeat procedure if leave is extended.
5. E-mail/Fax/Call the Office of Human Resources when in receipt of employee "Return to
Work" doctor's note. *Employee may not return to work without documentation.
Office Staff Charged with Completing Appointment Form(s)
1. Complete Appointment Status Change Form clearly indicating dates of leave, include
how charging accruals in remarks.
2. Forward all three forms (employee request, doctor’s certification (note), and
Appointment Status Change form) to Human Resources.
3. Complete a return from leave appointment status change form and forward to the office
of Human Resources.
1. Complete letters of notification to employees, copy department.
2. Data entry for any leaves that affect benefits/service credit.
3. Monitor Leave end date. Process a Leave without Pay if appointment form and
documentation not received prior to end date.