Personal Health Leave
A serious health condition is an illness, injury, impairment, or physical or mental condition that also involves:
- Inpatient care in a hospital, hospice, or a residential medical care facility.
- More than three (3) consecutive days of incapacitation plus continuing treatment by a health care provider.
- Incapacity due to pregnancy or for prenatal care.
- Permanent or long-term conditions.
- Ongoing treatment for a condition that, if left untreated, would result in an incapacity of more than three (3) consecutive days.
Intermittent Leave
Employees approved for intermittent leave for their own serious health condition are not required to submit a return-to-work notification after each absence/flare-up. Employees and supervisors are required to track and submit intermittent FMLA usage on the monthly Intermittent Family and Medical Leave Time Tracking Report (link requires VPN).
How to Apply
Submit BOTH items below to Leave Administration for consideration of the FMLA request.
- A completed Family and Medical Leave Act Request Form (link requires VPN). (The employee’s supervisor may submit a request form on behalf of the employee if the employee is hospitalized one (1) night or incapacitated or unavailable for more than three (3) consecutive days.)
- A completed form WH-380-E Certification of Health Care Provider for Employee's Serious Health Condition. (Supervisors should never receive/retain this information.)
Questions about leave?
Leave Administration
214-648-9840