Using FMLA for 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.
Please review this Policy Update effective Oct. 5, 2025.
Intermittent Leave
Employees must report their Intermittent Leave/Reduced Work Schedule FMLA leave usage to their supervisor or timekeeper but will no longer need to report it via the Intermittent Leave Tracking form. Supervisors and timekeepers must enter the Intermittent/Reduced Work Schedule FMLA leave usage on behalf of the employee by the end of the pay period to ensure there is no impact to the employee’s pay or accruals.
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