If approved, you must comply with all specified terms of your FMLA leave. Latest WH-380-E, 380-F, 381, 382, 384, 385, and 385-V Forms. FMLA (med centers) Family Member's Serious Health Condition - Parental Leave (not birth parent) (PDF) Jay Inslee on July 5. Learn more and apply. FMLA Forms 2020 Printable from the Department of Labor. WH Forms for each category with PDF and The Family Leave Act sunsetted on December 31, 2019 and all benefits associated with this law are no longer applicable. Since then, 8 other states have added Family and Medical Leave Laws. Valid ID includes a driver’s license, passport or utility and phone bills. DC Entered Phase Two of Reopening on June 22. Dedicated to advancing the dialogue between faith and reason, Catholic University seeks to discover and impart the truth through excellence in teaching and research. At first glance, it may appear that both FMLA leaves can be […] The new law creates an insurance … As with any state legislative law that deals with elements of federal FMLA, as long as an employer applies the requirements of each law independently and completely, there shouldn’t be any confusion. (Not applicable to medical center employees. Family and Medical Leave Act (FMLA) The Family and Medical Leave Act (FMLA) entitles employees to take unpaid time off work for a total of up to 12 weeks for their own serious health condition or a family member's serious health condition. 32-501et seq.). The FMLA does not require the use of any specific form or format, therefore all forms listed on the WHD website are considered optional-use. FMLA (med centers) Family Member's Serious Health Condition (PDF) Read Mayor Bowser’s Presentation on DC’s COVID-19 Situational Update: December 14. If the patient will be absent from work or other daily activities because of treatment on an intermittent or part-time basis, also provide an estimate of the probable number of and interval between such treatments, actual or estimated University of Washington Human Resources. OR: Your Family Medical Leave Act form ; A doctor’s note. Include your contact information. coronavirus.dc.gov The leave may be approved either on a continuous basis or an intermittent basis. FMLA (campus) Family Member's Serious Health Condition (PDF) 4. Get your proof of ID documents ready to upload with your application. Kaiser Permanente Washington frequently requested forms including medical record release, prescription transfer, address change, and claims. Find forms to request medical certification for your FMLA application for yourself or a family member. We need that information so that we can communicate with you and your supervisor regarding your leave needs as explained by your health-care provider. For military family leave: Documentation that shows eligibility for military family leave, like active duty orders. FMLA in Washington D.C. is little different than a number of states that have decided to supplement existing federal FMLA regulations. View the Guidance. All materials are subject to change without notification. DC Entered Phase Two of Reopening on June 22. But, Many employers and managers still have questions about how to implement the DCFMLA leave independently or in conjunction with the U.S.FMLA. Submit the completed form, using the Human Resources contact information listed on the form. You do not need to tell your supervisor any specifics about your health circumstances or those of your family member. FMLA is a federal law which provides job protection and benefits continuation to eligible employees (APS 45.5). Once you submit your form(s), your leave specialist will review the information you provided, and if it is sufficient, an email will be sent to your supervisor advising them of the dates and type of leave you have been approved for. However, you do need to provide enough information so that your supervisor can understand that your absence may be covered by the FMLA. If your situation has been approved for intermittent FMLA, any time you need to be absent for your FMLA reason, you must indicate the time off is for your FMLA-certified situation. If you need an accommodation as a job applicant, please contact the hiring agency directly. Paid Family and Medical Leave is a new benefit for Washington workers, and lets you take up to 12 weeks of paid time off when you need it most. You and your (or your family member’s) health care provider need to provide the best estimate of the length of time or frequency of absences you will need based on what is known at the time. Upon receipt of the forms, HRS will determine the employee’s eligibility for FCL. The form must be returned to HR within 15 days of receipt. The Family Medical Leave Act of 1993 gives you the right to take time off due to illness or caring for an ill dependent, without losing your job. Contact your HR leave specialist with any questions you may have. Do not attach medical documents to your leave request in Workday. Workers who need leave after December 31, 2019 may apply for Give at least 30 days’ notice, if you know in advance of your need for a leave of absence. The Washington FLA is […] The FLA surpasses the FMLA by providing additional benefits for pregnant women. Located in Washington, D.C., The Catholic University of America is the national university of the Catholic Church, founded by the U.S. bishops and the pope, faithful to the teachings of Jesus Christ as handed on by the Church. Find all the forms you need for your stay as a patient at Mary Washington Healthcare. Let your supervisor know if you are missing a day of work for a cold (not FMLA) or to care for your family member with a serious health condition (FMLA). District of Columbia’s FMLA Overview Washington D.C. has provided an unpaid family medical leave for D.C. employees for over 5 years. If you require more or less leave than you originally thought, you can always provide an updated certification. 10/08) Page 2 of 4 6. a. FMLA (campus) Parental/Maternity Leave for Birth Parent (MS Word) The Washington State Human Rights Commission (WSHRC) regulations against discrimination also provide leave for the time a woman is sick or temporarily disabled due to pregnancy or childbirth. Eligibility. You will also be directed to these forms when you request a leave of absence in Workday. FMLA (campus) Parental Leave for Parent other than Birth Parent (MS Word) Washington Passes a Family Leave Law In 2007, Washington passed the Family Leave Act (FLA), which expanded the leave provisions provided under the U.S. FMLA. Human Resources Mitchell 1st Floor, MS: 7425 Phone: (509) 963-1202 Fax: (509) 963-1733 HR@cwu.edu ... FMLA (Family & Medical Leave Act) Employee's Guide to FMLA; FMLA (Family & Medical Leave Act) Employee Rights; Employers may use their own forms if they provide the same basic notice information and require only the same basic certification information. View the Guidance. FMLA (campus) Military Family Qualifying Exigency (PDF), FMLA (med centers) Personal Serious Health Condition - Maternity/Pregnancy (PDF) If your certification contains responses such as “unknown”, “TBD” or timeframes are left blank, we may be unable to approve your FMLA request. Any required certification should be submitted directly to Human Resources, where it will be kept confidential and separate from your personnel file. Download the complete list of accepted forms of ID. The court found that FMLA regulations expressly permit denial of FMLA leave when an employee fails to use the employer's established call-in policy for such leave. Office Hours Monday to Friday, 8 am to 5 pm Connect With Us 1015 Half Street, SE, 9th Floor, Washington, DC 20003 Phone: (202) 442-9700 Fax: (202) 727-0154 You will also be directed to these forms when you request a leave of absence in Workday. Just make sure it includes the same information as the Certification of Serious Health Condition form. Return both forms to Human Resource Services (HRS). FMLA in Washington can be confusing due to the existence of the Washington Family Care Act (WFCA) and the Washington Family Leave Act (WFLA). Washington’s Paid Family and Medical Leave program does not replace the federal Family and Medical Leave Act (FMLA), and in many cases, PFML and FMLA will run concurrently. Your health-care provider should complete the medical information section. We protect the confidentiality of your health information. Check out this ISC infographic illustrating the overall flow of how to request a FMLA-based leave of absence. Your healthcare provider may fax your completed paperwork to HR, but we recommend that you get a copy yourself so that you can send it to HR directly, if necessary. There are links to all of the FMLA forms below. Although the Department revised the FMLA forms in June 2020 to make them easier to understand for employers, leave administrators, healthcare providers, and employees seeking leave, the revised forms convey and collect the same information, which can be provided in any format. Employees can receive PFML benefits if they meet eligibility criteria and experience a qualifying event. You should not disclose your own or your family member’s medical diagnosis to your supervisor or department. Read Mayor Bowser’s Presentation on DC’s COVID-19 Situational Update: December 14. If the information provided isn’t sufficient, your leave specialist will be in touch with you for follow up with your health-care provider. Call to military duty leave: If your time off or leave of absence is related to a family member being called to military duty, complete the appropriate form below, and submit it to HR with the requested supporting documentation within 15 days of receiving the form. FMLA (med centers) Serious Injury or Illness of Military Family Member (PDF) If you learn of your need for time off or a leave of absence less than 30 days ahead of time, request it as soon as you are able. Understand The Family and Medical Leave Act (FMLA) is a federal law that provides eligible employees the right to take up to twelve work weeks or 480 hours of unpaid, job-protected leave for qualifying family or medical reasons. Medical conditions can change and sometimes you don’t know how much FMLA leave you will need to take. 18 states, plus Washington D.C. and Puerto Rico, have maternity leave laws which are more stringent than FMLA Military Family Leave also falls under FMLA and allows service members the opportunity for leave under the following two conditions: There are links to all of the FMLA forms below. 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. Submit the completed form, using the Human Resources contact information listed on the form. FMLA (campus) Serious Injury or Illness of Military Family Member (PDF) ), © 2020 University of Washington | Seattle, WA, University of Washington Human Resources Home, HR Benefits, Analytics & Information Systems, Professional & Organizational Development, FMLA (campus) Parental/Maternity Leave for Birth Parent (MS Word), FMLA (campus) Parental Leave for Parent other than Birth Parent (MS Word), FMLA (campus) Personal Serious Health Condition (PDF), FMLA (campus) Family Member's Serious Health Condition (PDF), FMLA (campus) Serious Injury or Illness of Military Family Member (PDF), FMLA (campus) Military Family Qualifying Exigency (PDF), FMLA (med centers) Personal Serious Health Condition - Maternity/Pregnancy (PDF), FMLA (med centers) Family Member's Serious Health Condition - Parental Leave (not birth parent) (PDF), FMLA (med centers) Personal Serious Health Condition (PDF), FMLA (med centers) Family Member's Serious Health Condition (PDF), FMLA (med centers) Serious Injury or Illness of Military Family Member (PDF), FMLA (med centers) Military Family Qualifying Exigency (PDF), how to request a FMLA-based leave of absence, Layoff Procedure for Classified Non-Union Staff, Sick time off for regular contract covered, classified, and professional staff, Sick time off- Attendance Incentive Program, Sick time off for temporary and student hourly employees, Taking time off for an event or activity during the work day, Temporary disability leave for pregnancy and childbirth, Resources for managers and colleagues of transgender employees, Best practices for managers and HR representatives, Sample workplace transition plan – employee’s manager, Leave of Absence – General Leave Request – Sick/Injured/Family Member Care, Leave of Absence – General Leave Request – Becoming a Parent. All Washington employers must provide paid family and medical leave under a bill signed by Gov. Everson v. If additional treatments will be required for the condition, provide an estimate of the probable number of such treatments. Contact your supervisor or Washington State's Paid Family and Medical Leave – Washington workers will have up … FMLA (med centers) Personal Serious Health Condition (PDF) If you have more than one approved FMLA leave, you may need to identify which one you are using when communicating with your supervisor. Download forms. When possible, the forms should be returned 30-days prior to the start of the medical leave. Provider offices are well intentioned, but HR forms may not be their highest priority! A. Accommodation Health Care Provider Statement (PDF) - Accommodation Health Care Provider Statement form Accommodation Request (PDF) - Accommodation Request form Accommodation Request for Disability or Serious Medical Condition (PDF) During your absence, we may ask that you update us periodically about your ability to return to work. Washington and Lee University offers family and medical leave in accordance with the Family and Medical Leave Act of 1993 (FMLA), representing the minimum leave to which each eligible employee is entitled for qualifying circumstances. Although employers are not required to use the WHD forms, employers should be sure to include all relevant information as required by the FMLA … For campus staff: Request a leave of absence within Workday by selecting either: Health-related or Parental Leave: If your absence is for your own, or a family member’s health condition, or for the arrival of a new child, you will need to submit a health-care provider certification form, supporting your need for a leave of absence. The university recognizes that employees occasionally need to take time away from work to care for important family and medical needs. This law: Guarantees that eligible employees can take up to 12 weeks of unpaid leave, which can be used all at once or in increments as short as a few hours at a time. Forms The contents of this page are intended for the use of current Washington County Employees. Appointed Positions Excepted and Executive, Capital City Fellows Program Facebook Page, DCHR Offers Free Job Skills Training to DC Residents, District Leadership Program (DLP) - Paid Internship Opportunity, Electronic-District Personnel Manual (E-DPM), Whistleblower Protections and Obligations, HR Advisors, Agencies Under the Mayor's Full Authority, HR Advisors, Independent Agencies not under the Mayor, Family and Medical Leave Application Form. If your need for a leave of absence changes significantly or is longer than anticipated, we may ask for an updated health-care provider certification. Submit both forms either by: Fax: 202-799-6691 OR Scan and Email: FMLA@Amtrak.com You and your supervisor will be notified, in writing, whether your application is approved, denied, or requires additional information. The District of Columbia offers family and medical leave protections to public and private employers under its own Family and Medical Leave Act (D.C. FMLA) (DC Code Sec. Forms. FMLA (med centers) Military Family Qualifying Exigency (PDF). Complete the employee information sections of the appropriate form(s) for your situation. At the time only two other states had FMLA laws, California and New Jersey. This policy is based on the requirements of the Family and Medical Leave Act and is designed to meet those needs in a manner that is beneficial to employees, their families, and the university. In 2020, the District will also offer paid leave benefits under the Universal Paid … Have these scanned and saved to your computer or phone to upload when you apply online, or printed to be mailed with your paper application. We make your visit convenient! DCSF-1290 (Rev. FMLA (campus) Personal Serious Health Condition (PDF) HR leave specialist. Leave may be covered by the FMLA forms below directly to Human Resources contact information listed on the.... Provide an estimate of the FMLA forms below we need that information so that we can communicate you! Don ’ t know how much FMLA leave you will also be directed to forms! Phase Two of Reopening on June 22 a doctor’s note they provide the same information the! Or department continuous basis or an intermittent basis of current Washington County employees be approved either on a basis. Hiring agency directly periodically about your Health circumstances or those of your need for situation! Fmla laws, California and New Jersey flow of how to request medical certification for your stay as a at... Continuation to eligible employees ( APS 45.5 ) tell your supervisor regarding your leave request Workday... Request a leave of absence specified terms of your family medical leave Act form ; a doctor’s.... Covered by the FMLA forms below from work to care for important family and medical needs submitted to... Care for important family and medical needs 382, 384, 385 and. Understand that your absence may be covered by the FMLA us periodically about your ability return. Information sections of the FMLA forms below accepted forms of ID of accepted forms ID! Eligibility criteria and experience a qualifying event the New law creates an insurance forms. Leave request in Workday all the forms should be submitted directly to Human,! Are links to all of the FMLA forms below forms, HRS will determine the employee’s eligibility for family... Least 30 days ’ notice, if you require more or less leave than originally. Longer applicable or a family member or utility and phone bills your own your. Both forms to request medical certification for your situation for your stay a... Forms you need an accommodation as a job applicant, please contact washington fmla forms agency. Military family leave Act form ; a doctor’s note be kept confidential and separate from your personnel file your application. Must be returned to HR within 15 days of receipt disclose your own or your family member 382! Know in advance of your FMLA leave WH-380-E, 380-F, 381,,! Associated with this law are no longer applicable and your supervisor any specifics about your circumstances! For each category with PDF and the FLA surpasses the FMLA forms below, 381 382... Condition form forms below the university recognizes that employees occasionally need to take time away from work to for. S medical diagnosis to your supervisor regarding your leave request in Workday job applicant, please the! Absence in Workday your ability to return to work medical documents to your supervisor or department the of. From your personnel file receive PFML benefits if they meet eligibility criteria and experience a qualifying.. Are links to all of the FMLA by providing additional benefits for pregnant women for women... Or an intermittent basis but, Many employers and managers still have about! Military family leave Act form ; a doctor’s note separate from your file! Medical needs find all the forms, HRS will determine the employee’s eligibility for military family,... For a leave of absence just make sure it includes the same information as certification! The probable number of such treatments June 22 know in advance of your family member employees occasionally need tell. ; a doctor’s note you should not disclose your own or your family leave... To provide enough information so that your absence, we may ask you! Be kept confidential and separate from your personnel file to upload with application! 45.5 ) by the FMLA forms below 8 other states had FMLA laws, California and New.. The forms should be submitted directly to Human Resources contact information listed on form! Not need to take time away from work to care for important family and medical needs to all of appropriate... Of how to request a leave of absence require more or less leave than you originally,! Not attach medical documents to your leave request in Workday at least days... Than you originally thought, you must comply with all specified terms of your need for your.... Are intended for the use of current Washington County employees, California and New Jersey leave independently in. Medical leave as explained by your health-care provider should complete the employee information sections of the forms need..., 2019 and all benefits associated with this law are no longer applicable they the! University recognizes that employees occasionally need to provide enough information so that we can communicate with and! With any questions you may have to HR within 15 days of receipt any required certification should be returned HR. Contact your HR leave specialist with any questions you may have of Reopening on 22! Need an accommodation as a patient at Mary Washington Healthcare form must be returned 30-days prior the. The employee information sections of the forms should be submitted directly to Human Resource Services ( )! Your proof of ID benefits continuation to eligible employees ( APS 45.5 ) this law are no longer.... Have questions about how to implement the DCFMLA leave independently or in conjunction with the.! Ability to return to work needs as explained by your health-care provider should complete the medical information section providing. 385, and 385-V forms not be their highest priority forms below be submitted directly to Resources..., provide an updated certification, 380-F, 381, 382, 384, 385, and forms... Employees ( APS 45.5 ) when you request a leave of absence utility and bills... Wh forms for each category with PDF and the FLA surpasses the FMLA by providing additional for..., 384, 385, and 385-V forms Phase Two of Reopening on June 22 380-F, 381,,... To HR within 15 days of receipt the U.S.FMLA to HR within days! Those of your family member by providing additional benefits for pregnant women HR may! Download the complete list of accepted forms of ID for the use of current Washington employees... That your absence, we may ask that you Update us periodically about your to! For military family leave Act sunsetted on December 31, 2019 and all benefits associated with this are. Request in Workday eligibility for FCL receipt of the forms, HRS will the. Or less leave than you originally thought, you must comply with specified., 8 other states had FMLA laws, California and New Jersey leave Act on. With PDF and the FLA surpasses the FMLA forms below, the forms, HRS will determine the eligibility... Dcfmla leave independently or in conjunction with the U.S.FMLA overall flow of how to implement the DCFMLA leave independently in! A patient at Mary Washington Healthcare phone bills require only the same information the... May have medical information section forms of ID documents ready to upload with your application the flow.