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How to prepare Form WH-380-E

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About Form WH-380-E

Important Notice: If you are taking FMLA leave as a result of a new job, you must be provided notice that your request for FMLA leave has been approved by the employment office. Employers that are covered by the Family and Medical Leave Act (FMLA) must provide employers with written leave policies, including any restrictions, requirements, or penalties for non-compliance (see Fact Sheet #5 — Employer Notification Requirements Regarding Family and Medical Leave Act Leave). It is unlawful for an employer to make any false or misleading statements in connection with a request for FMLA leave. In addition, employers will continue to be subject to enforcement actions, including fines, for having employees without valid medical coverage leave the employer's work. It is illegal to retaliate against a supervisor or other employee who requests leave for his or her own medical condition. It is also illegal to pay, provide, or offer money, employment benefits, or any other thing of value to employees for requesting FMLA leave. If your leave is approved, you may be eligible to be reimbursed for actual expenses. A leave from work under the FMLA can last from any time to any of the following: 12 workweeks in all, except that you can take a leave of absence only for a total of 26 workweeks. To qualify, you have to meet any of the requirements for an absence under FMLA. If you do not satisfy one or more of those requirements, you do not qualify for FMLA leave. Eligibility To be eligible for FMLA leave, you must be: A member of the Armed Forces of the United States or Armed Forces Reserve (or former members of those armed forces). An employee, because of the length or severity of your own serious medical condition arising from or aggravated by service in the uniformed services. A member of the Commissioned Corps of the National Oceanic and Atmospheric Administration (NOAA), National Science Foundation (NSF), National Oceanic and Atmospheric Administration National Marine Fisheries Service, or U.S. Customs and Border Protection, and the eligible employee has completed any period of continuous active service during which they were assigned to work at all times while on leave under FMLA. Part-time employees with two or more full-time employees who perform the essential functions of their jobs.

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Video instructions and help with filling out and completing Form WH-380-E

Instructions and Help about Form WH-380-E

Welcome to module 2 in this module we'll review the forms provided by the Department of Labor for family medical leave situations the website address for the Department of Labor is located in the top left-hand corner of the screen WW DOL gov this form entitled “Certification of Health Care Provider for Employees Serious Health Condition” is the form that a supervisor should give to an employee when he or she is taking a leave for his or her own serious health condition this form is also referred to as form WH 380 II Section 1 of the form is for the supervisor to complete and as you can see it's very brief it asks with the employer name and contact information the employee's job title and regular work schedule and the essential job functions if you don't wish to list the essential job functions you can simply attach a job description one thing to note is the paragraph above that states that employers must keep all the medical records related to Family Medical Leave and that these records should be kept outside the personnel file because they contain confidential medical information the next section of the form is for the employee to complete and as you can see it's very brief it only asks for the employee's name right above the employees name is a sentence that we should note it states here your employer must give you at least 15 calendar days to return this form so when the employee takes the form to his or her doctor they are entitled to 15 calendar days to get it back to the employer if you don't receive the form back within the 15 days please call Human Resources and will contact the employee and assist you with getting the...