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Employee documents

Employer leave of absence agreement

Record the work location, requested leave and agreed arrangements. Use the medical FMLA or parental interview to record an existing decision and the notices actually supplied. Incomplete or inconsistent terms produce an unsigned worksheet.

Choose the leave record

Medical accommodation and staying at work

Record an oral or written request and the actual discussion. An agreed schedule, workstation change or finite extension can be documented without calling a missed deadline or a job elimination a resignation. Consider ongoing work and separate leave options. For a pregnancy-related limitation, an employer cannot require leave if another reasonable accommodation can be provided. Send necessary supporting information to a confidential channel and share restrictions with managers. Review state and local law separately.

EEOC guidance on leave as an accommodation · Pregnant Workers Fairness Act

Employer coverage and employee eligibility

Check the employer’s category and workforce history, the employee’s service and the applicable worksite. Private employers ordinarily need at least 50 employees in 20 or more workweeks in the current or preceding calendar year. Public agencies and elementary or secondary schools have different employer coverage rules. The employee’s 50-within-75-surface-miles test is separate. For telework and mobile work, identify the reporting or assigning office. Check the special flight crew hours tests, service credits, federal employment and school or joint employment where applicable.

Federal FMLA definitions

Separate the two notice deadlines

The eligibility and rights process generally begins when the employer learns leave might qualify. The designation notice generally follows within five business days after the employer has sufficient information to determine whether the leave qualifies, absent extenuating circumstances. Track both deadlines and actual delivery. DOL forms WH-381 and WH-382 are optional formats. A compliant equivalent can be used. Record qualifying retroactive designation separately, including the notice and no-injury determination or mutual agreement.

DOL designation notice guidance

Record benefit and return arrangements

For a protected period, enrolled employees ordinarily keep group health coverage on the same terms and can return to the same or an equivalent position. Document the usual employee share of premiums and the actual terms. A return certification depends on the employee’s condition, policy and advance notice. Record the employer’s agreement for an intermittent bonding schedule and check separate state, local and contractual protections.

Federal restoration and benefit provisions

Employer leave examples

Compare the employment leave record, notices and designation.

Employer coverage and designation facts
Accommodation agreement or discussion
  • oral adjustment · PDF · Word
  • agreed early return · PDF · Word
  • discuss only · PDF · Word
  • private 19 weeks · PDF · Word
  • prior year size · PDF · Word
  • nonprivate routing · PDF · Word
  • unverified worksite · PDF · Word
  • unconfirmed qualification · PDF · Word
  • ada temporary suspension · PDF · Word
  • pregnancy stool · PDF · Word
  • pregnancy near future unknown · PDF · Word
  • pregnancy standard policy · PDF · Word
  • common request medical note · PDF · Word
  • already informed note · PDF · Word
  • reasonable limited request · PDF · Word
  • signed adaptive schedule · PDF · Word
  • blanket provider file · PDF · Word
  • individualized inquiry · PDF · Word
  • unexplained inquiry · PDF · Word
  • uniform work policy only · PDF · Word
  • managers receive files · PDF · Word
  • missing state review · PDF · Word
  • mixed wa ca · PDF · Word
  • finite extension · PDF · Word
  • no continuing work option · PDF · Word
  • compelled pregnancy leave · PDF · Word
  • finite dates reversed · PDF · Word
  • uncertain return · PDF · Word
  • contract disputed · PDF · Word
  • mitigation pending · PDF · Word
  • non ada other · PDF · Word
  • historical pay injection · PDF · Word