W/FMLA - RELATED FORMS
Employee Request for Family and/or Medical Leave (UWS 80) -
employee completes this form to request W/FMLA-protected leave.
An employee who requests a WFMLA leave to care for a domestic
partner or a domestic partner's parent must complete this form
in order to certify the domestic partnership for WFMLA purposes.
Notice of Eligibility and Rights & Responsibilities (UWS 81)
- employer gives this completed form to the employee to inform
the employee of eligibility to use W/FMLA leave, to outline any
information needed by the employee to certify the reason for
leave and to notify the employee of rights and responsibilities.
Certification by Health Care Provider for Employee's Serious
Health Condition (UWS 82) - employee's health care provider
must complete this form to certify the employee's serious health
condition if an employee is taking a concurrent FMLA and WFMLA
leave. Note regarding employees who take a WFMLA leave only - If
an employee is taking a WFMLA only leave (employee does not
qualify for federal FMLA), the employee should use the WFMLA
compliant form,
UWS
82a, to certify his or her own serious health condition.
Certification by Health Care Provider for Family Member's
Serious Health Condition (UWS 83) -the employee's family
member's health care provider must complete this form to certify
the family member's serious health condition if an employee is
taking a concurrent FMLA and WFMLA leave. Note regarding
employees who take a WFMLA leave only - If an employee is taking
a WFMLA only leave (employee does not qualify for federal FMLA
and/or the employee is taking a leave to care for a domestic
partner or a domestic partner's parent), the employee should use
the WFMLA compliant form,
UWS
83a, to certify a family member's serious health condition.
Certification of Qualifying Exigency for Military Family Leave
(UWS 84) - an employee must complete this form to certify the
exigency that was created because a family member was called to
active military duty from a reserve status.
Certification of Serious Injury or Illness of Covered
Servicemember for Military Leave (UWS 85) - an employee must
complete this form if the employee wants FMLA-protected leave to
care for a covered military servicemember who is a family member
or next of kin and who is seriously ill or injured due to
military service
Designation Notice (UWS 86) - employer gives this completed
form to the employee who has requested a W/FMLA-protected leave
to let the employee know if the leave is approved and/or if the
employee needs to submit any additional information before the
leave can be approved.