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Employer Is "On Notice"
On Monday, March 2, 2020, you notified your supervisor via email of the intended surgical procedure that will take place on Tuesday, March 31, 2020. -
Formally Notify Your Employer In Writing
You must submit a written, signed, and dated request for leave to your supervisor, cc your departmental HR representative, indicating:
1) That you are requesting medical leave,
2) The dates you anticipate being absent from work and the date you intend to return to work,
3) Be clear on how you are requesting that time and attendance be submitted in order to secure income (e.g., sick leave, unpaid leave, etc.), and
4) If requesting an intermittent leave, the work schedule you propose. -
Verification of Eligibility
Your employer will review your request and verify that you are eligible for leave under FMLA. -
Notice of Eligibility and Rights & Responsibilities
Your request has been deemed eligible for FLMA leave. Your department has provided you formal approval on Form WH-381. You have 15 calendar days to submit the completed Certification of Health Care Provider Form (WH-380-E). Section I has been completed by your employer. You are responsible for filling in Section II. Please then forward the paperwork to your doctor so that they can complete Section III. -
Turn In Completed Certification of Health Care Provider Paperwork
By this date, paperwork must be turned in to your Human Resources representative. Her name is Jane Doe and can be found in the Whitmore Administration Building, Rm 325. Her phone number is 555-0001. Before turning in the paperwork, please ensure that all three sections have been filled out completely. -
Formal Approval Letter From Supervisor
Review this approval letter from your supervisor. Your doctor specified a three-week post-surgery recovery period. Your supervisor has asked that you check-in at the end of each week by phone. Your supervisor's phone number is 555-0002. -
Best Wishes!
Please accept the department's best wishes for a speedy recovery! We look forward to your healthy return. -
Week 1: Please Call Your Supervisor via Phone
Your supervisor can be reached by phone at 555-0002. The purpose of these calls is to ensure that you are on track for return after your three-week recovery period. Should complications arise, please notify your supervisor during this call so that they may make alternative arrangements during your extended absence. -
Week 2: Please Call Your Supervisor via Phone
Your supervisor can be reached by phone at 555-0002. The purpose of these calls is to ensure that you are on track for return after your three-week recovery period. Should complications arise, please notify your supervisor during this call so that they may make alternative arrangements during your extended absence. -
Contact Your Doctor for a Document of Medical Release
Please have your health care provider fax a copy of a medical release to your Human Resources representative. This document officially clears you for return to work on Wednesday, April 22, 2020. This document must be received prior to your return to work. -
Week 3: Please Call Your Supervisor via Phone
Your supervisor can be reached by phone at 555-0002. The purpose of these calls is to ensure that you are on track for return after your three-week recovery period. Should complications arise, please notify your supervisor during this call so that they may make alternative arrangements during your extended absence. -
Welcome Back!
We are so happy to have you back!
