Family Medical Leave & Reasonable Accommodation Requests

The Family and Medical Leave Act (FMLA) (PDF) entitles eligible employees to take up to 12 weeks in a rolling 12-month period of unpaid, job-protected leave for specified family and medical reasons with continuation of group health coverage under the same terms and conditions as if the employee had not taken leave.

Employees who need to request FMLA leave should schedule an appointment with Human Resources (HR) to discuss their leave request.

FMLA Forms

• Certification of Health Care Provider for Employee's Serious Health Condition (PDF)
• Certification of Health Care Provider for Family Member's Serious Health Condition (PDF)
• Paid Family Leave (PFL)
• State Disability Insurance (SDI)
• Teamsters Disability Waiver Form (PDF)

Reasonable Accommodation Requests

Employees who require a reasonable accommodation should do the following:

1. Have a treating physician complete the Employee Reasonable Accommodation Request Form (PDF) with the employee's appropriate Job Description attached
2. Departments and Employees should immediately contact Human Resources by phone to notify HR of the request for approval of the reasonable accommodation; please do not move forward with any modified job duties without notifying HR and receiving HR's approval