Supervisor Tools

Family Medical Leave Policy (3-0708)
(to be given to employee with a copy of the rights/responsibilities document
(WH381) and the appropriate certification document
(WH380E, WH380F, WH384, WH385)

WH381-Notice of Eligibility and Rights and Responsibilities form
(give to the employee when notice is received of the need for the leave; also
provide the appropriate certification document
WH380E, WH380F, WH384, WH385 and a copy of the FMLA policy)

WH380E-Certification of Health Care Provider form for Employee’s Serious Health Condition
(use for employee only leave; provide a copy of FMLA policy & form WH381)

WH380F-Certification of Health Care Provider form for Family Member’s Serious Health Condition
(use for family member only; provide a copy of FMLA policy & form WH381)

WH384-Certification of Qualifying Exigency for Military Family Leave
(to be used for exigency leave for a qualifying family member; exigency is defined as short-term deployment, military events/activities; childcare/school activities or financial/legal arrangements-non routine, counseling, rest & recuperation, post-deployment activities, or other additional activities; provide a copy of FMLA policy & form WH381)

WH385-Certification for Serious Injury or Illness of Covered Service Member for Military Family Leave
(use for care of a family member who became ill or injured while serving in the military; provide a copy of FMLA policy & form WH381)

WH382-Designation Notice
(give to inform employee that FMLA has been approved & paid leave is/is not being used, leave does not apply to FMLA, FMLA leave has been exhausted, or FMLA leave is not approved; used after medical or supporting documentation has been received from the employee)

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