FAMILY AND MEDICAL LEAVE
Sample Statement (for companies with over 50 employees)
The Family and Medical Leave Act of 1993 allows employees of the company who have worked for at least one year and for 1,250 hours in the last 12 months, up to 12 weeks of unpaid, job-protected leave for certain family and medical reasons. Leave will be granted to 1) care for your child prior to or after birth or placement for adoption or foster care, 2) care for your spouse, son or daughter, or parent who has a serious health condition, or 3) for a serious health condition that makes you unable to perform your job.
You are required to provide 30 days advance notice if the leave is foreseeable. Please ask for the Employee Request for Family or Medical Leave form. In addition, you must provide a medical certification for serious health conditions and a fitness for duty report to return back to work. The company is allowed, at its expense, to obtain a second or third medical opinion regarding your condition.
Excluded from this coverage are certain salaried high-level employees. As soon as an employee is aware that family or medical leave is necessary, they should contact their supervisor and give notice of the period of time they expect to take their leave. If the leave is necessary to care for someone's illness, the employee is requested to provide medical proof of that illness to their supervisor. A physician's statement should indicate the type of illness, the probable duration of the illness, and a statement indicating that the illness requires the employee to take leave from employment to assist with family care.
Family leave is un-paid leave. Only under exceptional circumstances will the employee be allowed to take leave for a period in excess of the above. The employee may be required to pay any health or life insurance premium during his period of leave. The company will make every effort to maintain your job position consistent with the company's needs. You will retain any benefits accrued prior to your leave. The company may also require that you utilize any accrued vacation leave or other benefits during your period of leave. Should you have any questions about this policy, contact [Contact Name].
©1998 Phin Enterprises. Donald A. Phin, Esq., CPCM. No portion of these materials may be reproduced by any means without the express written permission of the author.