Miami University Employee & Labor Relations Request For Family & Medical Leave Page 2
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1
2Human Resources
Employee & Labor Relations
Request for Family & Medical Leave
INSTRUCTIONS FOR EMPLOYEE:
1. Notify your immediate supervisor regarding the need for Family & Medical Leave (FML).
2. Note the following reminders:
a. HR requests a certification from the health care provider (physician) in order to determine whether your
requested absence is FMLA related. This is either the Department of Labor Form WH-380(E) for the
employee or the Department of Labor Form WH-380(F) for a family member. Your failure to submit the
requested medical certification form within a timely manner (see below) may delay approval of your leave
request.
b. Full-time employees are eligible for up to 12 weeks of FML per 12 month fiscal year (7/1-6/30).
c. Employees must have worked for at least 1 year and must have worked 1,250 hours in the 12-month
period immediately prior to the request for FML to be eligible for leave.
3. Submit t h e form to HR, 15 Roudebush Hall. If leave is foreseeable ( e.g. planned surgery or pregnancy), the
law requires a 30-day notification for leave. In case of an emergency or unforeseeable illness, (e.g., car
accident, heart attack) contact Human Resources at 513-529-2027 as soon as possible.
EMPLOYEE INFORMATION:
1. Follow proper CALL-IN PROCEDURES to your supervisor on a daily basis.
2. If you are approved for Intermittent Leave you must call in each time you have an FML situation that requires
your attention. You must specify that you are using FMLA for your absence. If not, it could be annotated as
regular sick, unscheduled.
3. If you are approved for a Specific Period of FML, you must let your supervisor know the days you will be out and
expected return date.
4. If your leave is planned medical appointments, such as treatments, therapy, procedures, try to schedule
your appointments so they do not unreasonably and unduly disrupt the operations of your work unit.
Once your appointment is made, consult with your supervisor to obtain the time off.
5. Your absence from work is not approved as FML until it has been approved by Human Resources (HR). You,
your supervisor and your department will receive an email with a copy of the approval letter. If you do not
receive a letter at least 5 days after you submitted your package, please contact HR at 513-529-3131.
6. If you fail to give advance notice of your absence in writing to Human Resources, your leave may not be
considered or approved as Family & Medical Leave (FML).
7. It is your responsibility to submit the request form for FML to Human Resources no later than 30 days before
your requested leave date (or as soon as you become aware of the need for leave).
8. If you are taking leave for purposes other than those annotated on your Medical Certification from the
H ealth Care Provider, your absence(s) is not protected by the Family & Medical Leave Act.
9. It is your responsibility to ensure your FML is current and up to date. If your FML expires and you are
requesting time off for your medical condition, the absence could be considered an occurrence.
10. If you are taking more time off than estimated by your doctor and approved on your letter, you will have to
have your FMLA recertified by your health care provider.
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