NORRISTOWN AREA SCHOOL DISTRICT
Family & Medical Leave Kit
Dear NASD Colleagues,
Benefits Administration supplies this kit to handle the administrative aspects of a leave of absence
under any of the following laws and policies:
Family & Medical Leave (FML) under the federal Family & Medical Leave Act.
The kit contains all the forms needed to start, extend, or terminate a leave of absence. Employees
are required to use these forms. Please contact Suzanne Basile, HR/Benefits Administrator if you
need further information.
NASD Benefits Administration
Leave of Absence Checklist. A step-by-step guide for the documentation and
processing of a leave of absence request.
Staff Leave Request. A form for the employee to request leave. This form will
be forwarded to the Payroll/Business Office.
Notice to Employee. The Benefits Administrator uses this document to give
the employee notice of his or her rights under the laws listed above. The
employee should print and maintain a copy of this notice for their records.
FML Medical Certification. A health care provider will complete this form to
document the need for the leave. This form will be forwarded to the
FML Request for Leave. The employee completes this form to request and
document the need for the leave. This form will be forwarded to the Benefit
Return to Work Certification. A health care provider can use this form to
document that the employee is able to return to work.
FMLA instructions and checklist