Family Medical and Leave Act Forms
- Employee Request for Family and/or Medical Leave (UWS 80) LINK
- Notice of Eligibility and Rights & Responsibilities (UWS 81) PDF
- Certification of Health Care Provider for Employee’s Serious Health Condition (DOL WH-380-E) LINK
- WFMLA-Only Certification by Health Care Provider for Employee’s Serious Health Condition (UWS 82a) LINK
- Certification of Health Care Provider for Family Member’s Serious Health Condition (DOL WH-380-F) LINK
- WFMLA-Only Certification by Health Care Provider for Family Member’s Serious Health Condition (UWS 83a) LINK
- Certification of Qualifying Exigency for Military Family Leave (DOL WH-384) LINK
- Certification for Serious Injury or Illness of a Current Servicemember for Military Family Leave (DOL WH-385) LINK
- Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave (DOL WH-385-V) LINK
- Designation Notice (UWS 86) PDF
- Fitness-for-Duty Medical Certification to Return to Work from Family/Medical Leave or Absence PDF
Federal Family and Medical Leave Act
Leave is available under the Federal Family and Medical Leave Act (FMLA) for employees who have been employed with UWM for at least twelve (12) months in the past seven (7) years, who have worked 1,250 hours in the year preceding the start of the leave, and who need the leave for a qualifying reason. A qualifying reason includes leave for treatment for a serious health condition for the employee; leave for caring for a spouse, child or parent with a serious health condition; or for birth or adoption of a child. Leave for the previously listed reasons is for a total of 12 weeks and for can be used all at once for 12 consecutive weeks, or, for serious health conditions, may be used intermittently. Intermittent leave for the birth or adoption of a child is determined on a case-by-case basis by each department and/or division.
The term “child” includes individuals an employee stands in loco parentis to. The term in loco parentis refers to an employee who may not be biologically related to an individual, but stands in the position of a parent. Detailed information on this issue can be found at the link below.
Leave for the birth or adoption of a child is available to the mother, father or employee standing in loco parentis to the child. This leave must be used within twelve (12) months of the birth of the child.
Federal FMLA also provides 26 weeks of unpaid leave for an employee caring for spouse, son/daughter, parent, or next of kin, who is recovering from a serious illness or injury sustained in the line of active duty. Twelve (12) weeks of leave is also available to eligible employees who experience a “qualifying exigency” arising out of the fact that son/daughter, parent or spouse is on active duty in the Guards or Reserve Forces.
Wisconsin Family and Medical Leave Act
Leave is available under the Wisconsin Family and Medical Leave Act (WFMLA) for individuals who have worked at least 52 weeks and who have been on the payroll for a total of 1,000 hours during the 52 weeks prior to the start of the leave. It provides two weeks of leave for an employee’s own serious medical condition, two weeks for the care of a child, spouse, parent, domestic partner or parent of a domestic partner with a serious medical condition and six weeks of leave for birth or adoption of a child. As with FMLA, leave for medical conditions may be taken intermittently and intermittent leave for the birth or adoption of a child is determined by each department and/or division.
The term “parent” includes in-laws. The term “domestic partner” has the meaning given in Wis. Stat. §§ 40.02 (21c) or 770.01 (1). You may also find more information regarding this by visiting the UW System website.
Leave for the birth or adoption of a child must be taken within sixteen (16) weeks of the birth or adoption of the child.
Further, UW System Administration has included the federal in loco parentis relationship in the administration of WFMLA for UW System employees. As such, employees are eligible to take up to two weeks of WFMLA-covered leave to care for a domestic partner’s child with a serious health condition and take up to six weeks of WFMLA-covered leave to bond with the child within 16 weeks of birth or adoption. If an employee is eligible to take a leave under both FMLA and WFMLA, the leaves run concurrently.
Leave for employees qualifying for both FMLA and WFMLA will run concurrently. Further, leave provided under the WFMLA and FMLA is unpaid leave but employees may substitute any accrued leave.