Absences
Catastrophic Leave
- Catastrophic Leave Employee Request (UWS-420)*
- Catastrophic Leave Employer Approval (UWS-421)*
- Catastrophic Leave Donor Authorization (UWS-422)*
* form under review, please see Catastrophic Leave Policy
Family and Medical Leave Act (FMLA)
UW System Forms
- Employee Request for Family and/or Medical Leave (UWS 80)
- Notice of Eligibility and Rights & Responsibilities (UWS 81)
- Certification by Health Care Provider for Employee’s Serious Health Condition (UWS 82a) [WFMLA Only]
- Certification by Health Care Provider for Family Member’s Serious Health Condition (UWS 83a) [WFMLA Only]
- Designation Notice (UWS 86)
U.S. Department of Labor Forms
- Certification of Health Care Provider for Employee’s Serious Health Condition (DOL WH-380-E)
- Certification of Health Care Provider for Family Member’s Serious Health Condition (DOL WH-380-F)
- Certification for Military Family Leave for Qualifying Exigency (DOL WH-384)
- Certification for Serious Injury or Illness of a Current Servicemember for Military Caregiver Leave (DOL WH-385)
- Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave (DOL WH-385-V)
UW-Milwaukee Form
Worker’s Compensation
Employees
- Employee’s Work Injury and Illness Report
- Labor Market Availability Restriction Statement
- Lost Time Fact Sheet: PDF DOC
- Worker’s Compensation Mileage Record