FMLA Forms – May 2015 - Current as of April 2019

The USDOL Wage Hour Division has published new FMLA forms for employers to use with the Family and Medical Leave Act. The forms released in late May 2015 replace all previously published forms. Most changes are minor and primarily update the forms. While the forms are “suggested,” most agree that employers should use these forms. Employers preparing their own forms could create unwanted issues or compliance failures. Failure to provide complete information and rights on a form could limit the employer’s rights if an employee fails to follow instructions. It could also result in a charge of “interference” a violation if the employee was not given all the rights and information.

The initial notification and designation forms must be provided the employee within five (5) business days. Always photocopy of scan to PDF a copy of all forms sent to an employee. The Courts have ruled that the employer must prove receipt of a form by the employee. Employees should sign acknowledging receipt of a form. Forms mailed to an employee should require a signed delivery receipt.

 All employers should have the following forms ready for use.

Form WH-380-E: Certification of Health Care Provider for Employee’s Serious Health Condition 

Form WH-380-F: Certification of Health Care Provider for Family Member’s Serious Health Condition

Form WH-381: Notice of Eligibility and Rights & Responsibilities

Form WH-382: Designation Notice

Form WH-384: Certification of Qualifying Exigency for Military Family Leave

Form WH-385: Certification for Serious Injury or Illness of a Current Servicemember for Military Family Leave

Form WH-385-V: Certification for Serious Injury or Illness of a Veteran for Military Family Leave

They are available from our Download file area. Click on Downloads, then FMLA, and look for files for the forms with May 2015 in the title.