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Requesting Family Medical Leave

Employees must provide 30 days of advance notice for foreseeable leave, or as much advance notice as is practicable. When 30 days’ notice is not possible based upon, for example, an expected birth, placement of a child for adoption or fostercare or planned medical treatment for the employee or a family member’s serious health condition, the employee must give notice to the employer on the same day that they learn of the need for leave, or the next business day after the need arises for unforeseeable leave, unless impracticable to do so.

An employee who takes a foreseeable leave based on planned medical treatment must make a reasonable effort to schedule planned medical treatment or necessary medical supervision to minimize any disruption to campus operations. The employee should provide the anticipated date upon which the leave will commence and the projected duration of the leave to the extent known at the time of providing notice.

51�ԹϺ��� has the right to require employees to provide certification of their need for leave to care for a qualified family member with a serious health condition as well for the employee’s own serious health condition from a healthcare provider.

To request FML:

1. Inform your supervisor and 51�ԹϺ���’s benefits team of the need for FML based upon the timeframes referenced above.
2. Obtain and complete the necessary request and certification forms (FML Packet) provided by the benefits team.
3. Review the FML packet provided to you by the benefits Office upon your request for leave:
   • Notice of Eligibility - Informs employees of their eligibility/lack of eligibility under FML. The notice also provides information on employee rights and responsibilities for taking leave.
   • Employee Rights and Responsibilities under theFamily and Medical Leave Act – Provides information about employee rights and responsibilities associated with leaves under the Family Medical Leave Act (FMLA).
   • Certification of Health Care Provider (CHCP) – This form must be completed by you / your family member’s healthcare provider to certify that you / your family member’s illness is considered a “serious health condition” covered under FML when leave is for a serious health condition. In the case of pregnancy, you must provide a physician’s note stating the expected delivery and leave dates. Certified placement documents will be required for placement of a child.
   • Medical Leave of Absence Request Form

Contact the benefits team to schedule an appointment if advising and planning are required.

Consult your healthcare provider:

1. Request that you / your family member’s health care provider complete the (Certification of Healthcare Provider) CHCP form:
   • The university requires that the CHCP form include the date on which the condition commenced and the probable duration of the condition. The campus also requires a statement from the healthcare provider that the employee is needed to care for the family member.
     • If leave is for a serious health condition of the employee, a statement that the employee is unable to perform one or more of the essential functions of their job.
   • f the employee requests an intermittent leave or a reduced work schedule, the university requires that the CHCP include a statement of the medical necessity for the intermittent or reduced work schedule and estimate of the frequency and duration of the episodes of incapacity.
   • The campus also requires an estimate of the employee's modified work schedule and the expected dates and duration of treatment.
2. Complete the State of Nevada - FMLA Leave of Absence Form and submit it to Absence Management.
3. Return the completed CHCP and the State of Nevada FMLA Leave of Absence Request form to the benefits team prior to the 15 calendar day deadline indicated on your Notice of eligibility.

DO NOT submit the completed CHCP to your department. This form should be submitted directly to the benefits team.

Note: It is important that you / your family member’s health care provider answer fully and completely all applicable parts of the CHCP. Responses should include the provider’s best estimate based upon the provider’s medical knowledge, experience, and examination. Terms such as “lifetime,” “unknown,” or “indeterminate” may not be sufficient to determine eligibility for FML.

CHCP’s that are incomplete or insufficient will be returned to the employee and the employee will be directed to obtain the missing information from their health care provider. Failure to timely provide the required information may result in a delay or non-approval of leave.

Returning to Work

Employees on leave due to their own serious health condition and returning to work without any restrictions must:

1. Request your healthcare provider to complete the Family & Medical Leave Act (FMLA) Medical Release form. Alternately, a doctor note which states the employee may return to work without restrictions is acceptable.
   • Do not submit the Family & Medical Leave Act (FMLA) Medical Release form to your department. Submit it directly to the benefits team.
2. Submit the completed Family & Medical Leave Act (FMLA) Medical Release form directly to the benefits team prior to your return-to-work date.
3. Return to work on the appropriate date.

Employees on leave due to their own serious health condition and returning to work with restrictions must:

1. Request that your health care provider complete the Family & Medical Leave Act (FMLA) Medical Release form.
2. Submit the completed Family & Medical Leave Act (FMLA) Medical Release form the benefits team for review prior to your return-to-work date. We recommend that you provide as much advance notice as possible with regards to a request for accommodation to avoid a delay in your return date. Any restrictions will be evaluated as a request for reasonable accommodation.
3. Participate in the interactive process – The ADA Administrator will contact you to discuss your request for an accommodation.

If you have any questions about Family Medical Leave, please contact the benefits team.