Sample FMLA policy

Employees who have worked for the Company for at least twelve (12) months and at least 1,250 hours during the prior twelve (12) months may take up to twelve (12) weeks of unpaid leave (FMLA leave) for the following reasons:

A “qualifying exigency” arising from the fact that the employee's spouse, son, daughter or parent is on (or has been called to) active duty in the Armed Forces in support of a contingency operation.

A eligible employee who is the spouse, son, daughter, parent or next of kin of a member of the Armed Forces (including a member of the National Guard or National Reserves) may take up to twenty-six (26) weeks of unpaid FMLA leave during a single twelve (12) month period to care for a covered servicemember who, for a serious injury or illness, is undergoing medical treatment, recuperation or therapy, is otherwise in outpatient status, or is otherwise on the temporary disability retired list. The injury or illness must be incurred in the line of active duty and have to potential to render the servicemember unfit to perform the duties of his or her office, grade, rank or rating.

Any FMLA leave taken by an employee during the preceding twelve (12) month period will be used to determine the amount of available leave pursuant to the Family and Medical Leave Act. For example if, for an employee's own serious health condition, the employee used four weeks of leave beginning February 1, 2007, four weeks of leave beginning June 1, 2007, and four weeks of leave beginning December 1, 2007, the employee would not be entitled to any additional leave until February 1, 2008. On February 1, 2008, the employee would be entitled to four weeks of leave and on June 1, the employee would be entitled to an additional four weeks of leave, and so on.

If an employee is eligible for leave to care for a servicemember as well as for another FMLA-eligible reason, the total combined leave may not exceed twenty-six (26) weeks during that single twelve (12) month period.

The right to family leave for the birth and/or placement of a child into an employee's family may only be taken within the twelve (12) month period after the date of the birth or placement of the child. In the case of unpaid leave for the birth or placement of a child, intermittent leave or working a reduced number of hours is not permitted, unless both the employee and the Company agree.

If both spouses are employed by the Company, the combined leave shall not exceed twelve (12) weeks, or twenty-six (26) weeks for leave to care for an injured or ill servicemember.

For purposes of this policy, a serious health condition means an illness, injury, impairment or physical or mental condition that involves:

• any period of incapacity or treatment in connection with or a consequence of in-patient care in a hospital, hospice or residential medical care facility or
• any period of incapacity requiring absence from work or other regular daily activities for more than three (3) calendar days that also involves:
  • continuous treatment by or under the supervision of a healthcare provider
  • continuous treatment by or under the supervision of a healthcare provider for a chronic long-term health condition that is incurable or so serious that if not treated would result in a period of incapacity of more than three (3) calendar days or prenatal care.

In the case of unpaid leave for serious health conditions, the leave may be taken intermittently or on a reduced-hours basis only if such leave is medically necessary. Where an employee requests intermittent leave or leave on a reduced hours basis due to a family member's or the employee's own serious health condition, the Company has the option, in its sole discretion, to require the employee to transfer to a temporary alternative job for which the employee is qualified and that better accommodates the intermittent leave or reduced-hours leave than the employee's regular job. The temporary position will have equivalent pay and benefits as the employee's regular job.

Employees are required to use their available vacation time during the twelve (12) week family leave period, or twenty-six (26) week period in the case of servicemember family leave, and available sick days will be used when family leave is taken because of serious health conditions.

Note  That portion of the family leave of absence that is vacation time and/or sick days will be with pay according to the Company's policies regarding vacation time and sick days. The employee will be notified immediately in writing that the vacation time and/or sick days will be counted toward the twelve (12) weeks of family leave, or twenty-six (26) weeks of servicemember family leave. If written notice is not given to the employee by the date of expiration of the leave, the leave will not be counted towards the employee's available weeks of family leave.

When the necessity of leave is foreseeable due to the expected birth or placement of a child, the employee must provide the Company at least thirty (30) days' notice of the employee's intention to take leave. If the date of birth or placement of a child requires the employee's leave to begin in less than thirty (30) days from the date of notice to the Company, the employee must provide such notice as soon as practical. Where the necessity for leave is due to a family member's or an employee's own serious health condition and is foreseeable based on planned medical treatment, the employee must:

• give at least thirty (30) days' notice, or give notice as soon as practical if treatment starts in less than thirty (30) days
• make a reasonable effort to schedule the treatment so as not to unduly disrupt the operation of the Company, subject to the approval of the healthcare provider.

When leave due to a qualifying exigency is foreseeable, due to a family member being on active duty or due to a notification of an impending call to active duty in support of a contingency operation, the employee must give notice as is reasonable and practicable.

When the need for leave is unforeseeable, the employee must give notice as soon as practical.

Any leave request based on a family member's or employee's own serious health condition must be supported by certification from a health care provider. The employee must provide a copy of the certification to the Company in a timely manner. (Fifteen calendar days will be allowed to provide the certification). Certification from the health care provider must contain:

• the date the serious health condition began
• the possible duration of the condition
• the appropriate medical facts regarding the condition
• a statement that the employee is needed to provide the care and an estimate of the amount of time that need will continue, if the leave is based on the care of a spouse, child or parent
• a statement that the employee is unable to perform the functions of his/her job, if the leave is based on the employee's own serious health condition
• the date the treatment is expected to be given and the duration of the treatment, in the case of intermittent leave or leave on a reduced-hours basis for planned medical treatment.

Any leave request due to a qualifying exigency must be supported by certification showing that the service member is on (or has been called to) active duty.

During family leaves of absence, the Company will continue to pay its portion of the health insurance premiums and the employee must continue to pay his/her share of the premium. Failure of the employee to pay his/her share of the health insurance premium may result in loss of coverage. If the employee does not return to work after the expiration of the leave, the employee will be required to reimburse the Company for payments of health insurance premiums during the family leave, unless the employee does not return because of the presence of a serious health condition that prevents the employee from performing his/her job or circumstances beyond the control of the employee.

During leave, the employee shall not accrue employment benefits such as vacation pay, sick pay, pension, etc. Employment benefits accrued by the employee up to the day on which the family leave of absence begins will not be lost.

The Company may require an employee on FMLA leave to report periodically on his/her status and the intention of the employee to return to work, and also may require periodic recertification of the medical condition. An employee taking leave due to the employee's serious health condition is required to obtain certification that the employee is able to resume work prior to the return from any FMLA leave. Employees who return to work from a family leave of absence within or on the business day following the expiration of the twelve (12) weeks are entitled to return to their job or an equivalent position without loss of benefits or pay.

Procedure. Applications for family leave of absence must be submitted in writing and signed by the employee's immediate manager. Applications should be submitted at least thirty (30) days before the leave is to commence or as soon as possible if thirty (30) days' notice is not possible. Appropriate forms must be submitted to Human Resources to initiate a family leave and to return the employee to active status.

Each employee taking leave that meets the requirements for FMLA leave will be provided the Response to Your Request for Leave form.