FMLA gives you up to 12 weeks of unpaid, job-protected leave for a serious health condition — yours or a family member’s. This is the paperwork to gather and submit.

Eligibility check

• I’ve worked for this employer 12+ months
• I’ve worked 1,250+ hours in the past 12 months
• Employer has 50+ employees within 75 miles
• The condition qualifies as a ‘serious health condition’

Paperwork to gather

• FMLA Form WH-380-E (employee’s own condition) OR WH-380-F (family member)
• Medical certification from physician
• Pre-fill the dates of expected leave (continuous OR intermittent)
• Coordinate with HR on STD / LTD if applicable
• Save copies of everything

Submit to