EMPLOYEE FAMILY AND MEDICAL LEAVE REQUEST FORM

Transcription

1 EMPLOYEE FAMILY AND MEDICAL LEAVE REQUEST FORM Employee Name Date Position: Department Supervisor I am requesting Family or Medical Leave under the University s Family and Medical Leave policy which is governed by Federal and State Family and Medical Leave Laws. I am requesting leave for the following reason: Personal serious health condition Serious health condition of family member Family Member s Name & Relationship Birth of a child Expected delivery date is Adoption or placement of a child for foster care Child s Name Scheduled date of adoption or placement: Family of Service Member Leave (Will need copy of call-up orders) Name & Relationship DATES OF LEAVE REQUESTED I request leave from (If additional space is required, please use back of form) to I request intermittent leave according to the following schedule I request a reduced schedule leave according to the following schedule The total number of weeks/days/hours of leave requested is: all available sick time all available vacation all available of both (unless instructed otherwise, sick time will be used 1 st followed by available vacation time) hours of sick time and/or hours of vacation time EMPLOYEE STATEMENT: I agree to return to work on. If circumstances change such that I will not be able to return to work on that date, I agree to inform my supervisor and Human Resources by submitting revised Employee Family and Medical Leave Request and Supervisor Family and Medical Leave Request along with an updated Family/Medical Leave Certification of Physician or Practitioner. I understand that my benefits will continue during my leave and that I MUST arrange to pay my share of applicable premiums. Employee Signature Date X:\share\HR_restricted\FMLA\FMLA Forms\FMLA Employee Request Form.doc Revised: Dec 2008

2 SUPERVISOR FAMILY AND MEDICAL LEAVE REQUEST FORM Employee Name Date Position: Department Supervisor Submit this request form to your supervisor at least 30 days before the leave is to commence, when practicable. When submission of the request 30 days in advance is not practicable, submit the request as early as possible. The employer reserves the right to deny or postpone leave for failure to give appropriate notice when such denial/postponement would be permitted under federal or state law. TO BE COMPLETED BY SUPERVISOR Leave requested from to Individual requesting leave is Full-time Part-time Regular work schedule is Sunday from to Thursday from to Monday from to Friday from to Tuesday from to Saturday from to Wednesday from to How will the staff member s duties & responsibilities in your unit be handled during his/her leave of absence? Supervisor Signature Title Date Telephone # Please return completed form to the Human Resources Department. (A copy of the completed form will be sent to the supervisor as notification.) TO BE COMPLETED BY HUMAN RESOURCES Date of Hire Dates of Previous Leave Requests Leave is: Approved Denied for the following reason(s) Employee has requested to use all available sick time all available vacation time all of both (unless instructed otherwise, sick time will be used 1 st followed by available vacation time) hours of sick time and/or hours of vacation time Request approved/denied by Date COPY TO PAYROLL COPY TO SUPERVISOR X:\share\HR_restricted\FMLA\FMLA Forms\FMLA Supervisor Request Form.doc Revised: Dec 2008

3 LAWRENCE UNIVERSITY Human Resources Department 711 East Boldt Way, SPC 34 Appleton, WI FAMILY/MEDICAL LEAVE CERTIFICATION OF PHYSICIAN OR PRACTITIONER (This section to be completed by employee) 1. Name and SSN (First Name, Middle Initial, Last Name SSN): 2. Patient s Name (if other than employee, include relationship): (This section to be completed by physician) 3. Indicate Diagnosis, Treatment Plan and Frequency of visits. Circle appropriate number of the FMLA category. 1) Hospital Care 2) Absence Plus Treatment 3) Pregnancy 4) Chronic Conditions Requiring Treatment 5) Permanent/Long-term Conditions Requiring Treatment 6) Multiple Treatments (Non-Chronic Conditions) 4. Date condition commenced: 5. Probable duration of condition: 6. Regimen of treatment to be prescribed: (Indicate number of visits, general nature and duration of treatment, including referral to other provider of health services. Include schedule of visits or treatment (even if only an estimate) if it is medically necessary for the employee to be off of work on an intermittent basis or to work less than the employee s normal schedule of hours per day or days per week.) 6a. By physician or practitioner: 6b. By another provider of health services if referred by physician or practitioner, if so who: [ ] Yes [ ] No IF THIS CERTIFICATION RELATES TO CARE FOR THE EMPLOYEE S SERIOUSLY ILL FAMILY MEMBER, SKIP ITEMS 7, 8 AND 9 AND PROCEED TO ITEMS 10 THRU 14. OTHERWISE, COMPLETE ITEMS 7, 8, 9, 14 AND Is in-patient hospitalization of the employee required? 8. Is employee able to perform work of any kind? (If No skip Item 9.) [ ] Yes [ ] No [ ] Yes [ ] No 9. Is employee able to perform the functions of employee s position? (Answer after reviewing statement from employer of essential functions of employee s position, or if none provided, after discussing with employee.) [ ] Yes [ ] No FOR CERTIFICATION RELATING TO CARE FOR THE EMPLOYEE S SERIOUSLY ILL FAMILY MEMBER, COMPLETE ITEMS 10 THRU 14 BELOW AS THEY APPLY TO THE FAMILY MEMBER, AND COMPLETE ITEM Is in-patient hospitalization of the family member (patient) required? 11. Does (or will) the patient require assistance for basic medical, [ ] Yes [ ] No hygiene, nutritional needs, safety or transportation? 12. After review of the employee s signed statement (see Item 14 below), is the employee s presence necessary or would it be beneficial for the care of the patient? (This may include psychological comfort.) [ ] Yes [ ] No [ ] Yes [ ] No 13. Estimate the period of time care is needed or the employee s presence would be beneficial. 14. To be completed by the Employee Needing Family Leave (Please attach information if applicable) When Family Leave is needed to care for a seriously ill family member, the employee shall state the care he or she will provide and an estimate of the time period during which this care will be provided, including a schedule if leave is to be taken intermittently or on a reduced leave schedule. Signature of Employee: Work #: Home #: Date: 15. Type of Practice (Field of specialization, if any): Print name of physician or practitioner: Office Telephone #: Address: Signature of Physician: Date: Please return completed form to the address listed above. 06/06/05

4 FITNESS FOR DUTY CERTIFICATION FORM Employee Name Position: Date Department This employee was certified to have a serious health condition which made him/her unable to perform the essential functions of his/her job with Lawrence University. Before we can return the patient to his/her job, you must certify that the patient is able to return to work and perform all the essential functions of his/her position. Attached is a description of the patient s job and a list of all of the essential functions of his/her position. Please complete this form and return it to the patient as soon as possible. The patient will not be eligible to return to work without this completed form. 1. Is the patient currently able to perform the essential functions of his/her job without restrictions? YES NO If no, please identify each essential function(s) that the patient is not currently able to perform without restrictions: 2. Is the patient currently able to perform the essential functions of his/her job with restrictions? YES NO If yes, please describe all necessary restrictions. Are these restrictions permanent? YES NO If no, what is their anticipated duration? If yes, please identify which restrictions are permanent: 3. If the patient is now currently able to perform the essential functions of his/her job, when, in your best medical opinion, will the patient be able to perform the essential functions of his/her job? Will the patient have work restrictions at that time? YES NO If yes, what will those restrictions be? Revised: August 2010 Page 1 of 2

5 FITNESS FOR DUTY CERTIFICATION FORM Will those restrictions be permanent? YES NO If no, what is their anticipated duration? If yes, please identified which restrictions are permanent: 4. After having examined the above patient on, is it your medical opinion that he/she is currently capable of returning to work without creating a significant risk (i.e., high probability) of substantial harm to the patient or his/her safety and/or the safety of the patient s co-workers? If there is a significant risk, please identify the risk: Further, can the risk be reduced or eliminated by reasonable accommodation? YES NO If yes, what reasonable accommodation(s) would be necessary to reduce or eliminate this risk? Signature of Health Care Provider Type of Practice/Medical Specialty Printed Name of Health Care Provider Street Address Telephone Number City, State and ZIP Code Fax Number Revised: August 2010 Page 2 of 2

6 Basic Leave Entitlement FMLA requires covered employers to provide up to 12 weeks of unpaid, jobprotected leave to eligible employees for the following reasons: For incapacity due to pregnancy, prenatal medical care or child birth; To care for the employee s child after birth, or placement for adoption or foster care; To care for the employee s spouse, son or daughter, or parent, who has a serious health condition; or For a serious health condition that makes the employee unable to perform the employee s job. Military Family Leave Entitlements Eligible employees with a spouse, son, daughter, or parent on active duty or call to active duty status in the National Guard or Reserves in support of a contingency operation may use their 12-week leave entitlement to address certain qualifying exigencies. Qualifying exigencies may include attending certain military events, arranging for alternative childcare, addressing certain financial and legal arrangements, attending certain counseling sessions, and attending post-deployment reintegration briefings. FMLA also includes a special leave entitlement that permits eligible employees to take up to 26 weeks of leave to care for a covered servicemember during a single 12-month period. A covered servicemember is a current member of the Armed Forces, including a member of the National Guard or Reserves, who has a serious injury or illness incurred in the line of duty on active duty that may render the servicemember medically unfit to perform his or her duties for which the servicemember is undergoing medical treatment, recuperation, or therapy; or is in outpatient status; or is on the temporary disability retired list. Benefits and Protections During FMLA leave, the employer must maintain the employee s health coverage under any group health plan on the same terms as if the employee had continued to work. Upon return from FMLA leave, most employees must be restored to their original or equivalent positions with equivalent pay, benefits, and other employment terms. Use of FMLA leave cannot result in the loss of any employment benefit that accrued prior to the start of an employee s leave. Eligibility Requirements Employees are eligible if they have worked for a covered employer for at least one year, for 1,250 hours over the previous 12 months, and if at least 50 employees are employed by the employer within 75 miles. Definition of Serious Health Condition A serious health condition is an illness, injury, impairment, or physical or mental condition that involves either an overnight stay in a medical care facility, or continuing treatment by a health care provider for a condition that either prevents the employee from performing the functions of the employee s job, or prevents the qualified family member from participating in school or other daily activities. Subject to certain conditions, the continuing treatment requirement may be met by a period of incapacity of more than 3 consecutive calendar days combined with at least two visits to a health care provider or one visit and a regimen of continuing treatment, or incapacity due to pregnancy, or incapacity due to a chronic condition. Other conditions may meet the definition of continuing treatment. EMPLOYEE RIGHTS AND RESPONSIBILITIES UNDER THE FAMILY AND MEDICAL LEAVE ACT Use of Leave An employee does not need to use this leave entitlement in one block. Leave can be taken intermittently or on a reduced leave schedule when medically necessary. Employees must make reasonable efforts to schedule leave for planned medical treatment so as not to unduly disrupt the employer s operations. Leave due to qualifying exigencies may also be taken on an intermittent basis. Substitution of Paid Leave for Unpaid Leave Employees may choose or employers may require use of accrued paid leave while taking FMLA leave. In order to use paid leave for FMLA leave, employees must comply with the employer s normal paid leave policies. Employee Responsibilities Employees must provide 30 days advance notice of the need to take FMLA leave when the need is foreseeable. When 30 days notice is not possible, the employee must provide notice as soon as practicable and generally must comply with an employer s normal call-in procedures. Employees must provide sufficient information for the employer to determine if the leave may qualify for FMLA protection and the anticipated timing and duration of the leave. Sufficient information may include that the employee is unable to perform job functions, the family member is unable to perform daily activities, the need for hospitalization or continuing treatment by a health care provider, or circumstances supporting the need for military family leave. Employees also must inform the employer if the requested leave is for a reason for which FMLA leave was previously taken or certified. Employees also may be required to provide a certification and periodic recertification supporting the need for leave. Employer Responsibilities Covered employers must inform employees requesting leave whether they are eligible under FMLA. If they are, the notice must specify any additional information required as well as the employees rights and responsibilities. If they are not eligible, the employer must provide a reason for the ineligibility. Covered employers must inform employees if leave will be designated as FMLA-protected and the amount of leave counted against the employee s leave entitlement. If the employer determines that the leave is not FMLAprotected, the employer must notify the employee. Unlawful Acts by Employers FMLA makes it unlawful for any employer to: Interfere with, restrain, or deny the exercise of any right provided under FMLA; Discharge or discriminate against any person for opposing any practice made unlawful by FMLA or for involvement in any proceeding under or relating to FMLA. Enforcement An employee may file a complaint with the U.S. Department of Labor or may bring a private lawsuit against an employer. FMLA does not affect any Federal or State law prohibiting discrimination, or supersede any State or local law or collective bargaining agreement which provides greater family or medical leave rights. FMLA section 109 (29 U.S.C. 2619) requires FMLA covered employers to post the text of this notice. Regulations 29 C.F.R (a) may require additional disclosures. For additional information: US-WAGE ( ) TTY: U.S. Department of Labor Employment Standards Administration Wage and Hour Division WHD Publication 1420 Revised January 2009

7 Family and Medical Leave Act Section , Statutes, requires that all employers with 50 or more employees display a copy of this poster in the workplace. Employers with 25 or more employees are required to post their particular leave policy Under state law all employers with 50 or more permanent employees must allow employees of either sex: Up to six (6) weeks leave in a calendar year for the birth or adoption of the employee's child, providing the leave begins within sixteen (16) weeks of the birth or placement of that child. Up to two (2) weeks of leave in a calendar year for the care of a child, spouse, domestic partner, as defined in 40.02(1) or (1) or parent or a parent of a domestic partner with a serious health condition. Up to two (2) weeks leave in a calendar year for the employee's own serious health condition. This law only applies to an employee who has worked for the employer more than 52 consecutive weeks and for at least 1000 hours during that 52-week period. The law also requires that employees be allowed to substitute paid or unpaid leave provided by the employer for Family and Medical Leave. Employers may have leave policies, which are more generous than leaves required by the law. A complaint concerning a denial of rights under this law must be filed within 30 days after the violation occurs or the employee should have reasonably known that the violation occurred, whichever is later. For answers to questions about the law, a complete copy of the law, or to make a complaint about a denial of rights under the law contact: STATE OF WISCONSIN DEPARTMENT OF WORKFORCE DEVELOPMENT EQUAL RIGHTS DIVISION 201 E WASHINGTON AVE ROOM A N 6th ST PO BOX 8928 ROOM 255 MADISON WI MILWAUKEE WI Telephone: (608) Telephone: (414) TTY: (608) TTY: (414) Website: The Department of Workforce Development is an equal opportunity employer and service provider. If you have a disability and need to access this information in an alternate format or need it translated to another language, please contact us. ERD-7983-P (R-01/2010)

8 ERD-7983-P (R-01/2010)

9 State of Department of Workforce Development Equal Rights Division COMPARISON OF FEDERAL AND WISCONSIN FAMILY AND MEDICAL LEAVE LAWS The following comparison of federal and state Family and Medical Leave Acts (FMLA) presumes, in comparing any two provisions, that employer coverage and employee eligibility requirements have been met for both jurisdictions. In addition, commonly asked questions and answers are included. Employers must comply with any provisions of state or local law that provide greater family or medical leave rights than the rights established by the federal FMLA. The U.S. Department of Labor will not enforce state family and medical leave laws, and states may not enforce federal family and medical leave laws. Employees have no obligation to designate whether the leave they are taking is federal or state FMLA leave. Thus, employers covered by both federal and state FMLA must comply with the provisions of both. Further information on federal FMLA may be obtained by contacting the nearest office of the Wage and Hour Division, listed in most telephone directories under U.S. Government, Department of Labor, Employment Standards Administration. State of Department of Workforce Development Equal Rights Division Labor Standards Bureau 201 E WASHINGTON AVE ROOM A N. 6TH STREET PO BOX 8928 ROOM 255 MADISON WI MILWAUKEE WI Telephone Number:(608) Telephone Number: (414) TTY Number: (608) TTY Number: (414) Web Site The Department of Workforce Development is an equal opportunity employer and service provider. If you have a disability and need to access this information in an alternate format or need it translated to another language, please contact us. ERD-9680 (R. 02/2010)

10 Issues Employers Covered Employees Eligible Amount of Leave MAJOR PROVISIONS OF FEDERAL AND STATE FAMILY AND MEDICAL LEAVE LAWS Federal Enforced by the U. S. Department of Labor. Employers of 50 or more employees in at least 20 weeks of current or preceding year. Have worked for employer at least 1,250 hours in preceding 12 months and employed for at least 12 months and employed at worksite by employer with 50 or more employees within 75 miles of that worksite. 12 weeks during a 12 month period. Leave for birth, adoption, or to care for sick parent must be shared by spouses working for same employer. Enforced by the Department of Workforce Development Employers of at least 50 permanent employees during at least 6 of the preceding 12 calendar months. Have worked for employer at least 1,000 hours in preceding 52 weeks and for at least 52 consecutive weeks. During a 12 month period. * 6 weeks for birth or adoption * 2 weeks for serious health condition of parent, child or spouse. * 2 weeks for employees own serious health condition. Type of Leave Contact USDOL@ for inquiries. Birth, placement of child for adoption or foster care, to provide care for parent, child, spouse, domestic partner or parent of domestic partner with serious health condition, or employee's own serious health condition. Serious Health Condition (1). Illness, injury, impairment, or physical or mental condition involving incapacity or treatment connected with inpatient care in hospital or hospice. (2). Residential medical care in hospital, hospice, or residential medical care facility. (3). continuing treatment by a health care provider involving: (a). Incapacity or absence of more than 3 days from work, school, or other activities. (b). Chronic or long-term condition incurable, or so serious if not treated would result in incapacity of more than 3 days. (c). Prenatal care. Means a disabling physical or mental illness, injury, impairment, or condition involving inpatient care in a hospital, nursing home, hospice, or out patient care that requires continuing treatment or supervision by a health care provider. Most Favorable to Employees. See attached Questions and Answers. See attached Questions and Answers. See attached Questions and Answers. Comparable

11 Issues Health Care Provider Intermittent Leave Substitution of Paid Leave Reinstatement Rights Key Employee Exception Maintenance of Health Benefits During Leave Leave Requests Medical Certification May be Required By Employer to Support Federal Enforced by the U. S. Department of Labor. (1). doctors of medicine or osteopathy authorized to practice medicine or surgery in the State; (2). podiatrists, dentists, clinical psychologists, optometrists, chiropractors (for manual manipulation of spine to correct subluxation demonstrated by X-ray) (3). nurse practitioners, and nurse-midwives, if authorized to practice under State law; or, (4). Christian Science practitioners listed with the First Church of Christ Scientist in Boston, Massachusetts. Permitted for serious health condition when medically necessary. Not permitted for birth or adoption unless employer agrees. Employee may elect or employer may require accrued paid leave to be substituted in some cases. No limits on substituting paid vacation or personal leave. Employee may not substitute paid sick leave, medical, or family leave for any situation not covered by employer's leave plan. Must be restored to same or equivalent position in all terms and conditions. Exempts salaried employees if among highest paid 10% and if restoration would lead to grievous economic harm to employer. Health insurance must be continued under same conditions as prior to leave. Made by employee 30 days in advance or as soon as practicable. Request for leave because of serious health condition. Employee's fitness to return to work from medical leave. Enforced by the Department of Workforce Development Means: licensed physician, nurse, chiropractor, dentist, podiatrist, physical therapist, optometrist, psychologist; certified occupational therapist, occupational therapy assistant, respiratory care practitioner, acupuncturist, social worker, marriage and family therapist, professional counselor, speech-language pathologist or audiologist; and Christian Science practitioner. Permitted for all family and medical leaves in increments equal to the shortest increment permitted by employer for any other nonemergency leave Employee may elect to substitute accrued paid or unpaid leave of any other type provided by employer. Similar Provision No Similar Provision Similar Provision Made by employee in advance in a reasonable and practicable manner. Similar Provision No Specific Provision Most Favorable to Employees. Varies, as Federal and State laws each include several different types of health care providers. Comparable Comparable Comparable

12 Issues Executive, Administrative and Professional Employees Federal Enforced by the U. S. Department of Labor. Salaried executive, administrative and professional employees of covered employers, who meet the Fair Labor Standards Act (FLSA) criteria for exemption from minimum wage and overtime under Regulation 29 CFR part 541, do not lose their FLSA-exempt Status by using any unpaid FMLA leave. This special exception to the salary basis requirement extends only to eligible employees use of leave required by FMLA Enforced by the Department of Workforce Development Unpaid leave would not result in loss of exempt status under State minimum wage and overtime law. Most Favorable to Employees. Comparable

13 QUESTIONS AND ANSWERS ABOUT THE INTERFACE OF WISCONSIN AND FEDERAL LEAVE The existence of different Family Medical Leave Laws on state and federal levels raises questions about the coordination of rights and responsibilities of employers and employees. The following questions and answers are intended to provide users with information on the coordination of leave entitlement. They are intended to provide general advice. For advice on specific situations involving entitlement to Family and Medical Leave, please contact the State of, Department of Workforce Development, Equal Rights Division at (608) Madison or (414) Milwaukee. US Department of Labor's telephone number is (608) Madison. 1. What are an employee's leave entitlements under the federal law? Answer: The federal Family and Medical Leave Act of 1993 entitles employees who have worked 12 months for an employer and at least 1,250 hours in the 12 month period prior to leave, up to 12 weeks of leave. This leave may be taken for the birth or placement for adoption or foster care of a son or daughter, the serious health condition of the employee's parent, son, daughter, or spouse, or on the serious health condition of the employee. An employee is not entitled to 12 weeks for each of these reasons within a 12-month period. Questions concerning entitlement to federal leave should be addressed to the United States Department of Labor. 2. What are an employee's leave entitlements under the Family and Medical Leave Law? Answer: The Family and Medical Leave Law entitles employees who have worked for an employer for 52 consecutive weeks and at least 1,000 hours in the 12 months prior to leave, up to six (6) weeks of leave on the birth or adoption of a child. Two (2) weeks to care for a parent, child or spouse of the employee with a serious health condition and two (2) weeks for the serious health condition of the employee. Unlike leave under the federal law, entitlement under the Family and Medical Leave Law are specific to the category of leave requested. 3. Does an employee's pay continue during a period of leave? Answer: Leave under both state and federal law is unpaid. However, under the state law, an employee may substitute paid or unpaid leave. Under federal law, an employer may require or an employee may elect to substitute paid leave for the otherwise unpaid leave. 4. Do employee's health benefits continue during a period of leave? Answer: If the leave is covered by either state or federal law, the employee's health insurance shall continue, under the same conditions as comparable active employees. 5. What is the 12-month period within which an employee's leave is to be taken? Answer: For leave purposes, the 12 month period during which leave must be taken is based on a calendar year. The federal 12-month period during which leave may be taken is based on the period selected by the employer, which may be a rolling or fixed year. The year may be based on a calendar year, fiscal year, or the employee's anniversary date.

14 6. If an employee qualifies for leave under one of the laws, does the employee automatically qualify for leave under the other law? Answer: An employee must qualify under the federal law to be entitled to the 12 weeks of leave. The employee must qualify under law to be eligible for the leave entitlement. Satisfaction of one law's eligibility requirements does not necessarily mean the employee has satisfied the requirements of the other. However, an employer may use the lower of the federal and state requirements for purposes of leave administration. In such a case, the satisfaction of the lower thresholds for federal and leave will result in employee entitlement to such leaves. 7. If an employee is entitled to leave under both laws, how is his or her leave charged against the entitlement? Answer: If an employee qualifies for federal family and medical leave and for leave under state law, leave used counts against the employee's entitlement under both laws. 8. If an employee is entitled to leave under only one law, how is his or her leave accounted for? Answer: If an employee is entitled to leave under only one law, his or her leave used counts against the entitlement under that law. 9. If an employee is entitled to leave under both laws, which requirements for notice, certification, substitution and intermittent leave apply? Answer: Nothing in the Federal Family and Medical Leave Act supersedes any provision of state or local law which provides greater family and medical leave rights than those provided by the federal law. Therefore, where an employee is entitled to leave under both laws, the notice, certification, substitution and intermittent leave requirements which provide the greater leave rights apply. However, if an employee's leave extends beyond the period of coverage under one of the laws, an employer may require the employee to comply with the requirements of the continuing law. 10. If an employee is entitled to leave under only law, what rules apply as to notice, certification and intermittent leave. Answer: When an employee is entitled only to leave under law, then only the rules regarding notice, certification, and intermittent leave apply. 11. If an employee is only entitled to leave under the federal law, what rules apply concerning notice, certification, substitution, and intermittent leave? Answer: If an employee is only entitled to leave under the federal law, then the federal rules concerning notice, certification, substitution, and intermittent leave apply. 12. If an employer's policy or collective bargaining agreement provides greater family and medical leave rights than are provided by either federal or state law, which rules apply? Answer: To the extent that an employer's policy or collective bargaining agreement provides leave rights in addition to or greater than those provided by state or federal law, the employer's policy or collective bargaining agreement shall apply to the extent they are more generous.

15 13. If an employee takes leave for the birth or adoption of a child and is eligible for leave under and federal laws, how are the leaves coordinated? Answer: For an employee who qualifies under both the federal and laws for leave on a birth or adoption, the six weeks of and federal leave may commence prior to, on or after the birth or adoption. law provides that the six weeks of leave must commence within 16 weeks before or after the birth or adoption. Under federal law, up to 12 weeks of leave is available for the birth or placement for adoption provided the leave is concluded no later than 12 months after the birth or placement. The federal and leaves will run concurrently where an employee is entitled to both. Example: Following the birth of a child, mother desires to take off 12 weeks and father six weeks. Mother will be on leave for her own serious health condition for a period of six weeks, under her employer's disability plan, concurrently using two weeks of leave for her serious health condition and six weeks of federal leave for her serious health condition. At the end of the six weeks of disability, she may take an additional six weeks of leave for the birth of the child under law, concurrently utilizing the remaining six weeks of her federal leave. The father will take six weeks of leave for the birth of a child. Concurrently using his six weeks for the birth of a child under law and six weeks of his federal entitlement, leaving six weeks of leave under the federal law which may be used for other qualifying purposes later in the year. 14. Is placement for foster care covered? Answer: Placement for foster care is covered only under federal law; it is not covered under state law. 15. If an employee is eligible for leave to care for a family member with a serious health condition under and federal law, how are the leaves coordinated? Answer: Under law, an employee is entitled to take up to two weeks per year to care for a parent (including parent-in-laws), child, or spouse with a serious health condition. Federal law allows an employee up to 12 weeks per year to care for a parent, child, or spouse with a serious health condition. If the requirements for leave under both laws are met, the leave under both laws run concurrently. Example: The child of an employee experiences a serious health condition, which has a duration of 12 weeks. The first two weeks are covered by both laws with the next 10 weeks of leave covered only by federal law. If the employee's need for leave should extend beyond 12 weeks, the availability of additional weeks will be governed by the employer's leave policies. 16. If an employee experiences a serious health condition, how are his or her leave entitlement coordinated under and federal law? Answer: An employee will be entitled to up to two weeks of leave under 's law for his or her own serious health condition, and up to 12 weeks of leave under federal law, provided the leave has not been used for other purposes. If the employee is entitled to leave under both laws, then leave use will be counted against both entitlements concurrently. Example: An employee experiences a serious health condition which renders him or her unable to perform the functions of his or her position. The first weeks of leave are covered by both the and federal laws, concurrently, with any additional leave covered and charged only against the employee's federal entitlement, for up to 10 additional weeks. If the employee's need for leave extends beyond 12 weeks from its commencement, the availability of leave from work will be governed by the employer's leave policies.