Table of Contents (see Step 8 and Appendix A for samples)

I. Introduction

II. Compliance Steps

Step 1: Evaluate Whether the Employer is Covered by the FMLA

Step 2: Ensure FMLA Poster is Posted/Obtain Statute and Regulations

Step 3: Evaluate Whether Employee is Eligible for Leave

Step 4: Evaluate Whether Employee’s Leave Request Satisfies FMLA Criteria

Step 5: Evaluate Whether Employee Provided Adequate Notice

Step 6: Evaluate Whether Medical Certification Requirements Are Met

Step 7: Give Written Confirmation of FMLA Leave

A. Conditional Grant of Leave

B. Evaluate Whether Employee is "Key Employee"

Step 8: Review Employer’s Obligation to Provide Benefits During Leave

Step 9: Arrange For Payment of Benefit Premiums

Step 10: Provide Notice of Failure to Pay Premiums

Step 11: Obtain Subsequent Recertifications (if desired)

Step 12: Obtain Periodic Updates (if desired)

Step 13: Confirm Employee’s Intent To Return or Not Return After Leave

Step 14: At the End of Leave, Obtain Fitness-For-Duty Certification

Step 15: At the End of Leave, Reinstate Employee to Equal or Equivalent Position

Step 16: If Employee Does Not Return to Work, Offer COBRA Continuation Coverage and Recover Group Health Plan Premiums

A. COBRA Continuation Coverage

B. Recover Group Health Plan and Non-Health Plan Premiums

Step 17: Evaluate Whether Employee Returning from Leave Owes Premium Payments for Coverage Maintained While on FMLA Leave

III. Model Forms

Appendix A: Model FMLA Policy - Washington State Version (PDF | Word)

Appendix B: Model Leave Request Form (PDF | Word)

Appendix C: Model FMLA Leave Tracking Form (PDF | Word)

Appendix D: Model Certification of Health Care Provider (PDF | Word)

Appendix E: Model Response to Request for FMLA Leave and Confirmation of Benefit Coverage (PDF | Word)

Appendix F: Model Confirmation of Leave (PDF | Word)

Appendix G: Model Notice of Overdue Premium Payment (PDF | Word)

Appendix H: Model Recertification Request (PDF | Word)

Appendix I: Model Periodic Update (PDF | Word)

Appendix J: Model Confirmation of Intent Not to Return (PDF | Word)

Appendix K: Model Fitness-For-Duty Reminder (PDF | Word)

Appendix L: Model Request for Reimbursement (PDF | Word)