Family Medical Leave Act (FMLA)


Employee Rights under FMLA

Department of Labor COVID-19 FMLA Changes

Request Forms

FMLA Request Form

The FFCRA form should be used for one of the following reasons, all other requests should use the FMLA Request Form:

  • You are subject to a federal, state, or local quarantine or isolation order related to COVID-19
  • You have been advised by a health care provider to self-quarantine due to concerns related to COVID-19
  • You are experiencing symptoms of COVID-19 and are seeking a medical diagnosis.
  • You are caring for an individual who is subject to either numbers 1 or 2 above.
  • You are caring for a child (up to age 14, or age 15-18 with special circumstances) whose school or place of care has been closed, or your childcare provider is unavailable due to COVID-19 precautions and,
    • You attest that no other suitable person is available to care for your child during the requested period of leave; and/or
    • You attest that special circumstances exist requiring your need for leave to care for a child ages 15-18.
  • You are experiencing another substantially similar condition specified by the Secretary of Health and Human Services in consultation with the Secretary of the Treasury and Secretary of Labor.

Certification FOrms