To facilitate compliance with the revised federal Family and Medical Leave Act and the new Military Family Leave entitlements, the At Your Service (AYS) “Family Medical Leave” website has been updated to include links to a number of required new/revised leave forms.
- Certification of Health Care Provider for Employee’s Serious Health Condition
- Certification of Health Care Provider for Family Member’s Serious Health Condition
- Certification of Health Care Provider for Employee’s Pregnancy Disability
- Certification of Qualifying Exigency for Military Family Leave (FMLA)
- Certification for Serious Injury or Illness of Covered Service Member (FMLA)
- Notice of Eligibility and Rights & Responsibilities – Family and Medical Leave Act
- Designation Notice – Family and Medical Leave Act
The forms are subject to further review and any changes will be posted on the “Family Medical Leave” website and communicated to you.
The revised “Employee Rights and Responsibilities under the Family and Medical Leave Act” notice is currently available at the AYS “Mandatory Employment Notices/Posters” web portal. Please ensure that the revised notice has been posted, and that a copy of the revised notice is included with new employee orientation materials.
We will continue to review PPSM and related policies and resources to identify changes required to conform to the new FMLA regulations, as well as changes required by the recent ADA Amendments Act. The “Family Medical Leave” website portal will reflect the changes as they are applied.
Campus Human Resources, Personnel Services
Phone: (310) 794-3147 | Fax: (310) 794-0865
