This toolkit is designed to help you administer family and medical leaves, providing the essential employee memos, applications for leave, required federal notices, and a leave tracking Excel spreadsheet.
Does the law apply to your organization?
| Federal FMLA | 50 employees within a 75 mile radius |
| Wisconsin FMLA | 50 employees (need not all be employed in Wisconsin) |
| Iowa Pregnancy Leave | 4 or more employees (need not all be employed in Iowa) |
| Illinois Crime Victims Leave Act (VESSA) | 15 or more employees (need not all be employed in Illinois) |
| Minnesota Parental Leave Act | 21 or more employees at any one site in Minnesota |
- Related Compliance Posters
- Sample Policies
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Leave Application & Notices
Leave Application & Notices
Leave Application/Notice to Organization
- Application for Leave of Absence Form
- Certification of Relationship (Optional FMLA Administration Form)
- Wisconsin FMLA Optional Form for Domestic Partner Relationship
Determine Employee Eligibility
- Federal FMLA - 12 months (need not be consecutive) and 1250 hours worked
- Wisconsin FMLA - 52 consecutive weeks and 1000 paid hours
- Iowa Pregnancy Leave - Effective day one of employment
- Illinois Crime Victims Leave Act (VESSA) - Effective day one of employment
- Minnesota Parental Leave Act - 12 consecutive months, 50% of full time position hours
Issue Mandatory Employee Notices (Issue within 5 business days of notification)
- Notice of Eligibility and Rights and Responsibilities (DOL)
- Notice of Eligibility and Rights and Responsibilities - Spanish
- FMLA Leave Request Cover Letter
Issue Mandatory Designation Notice (Issue within 5 business days of notification)
- FMLA Designation Notice (DOL)
- FMLA Designation Notice (MRA)
- FMLA Designation Notice - Spanish (MRA)
- No Return of FMLA Packet Forms Letter
- FMLA Denied - Paperwork Not Returned
- Failure to Return from FMLA Letter (Caretaking / Bonding)
- FMLA Recertification and Approval Letter to Employee
- FMLA Letter to Employee on Benefit Payments
- FMLA Ending - Leave of Absence Continuing Letter
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Medical Certification
Medical Certification
DOL Versions
- Certification for Serious Injury or Illness of Current Servicemember - for Military Family Leave
- Certification for Serious Injury or Illness of Veteran - for Military Caregiver Leave
- 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 Qualifying Exigency For Military Family Leave
MRA Samples
- Manage Chronic / Intermittent Leaves
- Track Use of Leave
Determine Employee Eligibility
Federal FMLA - 12 months (need not be consecutive) and 1250 hours worked
Wisconsin FMLA - 52 consecutive weeks and 1000 paid hours
Iowa Pregnancy Leave - Effective day one of employment
Illinois Crime Victims Leave Act (VESSA) - Effective day one of employment
Minnesota Parental Leave Act - 12 consecutive months, 50% of full time position hours
Resources from the DOL
Employer’s Guide to the Family and Medical Leave Act - provides "essential information about the FMLA, including information about employers’ obligations under the law and the options available to employers in administering leave under the FMLA. The Guide is organized to correspond to the order of events from an employee’s leave request to restoration of the employee to the same or equivalent job at the end of the employee’s FMLA leave. It also includes a topical index for ease of use."
Wisconsin Human Resources Handbook – Family Medical Leave Act (WI DPM)
