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Designation Notice (Family and Medical Leave Act) U.S. Department of Labor Wage and Hour Division OMB Control Number: 1235-0003 Expires: 2/28/2015 Leave covered under the Family and Medical Leave
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Welcome to module 2 in this module we'rereviewing the forms provided by theDepartment of Labor for Family MedicalLeave situations the form we have hereis the final form that a supervisorgives to an employee to indicate to thatemployee whether or not they're leave isconsidered covered under the FamilyMedical Leave Act this form is calledthe designation notice it's alsoreferred to as form WH 382 so let's walkthrough this form as you can see it asksyou to give the employees name and thedate that you're completing the form andthen it indicates here we reviewed yourrequest for leave under the FamilyMedical Leave Act we've received yourmost recent information on and decidedand then it indicates here your familymedical leave request is approved if forsome reason the documentation receivedfrom the doctor is not sufficient pleasecontact human resources and will helpyou to navigate that process if you havereceived all the appropriatedocumentation you certainly can checkoff your family medical leave request isapproved as long as the employee iseligible for Family Medical Leave itstates here that Family Medical Leaverequires that you notify us as soon aspracticable if the dates of yourscheduled leave our extended or ifthey're unknown to get in touch with theemployer and let him or her know exactlywhat belief situation is so it indicateshere that if you do have an idea of theamount of time that you check offprovided there's no deviation from youranticipated schedule the followingnumber of hours days a week will becounted against your leave entitlementso if the employee has told you I need12 weeks starting on this dateyou certainly can indicate the datesthat will be covered by Family MedicalLeave if the leave is an emergency leaveand you're not sure how long theemployee will be off you certainly wantto check off because the leave you willneed will be unscheduled it's notpossible to provide the hours days orweeks that will be counted against yourfamily medical leave entitlement at thistime and of course the employee canrequest that once he or she's gotten theinformation needed to the supervisorabout the length of the leave then itindicates here please be advised checkif applicable we are not indicating herethat vacation leave has to be paid outbut we do require sick leave to be paidout so if an employee is taking leavefor Family Medical Leave purposes eitherfor his or her own medical condition orto care for a family member we may verywell require that they use sick leave soyou certainly can indicate here we arerequiring you to substitute or use paidleave during your family medical leaveso you do want to indicate that since wedo require that sick leave be paid toout to an employee on leave in someinstances an employee may not beeligible to use his or her and sickleave when caring for a family member soyou would want to call human resourcesand check into that before...