The Essential Guide to Family & Medical Leave

chapter 7 | Giving Notice and Designating Leave | 125
Tip
Use a form to designate leave. Although no particular form is required, it’s
a good idea to develop an FMLA designation form—such as the sample
we provide below (also in Appendix C and on the CD-ROM in the back of
this book)—and use it with every request for leave. This will ensure that
you’re giving the employee all required information and will create a clean
written record for you to keep in the employee’s file. (See Chapter 12 for
more on keeping records relating to FMLA leave.)
Sample
TO: [Employee’s Name]:
FMLA Designation (Preliminary)
You have requested leave from [Date] to [Date]. Based on the information you
provided, the leave you requested is preliminarily designated as FMLA leave.
Please provide the following additional information:
• [other information requested, such as medical certification, proof of family
relationship, and so on]
Once you have provided this information, we will determine whether your
leave is covered by the FMLA. If so, we will issue a final designation to that
effect, and the leave you take will be counted against your available FMLA
leave time. If not, we will withdraw this preliminary designation, in writing.
Sample
TO: [Employee’s Name]:
FMLA Designation (Final)
You have requested leave from [Date] to [Date]. Based on the information
you provided, the leave you requested is designated as FMLA leave and will
count against your available FMLA leave time.