The Essential Guide to Family & Medical Leave

appendix C | forms and checklists | 391
P Managers’
Checklist
Giving Notice and Designating Leave
o I have given a written designation form letter to the employee requesting leave.
The designation form letter includes:
o a statement that the leave is FMLA leave and will reduce the employee’s
available FMLA leave time, or
o a statement that the leave is preliminarily designated FMLA leave and will
reduce the employee’s available FMLA leave time, pending investigation
into whether the need for leave falls under the FMLA, or
o a statement that the leave is not FMLA leave.
o After giving the preliminary designation, I have asked the employee requesting
leave or his or her spokesperson to tell me the reason for the leave, and
o the employee has informed me that the employee needs the leave because
of a serious health condition, and I have confirmed the FMLA designation
in writing
o the employee has given me some information that leads me to believe that
the need for leave falls under the FMLA, and I have requested additional
information, including medical certification, or
o the need for leave does not fall under the FMLA, and I have withdrawn the
preliminary FMLA designation in writing.
o Where an employee’s behavior reveals the employee might have a serious
health condition, I have placed the employee on FMLA leave with a preliminary
designation and have conducted an inquiry into whether the employee actually
has a serious health condition.
o I have granted an employee’s request for leave and preliminarily designated the
leave as FMLA leave even though the employee did not mention the FMLA, where
o the employee gave me enough information to believe that the need for
leave might fall under the FMLA, or
o I have information from another source that the employee’s need for leave
falls under the FMLA.