UNIVERSITY OF WISCONSIN River Falls

Benefits and Retirement

Family and Medical Leave

Federal Family and Medical Leave Act (FMLA) and Wisconsin Family and Medical Leave Act (WFLMA)

The FMLA and WFMLA provide you with the right to take job-protected leave with continued medical benefits when you need time off from work to care for yourself or a family member who is seriously ill, or to care for a newborn or newly adopted child, or to attent to the affairs of a family member who is called to active duty in the military.

Once you know you need to take a leave of absence that may be covered by the Wisconsin and/or Federal Family and Medical Leave Acts, contact Jennifer Friedman to determine eligibility, complete the applicable forms below and forward them to Jennifer via email or fax to 715-425-0630.

 

FORMS

Employee Request for W/FMLA (UWS 80)pdf 

Complete and submit this form to your institution to request W/FMLA-protected leave. If you request a WFMLA leave to care for a domestic partner or a domestic partner's parent, you must complete this form in order to certify the domestic partnership for WFMLA purposes.

Certification of Health Care Provider for Employee's Serious Health Condition (DOL WH-380-E)pdf 

Your health care provider must complete this form to certify your serious health condition if you are taking a concurrent FMLA and WFMLA leave. Note: if you are taking a WFMLA leave only - use the WFMLA Certification form (UWS 82a) to certify your own serious health condition.

WFMLA Certification of Health Care Provider for Employee's Serious Health Condition (UWS 82a)pdf 

If you are taking a WFMLA leave only - use this form to certify your own serious health condition.

Certification of Health Care Provider for Family Member's Serious Health Condition (DOL WH-380-F)pdf 

Your family member's health care provider must complete this form to certify their serious health condition if you are taking a concurrent FMLA and WFMLA leave. Note: if you are taking a WFMLA leave only - use the WFMLA Certification form (UWS 83a) to certify your family member's serious health condition.

WFMLA Certification of Health Care Provider for Family Member's Serious Health Condition (UWS 83a)

If you are taking WFMLA leave only - use this form to certify your family member's serious health condition.

Certification of Qualifying Exigency for Military Family Leave (DOL WH-384)pdf  

Complete and submit this form to your institution to certify that an exigency was created because a family member is on covered active military duty or has been notified of an impending call or order to active duty to a foreign country or international waters. The family member may be in either the regular or reserve component of the Armed Forces.

Certification for Serious Injury or Illness of a Current Servicemember-- for Military Family Leave (DOL WH-385)pdf 

Complete and submit this form to your institution to request FMLA-protected leave to care for a current military servicemember, who is a family member or next of kin, who is seriously ill or injured due to military service.

Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave (DOL WH-385-V)pdf 

Complete and submit this form to your institution to request FMLA-protected leave to care for a veteran, who is a family member or next of kin, who is seriously ill or injured due to military service.

RESOURCES

FMLA Guide for Employees

UW System Administrative Policy 1213 (formerly BN 4): Wisconsin and Federal Family and Medical Leave Acts

FMLA Posterpdf

WFMLA Poster

Employee Notice

Employee's Rights and Responsibilities

Contact Us

Office of Human Resources
benefits@uwrf.edu
715-425-3518
M-F, 7:45 a.m. - 4:30 p.m.
216/218 North Hall