FMLA Form for Employee (WH-380E)

Download WH-380-F_FMLA-Form-for-Employee

The Family and Medical Leave Act (FMLA) provides that an employer may require an employee seeking FMLA protections because of a need for leave due to a serious health condition to submit a medical certification issued by the employee’s health care provider. Complete this form and send to Rebecca Rohde at or to our FP&M HR fax number: 608-265-3692.