FMLA Form for Family Member (WH-380F)

Download WH-380-F_FMLA-for-Family

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