Medical & FMLA

Family and Medical Leave Act

If you are absent for more than 5 days in a row due to your own illness or that of a family member, you are required to provide a medical certificate (P-33A or P33B). The first two pages of the document must be completed by your health care provider and forwarded directly to HR. The last page of the document entitled “Employee Fitness for Duty Certification” should also be completed by your health care provider and submitted upon return from your extended absence.

In addition, after three day of absence due to illness, the college is obligated to provide an employee with an FMLA request form (FMLA HR 1). This form should be completed by the employee and returned directly to HR. This information provides the college with the anticipated length of the absence and helps the college to determine if the absence is FMLA eligible or not, which is a requirement under State and Federal law.

FMLA Forms

 FMLA – Core-CT Coding Form – FMLA-HR2c

Form to be completed by agency human resources when the employee has been approved for family leave, medical leave or military family leave and is attached to the employee’s HR2b – Designation Notice.

FMLA – Employee’s Intent to Return to Work Form – FMLA-HR-3

Form to be completed by the employee indicating his/her intent to return to work prior to taking family leave, medical leave or military family leave.

FMLA Agency Response Designation Notice – FMLA-HR-2b

Form to be completed by agency human resources department notifying employee of the disposition of the employee’s request for family leave, medical leave or military family leave.

FMLA Agency Response Eligibility Notice to Employee – FMLA-HR-2a

Form to be completed by agency human resources department notifying employee of his/her eligibility in response to employee’s request for family leave, medical leave or military family leave.

FMLA Caregiver Medical Certificate P-33B

Form to be used by employees seeking family leave to care for a spouse, child, or parent with a “serious health condition”. Form must be completed by family member’s attending medical provider.

FMLA Employee Medical Certificate P-33A

Form to be used by employee who is absent for personal illness, including FMLA absences; form must be completed by employee’s attending medical provider.

FMLA Employee Request Form – FMLA-HR-1

Form to be completed by employee requesting family leave, medical leave or military family leave

Employee Responsibilities:
  • If you are absent for more than 5 days, you must obtain a completed medical certificate P-33A from your treating health care provider and have it returned directly to HR within 7 days. A doctor’s note is not a substitute for this form.
  • If you are absent for more than three days and the absence is FMLA related, please complete an FMLA request form (and return it directly to HR within 7 days.
  • Upon return to work from a medical leave of more than 5 days, please provide HR with a completed Employee Fitness for Duty Certification (on the last page of the P-33A) to insure that you have been medically cleared to work in either a regular or restricted capacity.
  • If an employee is removed from the premise by emergency personnel, he/she should return to work with a completed Employee Fitness for Duty Certification.
Supervisory Responsibilities:
  • If an employee is absent for more than 3 days in a row as a result of an FMLA related reason, please notify HR promptly.
  • If an employee is absent for more than 5 days in a row as a result of their own illness or the illness of a family member, please notify HR promptly. HR should not find out about the absence once we receive the employee timesheet.
  • Please make sure that the time sheet accurately reflects the absence and is coded correctly. HR will provide you with the correct time sheet coding once we are informed of the absence.
  • Any questions about this topic should be directed to Human Resources/Payroll.
  • If an employee is removed from the premise by emergency personnel, please make sure he/she returns to work with a completed Employee Fitness for Duty Certification.