VU NOTIFICATION OF FMLA STATUS FORM

(Guidelines to Complete)

Complete:

1. Date of notification: Current date (see guidelines above as to "when")
   
2. To: (Faculty/Staff member’s name)
   
3. From: Department Administrator
   
4. On _____________ (insert date of notification … follow guidelines above on "when"); then check the appropriate box for the reason
   
5. Include date that leave will begin and date that leave is expected to end
   

1. Consult with Employee Relations for questions or before indicating the faculty or staff member is not eligible for FMLA. Three issues to consider for eligibility:
   
   
   • event qualifies for FMLA leave according to the FMLA guidelines (serious health condition that involves hospital care, absence plus treatment, pregnancy, chronic conditions requiring treatments, permanent/long-term conditions requiring supervision, and multiple treatments (non-chronic conditions),
   • faculty or staff member has been employed by Vanderbilt for 12 months, not necessarily the preceding 12 months, and
   • faculty or staff member has worked at Vanderbilt at least 1250 hours during the 12 months prior to beginning FMLA leave.
     
     
2. Will – the leave will be counted against the annual FMLA leave entitlement. Before indicating "no," which would only be for a non-FMLA qualifying event, departments should contact Employee Relations.
   
   
3. Will -- A supervisor may require either medical certification from a health care provider, or the appropriate court documents for adoption or foster care placement, to certify the need for leave. If certification is required, the supervisor must provide the faculty/staff member with a copy of the Certification of Health Care Provider Form. The form is to be completed by the health care provider.
   
   

   Certification should include: date the serious health condition began, probable duration of condition, statement that the faculty/staff member is unable to perform the functions of his/her job or is required to take care of a family member who has an FMLA-qualifying event. Medical Certification is to be provided within 15 days. If the faculty/staff member does not provide within 15 days, the supervisor should call Employee Relations for appropriate action.
   
   

   If the supervisor needs clarification or authentication of a medical certification, contact Employee Relations to have a VU health care provider contact the faculty/staff member’s health care provider. Supervisors may not contact the faculty/staff member’s health care provider directly.
   
   

   Medical certification should be addressed to Occupational Health. Medical certification received in the department should immediately be forwarded to Occupational Health. Medical certification (original or copies) should not be maintained in department files.

1. Will -- Vanderbilt’s policy states, the following on usage of accrued paid/unpaid leave:
   • For own or family member’ serious health condition, faculty/staff member must use, in order, all accrued sick time, holiday, personal days, and vacation time before going on unpaid status (a PAF must be submitted by the department)

   NOTE: For the collective bargaining unit members, please see the bargaining agreement for usage availability.

   • For birth or adoption, or foster placement of a well child, faculty/staff member must use all accrued holiday and vacation time before going on unpaid status (may not use sick time for care of a well child).

   NOTE: If faculty/staff member is receiving workers’ compensation benefits for an injury or occupational disease, he/she may supplement those benefits with accrued sick, holiday, and vacation time to maintain full salary.
   
   

2. (a) Faculty/staff on approved FMLA leave will continue to receive benefit coverage under Vanderbilt’s health and dental care plans at the level and under the conditions that such coverage would have been provided if the faculty/staff member had continued working. Faculty/staff on paid leave will have premiums paid through payroll deduction, as long as the staff member has accrued time available to keep the staff member on a paid status. Faculty/staff on unpaid leave will submit monthly premium payments to the Accounts Payable Office for Vanderbilt to cover their portion of the premium in the same amount as if the faculty/staff member was working.
   
   
   

   (b) Will not -- Benefit coverage outlined above.
   
   

   (c) Will – Vanderbilt will do the same with other benefits, i.e. Vanderbilt will not pay the faculty/staff member’s share of other benefits while on FMLA leave. Will – Faculty/staff member will be expected to reimburse Vanderbilt
   
   

3. Will -- Faculty/staff member is expected to return by the end of the approved leave; and if on leave for a medical condition, must obtain certification from his/her health care provider prior to returning to work. The certification must address when the faculty/staff member can return to work and perform his/her regular duties or set forth the restrictions that prevent the staff member from resuming his/her regular duties. Consult Employee Relations or the Opportunity Development Center prior to making a determination on whether an employee can return to work with restrictions.
   
   
4. (a) Call Employee Relations to verify status as "key employee."

   (b) Must coordinate "have" response with Employee Relations; linked to definition of "key employee."
   
   

5. Will – Consult with Occupational Health or Employee Relations for determination of how often periodic reports will be required (this depends on the information provided by the health care provider in the medical certification). Will – Faculty/staff member will be required to notify department at least two work days prior to the date they intend to report for work.
   
   
6. Will – Consult with Occupational Health or Employee Relations for determination of recertification requirements (this depends on the information provided by the health care provider in the medical certification).