Skip to main content

Procedures for FMLA

 

Step 1 Complete the FMLA Request Form. The form must be filled out completely and submitted via WebApp, via email to FMLA@medic911.com, or in person to a member of Safety or Human Resources.
Step 2 Within five (5) business days of your FMLA Request Form submission, you will receive a Notice of Eligibility and Rights and Responsibilities along with one of the following certification forms:

·        Birth and Bonding Certification

·        Medical Certification for Employee

·        Medical Certification for a Family Member

·        Military Exigency Certification

·        Service Member/Veteran Caregiver Certification

 Carefully read the Notice of Eligibility and Rights and Responsibilities form as it informs you of all of your rights and responsibilities while out on leave as well as what to do when returning to work.

You must follow the call out policy and email FMLA@medic911.com within 24 hoursof use.

Step 3 The certification form (one of the five referenced above) must be completed in its entirety and submitted via email to FMLA@medic911.com, or in person to a member of Safety or Human Resources within 15 calendar days of receipt. The following forms include a required certification from a health care provider:

·        Medical Certification for Employee

·        Medical Certification for a Family Member

·        Service Member/Veteran Caregiver Certification

 If forms are not submitted within 15 calendar days, your FMLA leave may be delayed or denied. Forms may be  submitted via email to FMLA@medic911.com, via fax 704-943-6098, in person to a member of Safety or Human Resources or via postal mail:

ATTN: Human Resources

4425 Wilkinson Blvd

Charlotte, NC 28208

Note: A Designation Notice will be sent denying FMLA leave if the applicable certification form is not received within 15 days.

Step 4 Within five (5) business days of having enough information to determine whether the leave is FMLA qualifying, you will be emailed a Designation Notice.
Step 5 If your leave extends beyond 25 consecutive days, contact a member of Human Resources for information on Short Term Disability.
Step 6 Always communicate your leave plans and any status updates with your supervisor. Always provide updated information regarding your leave via email to FMLA@medic911.com as required and detailed on the Notice of Eligibility and Rights and Responsibilities.
Step 7 Refer to the Notice of Eligibility and Rights and Responsibilities throughout the course of your leave of absence to ensure you are following all required procedures.

Please be advised that your time off cannot be approved nor protected under the provisions of the FMLA (if eligible) if you do not complete your responsibilities as outlined in this document, including all required forms and information referenced above.