FMLA Policy Template

In accordance with the Family and Medical Leave Act (FMLA), [Company Name] provides eligible employees with up to 12 weeks of unpaid, job-protected leave per year for qualifying family and medical reasons.

[Company Name] is a covered employer under FMLA, employing [50+] employees within a 75-mile radius of each work location.

To be eligible for FMLA leave, employees must: • Have worked for [Company Name] for at least 12 months • Have worked at least 1,250 hours during the 12 months before leave begins • Work at a location with 50+ employees within 75 miles The 12 months of employment need not be consecutive.

FMLA leave may be taken for: • Birth of a child and bonding (within 12 months of birth) • Placement of a child for adoption or foster care (within 12 months) • Care for spouse, child, or parent with a serious health condition • Employee's own serious health condition that prevents performing job duties • Qualifying exigency related to family member's military service • Care for covered service member with serious injury or illness (up to 26 weeks)

• 12 workweeks of leave in a 12-month period for most qualifying reasons • 26 workweeks for military caregiver leave • [Company Name] uses a [rolling/calendar/fixed] 12-month period Leave may be taken: • Continuously (all at once) • Intermittently (in separate blocks) • As reduced schedule (fewer hours per day/week)

**Foreseeable Leave:** Provide at least 30 days advance notice, or as soon as practicable. **Unforeseeable Leave:** Provide notice as soon as practicable, generally within 1-2 business days. Employees must follow normal call-in procedures when absence is unforeseeable.

[Company Name] may require medical certification for: • Employee's serious health condition • Family member's serious health condition • Military caregiver or exigency leave Certification must be provided within 15 calendar days. Failure to provide certification may result in denial of leave.

FMLA leave is unpaid. However: • Employees may choose to use accrued PTO/vacation concurrently • [Company Name] [may require/allows but does not require] substitution of paid leave • State paid family leave benefits may be available • Short-term disability may cover employee's own medical leave

• Health insurance continues under same terms as active employment • Employee remains responsible for their share of premium costs • If payment is more than 30 days late, coverage may be terminated with 15 days notice • Other benefits [continue/do not continue] during leave

• Employees are entitled to return to the same or equivalent position • "Equivalent" means same pay, benefits, and terms of employment • Employer may require fitness-for-duty certification for own medical leave • Key employees (highest-paid 10%) may have limited restoration rights

[Company Name] will not: • Interfere with employee's FMLA rights • Retaliate against employees for taking or requesting FMLA leave • Count FMLA-protected absences against attendance policies • Require employees to "make up" FMLA time