Sioux City Community Schools -

Q. What type of documentation does the FMLA require or allow?

Employee Request for Leave Under the FMLA.

This form documents the employee’s request for FMLA and notifies the Sioux City School District that leave is needed.

Whose responsibility?

The employee must submit this request 30 days before the leave is needed when the leave is known or otherwise foreseeable. If the leave is not known or foreseeable, the employee shall submit the request as soon as possible. A verbal request can suffice but the employee should try to make it clear that leave is needed for a covered reason. An unreasonable delay in requesting leave may result in a delay in approving the time off.

Notice of Employee Eligibility and Rights and Responsibilities.

This form tells an employee whether he or she is eligible to take FMLA and also explains the employee’s rights and responsibilities when taking such leave.

Whose responsibility?

The Sioux City School District will provide this form to the employee at the home address or email (if requested) on record.

Certification of Health Care Provider for Employee’s Serious Health Condition.

This form documents the serious health condition of the employee to determine whether FMLA is warranted.

Whose responsibility?

The employee must return the certification to Human Resource Services within 15 calendar days. The medical certification must be complete and sufficient for the Sioux City School District to determine if FMLA is warranted. If any section of the certification is incomplete or insufficient, the employee will need to obtain more information before FMLA can be approved. If the certification confirms that it is medically necessary for the employee to take intermittent leave or leave on a reduced schedule for an FMLA condition, the employee does not need to 02/2010 provide certification for each subsequent absence for that condition. The employee must, however, notify the department of absences and the reason for those absences. If the employee develops additional health conditions, it may be necessary to obtain certification of those conditions to see if they are also covered by FMLA.

Certification of Qualifying Exigency for Servicemember Leave.

This form documents the reason for and amount of leave needed for an exigency due to a family member’s call to covered active duty.

Whose responsibility?

The employee must return this form to Human Resource Services within 15 calendar days.

Certification for Serious Illness or Injury of Covered Servicemember.

This form documents the reason for and amount of leave needed to care for a family member or veteran who is injured or ill due to covered active duty.

Whose responsibility?

The employee must return this form to Human Resource Services within 15 calendar days.

Designation Notice.

This form documents whether FMLA leave has been granted.

Whose responsibility?

The Sioux City School District will provide this form to the employee at the home address on record as soon as possible after the need for FMLA leave is determined based on the documentation received.

Second or Third Opinions.

These additional medical opinions may be sought if there is concern or question over the employee’s Certification of Health Care Provider.

Whose responsibility?

The Sioux City School District seeks and pays for a second opinion if needed. If the first and second opinions differ, the Sioux City School District may seek and pay for a third opinion. The third opinion is binding.

Recertification.

This medical certification is often used to update an employee’s chronic or ongoing condition. The Sioux City School District may request recertification every 30 days unless the original certification specified a certain date when the condition would be healed or updated; however, in all cases, the Sioux City School District may request recertification at least annually or may choose to seek recertification every 6 months even if the certification includes a certain date when the condition would be healed or 02/2010 updated. If the Department learns of new developments that cause the supervisor to question the employee’s need for leave or question the accuracy of the original certification, the Sioux City School District may seek recertification in those situations.

Whose responsibility?

It is the Sioux City School District’s responsibility to request the recertification. It is the employee’s responsibility to return the recertification within 15 calendar days.

Release to Return to Work.

If an employee has taken FMLA leave for his or her own serious health condition, a return to work release is required prior to returning to work. The employee cannot return to work without the release.

Whose responsibility?

It is the employee’s responsibility to provide the return to work release prior to returning to work.

Stefanie Verros
Assistant Director of Human Resources
712-293-2356 or 712-293-2354
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