FAMILY AND MEDICAL LEAVE ACT NOTICE FOR FACULTY MEMBERS
This notice, required by the federal Family and Medical Leave Act (“FMLA”), is intended to give Oakland University faculty members notice of their rights and obligations under the FMLA. In addition, this notice explains the consequences of a failure to meet these obligations.
1. Leave Entitlement:
A covered employer must grant an eligible employee up to a total of 12 workweeks of unpaid leave during any 12-month period for one or more of the following reasons:
• for the birth and care of a newborn child of the employee;
• for placement with the employee of a son or daughter for adoption or foster care;
• to care for a spouse, son, daughter, or parent with a serious health condition;
• to take medical leave when the employee is unable to work because of a serious health condition; or
• for qualifying exigencies arising out of the fact that the employee’s spouse, son, daughter, or parent is on active duty or call to active duty status as a member of the
National Guard or Reserves in support of a contingency operation.
“
Serious health condition
” means an illness, injury, impairment, or physical or mental condition that involves either:
• Inpatient care ( i.e
., an overnight stay) in a hospital, hospice, or residential medicalcare facility, including any period of incapacity ( i.e.
, inability to work, attend school, or perform other regular daily activities) or subsequent treatment in connection with such inpatient care; or
• Continuing treatment by a health care provider, which includes:
(1) A period of incapacity lasting more than three consecutive, full calendar days, and any subsequent treatment or period of incapacity relating to the same condition that also includes:
• treatment two or more times by or under the supervision of a health care provider ( i.e.
, in-person visits, the first within 7 days and both within 30 days of the first day of incapacity); or
• one treatment by a health care provider ( i.e.
, an in-person visit within 7 days of the first day of incapacity) with a continuing regimen of treatment ( e.g., prescription medication, physical therapy); or
(2) Any period of incapacity related to pregnancy or for prenatal care. A visit to the health care provider is not necessary for each absence; or
(3) Any period of incapacity or treatment for a chronic serious health condition which continues over an extended period of time, requires periodic visits (at least twice a year) to a health care provider, and may involve occasional episodes of incapacity. A visit to a health care provider is not necessary for each absence; or

(4) A period of incapacity that is permanent or long-term due to a condition for which treatment may not be effective. Only supervision by a health care provider is required, rather than active treatment; or
(5) Any absences to receive multiple treatments for restorative surgery or for a condition that would likely result in a period of incapacity of more than three days if not treated.
Under some circumstances, employees may take FMLA leave intermittently – taking leave in separate blocks of time for a single qualifying reason – or on a reduced leave schedule – reducing the employee’s usual weekly or daily work schedule. When leave is needed for planned medical treatment, the employee must make a reasonable effort to schedule treatment so as not to unduly disrupt the employer’s operation. If FMLA leave is for birth and care, or placement for adoption or foster care, use of intermittent leave is subject to the employer's approval. Any FMLA leave taken will be counted against your
FMLA leave entitlement of twelve (12) weeks per year.
2. Employee Eligibility:
To be eligible for FMLA benefits, an employee must :
• work for a covered employer;
• have worked for the employer for a total of 12 months;
• have worked at least 1,250 hours over the previous 12 months; and
• work at a location in the United States or in any territory or possession of the
United States where at least 50 employees are employed by the employer within 75 miles.
3. Employee Notice:
Employees seeking to use FMLA leave are required to provide 30-day advance notice of the need to take FMLA leave when the need is foreseeable and such notice is practicable.
If leave is foreseeable less than 30 days in advance, the employee must provide notice as soon as practicable – generally, either the same or next business day. When the need for leave is not foreseeable, the employee must provide notice to the employer as soon as practicable under the facts and circumstances of the particular case. Absent unusual circumstances, employees must comply with the employer’s usual and customary notice and procedural requirements for requesting leave.
Employees must provide sufficient information for an employer reasonably to determine whether the FMLA may apply to the leave request. Depending on the situation, such information may include that the employee is incapacitated due to pregnancy, has been hospitalized overnight, is unable to perform the functions of the job, and/or that the employee or employee’s qualifying family member is under the continuing care of a health care provider.

4. Medical Certification:
If you are requesting leave due to a serious health condition of yourself or an eligible family member (father, mother, spouse, child), and the leave will continue for five (5) days or more, you must furnish medical certification of the serious health condition to your supervisor. You must submit the medical certification within fifteen (15) calendar days, unless it is not practicable under the particular circumstances of your case to do so.
If you fail to provide timely certification, and your leave is foreseeable, the university has the right to deny the leave until the required certification is provided. If the need for leave is not foreseeable, you must provide certification within fifteen (15) days after your leave commences, or as soon as reasonably possible under the particular facts and circumstances of your case. If you fail to provide a medical certification within a reasonable time under the particular facts and circumstances or your case, the university may deny the continuation of your leave.
Medical certification forms are available in the Academic Human Resources Office or on the Academic Human Resources website under Faculty Employment ~ Human Resources
Forms.
5. Intent to Return to Work:
If you are out on an approved FMLA leave, you must report to your supervisor every four
(4) work weeks regarding your status and intent to return to work upon conclusion of your leave.
6. Exhaustion of Available Paid Leave:
A. Mandatory:
If leave is granted to you under the FMLA for your own serious health condition, you must first exhaust any paid sick leave; any portion of the remaining twelve
(12) workweeks of leave shall be unpaid.
B. Optional:
You may choose to substitute your accrued vacation or personal time for any portion of FMLA. When your paid leave is exhausted, any portion of the time remaining on your FMLA leave will be unpaid.
7. Health Coverage (Including Dental and Optical):
The university is obligated to continue your health coverage while you are out on FMLA leave. However, if you are required to contribute towards the premium for your healthcare coverage, you must pay your portion of the premium during the time you are out on leave to have continued health coverage. If your FMLA leave is substituted by paid leave, your share of the premiums for health care coverage, if any, will continue to be paid by payroll deduction. If your FMLA leave is without pay, you must make arrangement for the payment of your portion of the premium through the Benefit and
Compensation Services Office.

8. Fitness-for-Duty Report:
If the FMLA leave is due to your own serious health condition, and the period of the leave is for five (5) or more days (ten (10) or more days for administrative professional employees), you must present a medical certification (“fitness-for-duty” report) to your supervisor before the university will restore you to employment.
9. Key Employees:
Certain conditions apply to those individuals defined by the FMLA as “key employees.”
For purposes of the FMLA, a key employee is a salaried employee of the university who is among the highest paid ten percent (10%) of all university employees. If you are a key employee please read the attached page, which describes special circumstances relating to key employees of the university.
10. Return to Same or Equivalent Position:
Upon your return from FMLA leave, you have the right to be returned to the same position which you held when your leave commenced, or to an equivalent position with equivalent benefits, pay, and other terms and conditions of employment, unless you have been designated as a key employee. If you are a key employee, please see the attached page for special conditions, which may apply to you.
11. Liability for Health Insurance Premiums:
If you fail to return to work after taking the FMLA leave, you may be liable for payment of health insurance premiums paid by the university during your unpaid FMLA leave, unless the reason you do not return to work is due to:
(1) the continuation, recurrence, or onset of a serious health condition which would entitle you to leave under the FMLA
(2) other circumstances beyond your control
If you have any questions concerning this notice or your rights and obligations under the
FMLA, please contact the Benefit and Compensation Services Office in the University
Human Resources Department, extension 4207.
12. Military Family Leave Entitlements:
A. Military Caregiver Leave:
A covered employer must grant an eligible employee who is a spouse, son, daughter, parent, or next of kin of a covered servicemember with a serious injury or illness up to a total of 26 workweeks of unpaid leave during a “single 12-month period” to care for the servicemember. A covered servicemember is a current member of the Armed Forces, including a member of the National Guard or Reserves, who is undergoing medical treatment, recuperation, or therapy, is otherwise in outpatient status, or is otherwise on the temporary disability retired list, for a serious injury or illness. A serious injury or illness is one that was incurred by a servicemember in the line of duty on active duty that may render the servicemember medically unfit to perform the duties of his or her office,

grade, rank, or rating. The “single 12-month period” for leave to care for a covered servicemember with a serious injury or illness begins on the first day the employee takes leave for this reason and ends twelve months later, regardless of the 12 month period established by the employer for other types of FMLA leave. An eligible employee is limited to a combined total of 26 workweeks of leave for any FMLA-qualifying reason during the “single 12-month period.” (Only 12 of the 26 weeks total may be for a
FMLA-qualifying reason other than to care for a covered servicemember.
Under NDAA 2010, caregiver leave rights have been expanded to include leave to take care of a child, spouse, parent, or next of kin who is a veteran, is undergoing medical treatment, recuperation or therapy for a serious injury or illness, and who was a member of the Armed Forces (including the National Guard and Reserves) at any time during the period of five years preceding the date on which the veteran undergoes that medical treatment, recuperation, or therapy. This expanded provision thus permits family members to take unpaid leave to care for service members who have left the military and for those injuries or illnesses that may take months or years to manifest.
B. Qualifying Exigency Leave:
A covered employer must grant an eligible employee up to a total of 12 workweeks of unpaid leave during the normal 12-month period established by the employer for FMLA leave for qualifying exigencies arising out of the fact that the employee’s spouse, son, daughter, or parent is on active duty, or has been notified of an impending call or order to active duty, in support of a contingency operation. Under the terms of the statute, qualifying exigency leave is available to a family member of a military member in the
National Guard or Reserves, as well as family members of active duty service members in the Armed Forces deployed to a foreign country.
Qualifying exigencies include:

Issues arising from a covered military member’s short notice deployment (i.e., deployment on seven or less days of notice) for a period of seven days from the date of notification;

Military events and related activities, such as official ceremonies, programs, or events sponsored by the military or family support or assistance programs and informational briefings sponsored or promoted by the military, military service organizations, or the American Red Cross that are related to the active duty or call to active duty status of a covered military member;

Certain childcare and related activities arising from the active duty or call to active duty status of a covered military member, such as arranging for alternative childcare, providing childcare on a non-routine, urgent, immediate need basis, enrolling or transferring a child in a new school or day care facility, and attending certain meetings at a school or a day care facility if they are necessary due to circumstances arising from the active duty or call to active duty of the covered military member;

Making or updating financial and legal arrangements to address a covered military member’s absence;

Attending counseling provided by someone other than a health care provider for oneself, the covered military member, or the child of the covered military

member, the need for which arises from the active duty or call to active duty status of the covered military member;

Taking up to five days of leave to spend time with a covered military member who is on short-term temporary, rest and recuperation leave during deployment;

Attending to certain post-deployment activities, including attending arrival ceremonies, reintegration briefings and events, and other official ceremonies or programs sponsored by the military for a period of 90 days following the termination of the covered military member’s active duty status, and addressing issues arising from the death of a covered military member;

Any other event that the employee and employer agree is a qualifying exigency.
Spouses employed by the same employer are limited to a combined total of 26 workweeks in a “single 12-month period” if the leave is to care for a covered servicemember with a serious injury or illness, and for the birth and care of a newborn child, for placement of a child for adoption or foster care, or to care for a parent who has a serious health condition.
FMLA leave may be taken intermittently whenever medically necessary to care for a covered servicemember with a serious injury or illness. FMLA leave also may be taken intermittently for a qualifying exigency arising out of the active duty status or call to active duty of a covered military member. When leave is needed for planned medical treatment, the employee must make a reasonable effort to schedule treatment so as not to unduly disrupt the employer’s operation.
Under certain conditions, employees or employers may choose to “substitute” (run concurrently) accrued paid leave (such as sick or vacation leave) to cover some or all of the FMLA leave. An employee’s ability to substitute accrued paid leave is determined by the terms and conditions of the employer’s normal leave policy.

OAKLAND UNIVERSITY
FACULTY PERSONNEL
Certification of Physician or Practitioner (Optional Form WH-380)
Certification of Health Care Provider
(Family and Medical Leave Act of 1993)
1. Faculty Member’s Name:
________________________________________________________________________
2. Patient’s Name
________________________________________________________________________
(If different from faculty member)
3. Take a look at “Serious Health Conditions” and what that means under the Family and
Medical Leave Act. Does the patient’s condition qualify 1
under any of the categories described? If so, please check the applicable category.
1.____ 2.____ 3.____ 4.____ 5.____ None of the Above____
4. Describe the medical facts which support your certification, including a brief statement as to how the medical facts meet the criteria of one of the categories in #3.
________________________________________________________________________
________________________________________________________________________
5. a. State the approximate date the condition commenced, and the probable duration of the condition (and also the probable duration of the patient’s present incapacity
2
if different).
________________________________________________________________________
________________________________________________________________________ b. Will it be necessary for the faculty member to take work only intermittently or to work on a less than full schedule as a result of the condition (including for treatment described in Item 6 below)? ______________
If yes, give the probable duration:
________________________________________________________________________ c. If the condition is a chronic condition (condition #4) or pregnancy, state whether the patient is presently incapacitated
2
and the like duration and frequency of episodes of incapacity
2
.
1 Here and elsewhere on this form, the information sought relates only to the condition for which the faculty member is taking FMLA leave.
2 ”Incapacity”, for purpose of FMLA, is defined to mean inability to work, attend school or perform other regular daily activities due to the serious health condition, treatment therefore, or recovery there from.

________________________________________________________________________
________________________________________________________________________
6. a. If additional treatments will be required for the condition, provide an estimate of the probable number of such treatments___________________________________________
If the patient will be absent from work or other daily activities because of treatment on an intermittent or part-time basis, also provide an estimate of the probable number and interval between such treatments, actual or estimated dates of treatment if known, and period required for recovery if any.
________________________________________________________________________ b. If any of these treatments will be provided by another provider of health services (e.g., physical therapist), please state the nature of the treatments.
________________________________________________________________________ c. If a regimen of continuing treatment by the patient is required under your supervision, provide a general description of such regimen (e.g., prescription drugs, physical therapy requiring special equipment).
________________________________________________________________________
7. a. If medical leave is required for the employee’s absence from work because of the employee’s own condition (including absences due to pregnancy or a chronic condition), is the employee unable to perform work of any kind?
________________________________________________________________________ b. If able to perform some work, is the employee unable to perform any one or more of the essential functions of the employee's job (the employee or the employer should supply you with information about the essential job functions)? ____________________
If yes, please list the essential functions the employee is unable to perform._________________________________________________________________ c. If neither a. nor b. applies, is it necessary for the employee to be absent from work for treatment? _______________________________________________________________
8. a. If leave is required to care for a family member of the employee with a serious health condition, does the patient require assistance for basic medical or personal needs or safety, or for transportation?
________________________________________________________________________ b. If no, would the employee’s presence to provide psychological comfort be beneficial to the patient or assist in the patient’s recovery?
________________________________________________________________________ c. If the patient will need care only intermittently or on a part-time basis, please indicate the probable duration of this need:
________________________________________________________________________

9. If leave is required due to a Qualifying Exigency, please indicate which category(s) the leave will be taken under: a. Short notice deployment __________ b. Military events and related activities __________ c. Childcare and related activities __________ d. Financial or legal arrangements __________ e. Counseling __________ f. Rest and recuperation (up to 5 days) __________ g. Post-deployment activities __________ h. Other event previously agreed upon between faculty member and Oakland
University __________
PLEASE PRINT OR TYPE
___________________________ ________________________________
Date form Completed Name of Health Care Provider
___________________________ ________________________________
Signature of Health Care Provider Type of Practice
________________________________________________________________________
Address
Telephone Number____________________________
*Please note that if a faculty member has used FMLA leave due to her/his serious health condition, an unpaid leave of up to twelve weeks (including any unused FMLA leave) will be granted to care for the faculty member’s spouse, child, or parent with a serious health condition.
To be completed by the faculty member needing leave to care for a family member:
State the care you will provide and an estimate of the period during which care will be provided, including a schedule if leave is to be taken intermittently or if it will be necessary for you to work less than a full schedule.
________________________________________________________________________
________________________________________________________________________
____________________________ __________________ _________________________
Faculty Member Signature Date
PLEASE RETURN FORM TO:
Academic Human Resources
517 Wilson Hall

Oakland University
Rochester, MI 48309