Family Medical Leave
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Welcome to the Family Medical Leave page!
The State and Federal Family and Medical Leave Acts (FMLA) provides eligible employees with up to 12 work weeks of protected leave each year for specified family and medical reasons. The FMLA seeks to accomplish these purposes in a manner that accommodates the legitimate interests of employers and minimizes the potential for employment discrimination.
To view the full Family Medical Leave policy, please see the document below or refer to page 34 of the City of Racine Employee Handbook.
For Federal FMLA purposes, you are entitled to FMLA benefits if you;
1. Have been employed by the City of Racine for at least 12 months; and
2. Have worked at least 1,250 hours during the 12 months prior to the start of the FMLA leave.
For State FMLA purposes, you are entitled to FMLA benefits if you:
1. Have been employed by the City of Racine for at least 52 weeks; and
2. Have worked at least 1,000 hours during the 52 consecutive weeks prior to the start of the FMLA leave.
The list of Family Medical Leave qualifying events is as follows;
1. The birth of a child and to care for the newborn child.
2. The placement with the employee of a child for adoption or foster care and to care for the newly placed child.
3. To care for your spouse, child, or parent with a serious health condition.
4. For a qualifying exigency arising out of the fact that an employee’s spouse, child or parent is on active duty or has been notified of an impending call or order to active duty as a member of the Armed Forces (including a member of the National Guard or reserves) and being deployed to a foreign country.
5. For the employee’s own serious health condition that renders the employee unable to perform his/her job.
An eligible employee can take up to 12 work weeks of leave during any 12 month period. The City will calculate the twelve month period using the calendar year. Each time you take a leave, the City will compute the amount of leave the employee has taken under the policy and subtract it from the 12 weeks of leave available, and the balance remaining is the amount the employee is entitled to take at that time.
Non-continuous or Intermittent Leave
Employees are permitted to take leave on an intermittent (blocks of time) or reduced work schedule:
1. When it is medically necessary to care for a family member with a serious health condition or because of the employee’s serious health condition;
2. When it is necessary to care for a family member or next of kin who suffered an injury or illness while on active duty;
3. To care for a newborn, adopted or foster child.
The City allows for intermittent leave to be taken in no less than one hour increments or, under certain circumstances, may use the leave to reduce the work week or work day, resulting in a reduced hour schedule. In all cases, the leave may not exceed a total of 12 weeks in a 12 month period.
You must request the leave at least 30 days in advance. If it is not possible to give 30 days’ notice, you must give as much notice as practicable.
1. Complete a Family and Medical Leave of Absence Request Form, have it signed by your supervisor, and submit this form to the Human Resources Department. You must request the leave at least 30 days in advance. If that is not possible, you must give as much notice as practicable. All requests must include an anticipated start and ending date.
Family and Medical Leave of Absence Request Form
2. The Human Resources Department will provide a Response to Request for Family and Medical Leave confirming the approval/denial of the leave, as well as salary and benefit information.
3. The employee is responsible for notifying his/her immediate supervisor and Human Resources of any changes in his/her leave status.
4. The employee is responsible for providing re-certification of status or leave reports as specified in the Response to Request for Family and Medical Leave form or when otherwise requested.
5. The employee is responsible for providing evidence of fitness for duty to certify the employee is capable of returning to work with restrictions or full duty. Delays in turning in this certification may results in delays in returning the employee to duty and pay status.
Calling in “sick” is not enough to trigger the FMLA requirements. When an employee seeks leave due to a particular FMLA-qualifying condition for which the City has previously provided FMLA leave to the employee, the employee must specifically reference either the qualifying reason for the leave or the need for “FMLA leave.”
If the leave is for a family member’s or the employee’s serious health condition, the employee must submit medical certification from the employee’s or the family member’s health care provider. The employee must respond to this requirement within 15 days of the FMLA start date, or provide a reasonable explanation for the delay.
Medical Certification Form – Employee’s Serious Health Condition
Medical Certification Form – Family Member’s Serious Health Condition
If the medical certification is insufficient or incomplete, the employee will be provided with a list of what information is still needed and will have seven days in which to provide the information. If the required information is not provided within seven days, the leave could be denied.
If the employee plans to take intermittent leave or work a reduced work schedule, the certification must also include dates and the duration of treatment and a statement of medical necessity for taking an intermittent leave or work a reduced schedule.
The Certification can be faxed to the Benefits Coordinator. The Human Resources Fax Number is (262) 636-9585.
You have the option to substitute accrued, but unused vacation, comp time, or sick leave to remain in a paid status. However, the City may require substitution of vacation, comp time, or sick leave.
The City will allow an employee to take up to two weeks (10) days of unpaid leave. For the remainder of the leave, the City will require the substitution of available accrued vacation, comp time, and/or sick time.
The City will continue the employee’s benefits while on leave. Other benefit deductions, such as Aflac, Deferred Compensation, etc, will continue through payroll deductions. If you are on an unpaid leave, you are responsible for working with the Payroll Department for timely payments.
An employee returning from FMLA for their own serious health condition must provide a fitness for duty certification/physician’s statement releasing the employee back to full or restricted duty. If returning to restricted duty, the return to work slip should indicate the limitations and suggested accommodations, as well as the duration of the restrictions.
Families First Coronavirus Response Act Policy
Families First Coronavirus Response Act Request Form
Family and Medical Leave of Absence Request Form
Medical Certification Form – Employee’s Serious Health Condition
Medical Certification Form – Family Member’s Serious Health Condition
