Family Medical Leave Form Instructions for WH 382

After an employee has given notice of the need for leave under the Family and Medical Leave Act (FMLA), it’s the employer’s obligation to determine if the leave qualifies for FMLA. Based on the information provided, the employer then designates the eligible employees which then are notified with a form called the Designation Notice, also known as the Department of Labor’s form WH-382.

Click here: To View and Download FMLA Forms WH 382 Designation Notice of the Family and Medical Leave Act

The Designation Notice must be given to the employee within 5 business days of the employer getting all of the employee’s completed FMLA forms, including a completed medical certification form. The Designation Notice needs to be reevaluated every 12-months if the leave is longer than 12-months, and separate notices should be provided for each qualifying reason.

For example, if an employee takes FMLA leave for their own medical condition and then needs to take leave for a family member’s situation – separate FMLA forms should be provided for each situation.

The Department of Labor has form WH-382 available for download on its website, but employers can also use a form that can be customized to their particular industry or situation. A custom form can also be used to give specific information about moving forward with the leave request or the leave itself.

If the requesting employee is currently working, the Designation Notice can simply be handed to them. However, if the person is currently on leave.

WH 382 – To be Completed by the Employer

The employee should first be notified of when their completed FMLA forms were received by the company.

Next, the employer need to notify the employee whether or not their leave will be designated as FMLA. If the leave is designated as FMLA leave, you then need to give the amount of time that will be counted against the employee’s 12 weeks. If the amount of time is not known at the time of designation, the employee can ask how much of the leave time has been used every 30 days.

In the next part of the WH-382 form, tell the employee if they are required to use paid leave concurrently with the FMLA leave. You should also inform the employee at this point if they required passing a ‘fitness for duty’ examination if they are going out for their own medical condition.

If an exam is required, you should attach a description of the person’s job so the examining physician can determine if they are indeed fit to return to work.

The next section is used to inform the employee that they did not provide enough information to designate the leave as FMLA leave. In this case, you need to give the date by which additional information should be provided, at least 7 business days from the date the Designation Notice is given. You also need to inform the employee what additional information is needed.

This section of the WH-382 form can also be used to inform the employee that the company will be paying for a second or third medical opinion.

The last section of the WH-382 form is used to tell the employee that their FMLA leave request has not been approved, the request doesn’t fall under the Act or the employee has used up their 12 weeks of FMLA leave.


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