UCSD Blink: UC Family and Medical Leave Packet

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UC Family and Medical Leave Packet

Summary: Link to documents and forms used in setting up and managing Family and Medical Leave for UCSD employees.

Note: Federal regulations prohibit denying leave because an employee did not use the forms provided on this page.

Use the documents below to:

Inform an employee of his or her rights under the Federal Family and Medical Leave Act of 1993 (FMLA):
- See Your Rights and Obligations Under the Federal Family and Medical Leave Act of 1993 (PDF). When an employee provides notice of the need for leave for reasons covered by FMLA, the University must provide the employee with this notice or its equivalent pursuant to 29 CFR 825.301.
Document a request for leave for any purpose, its approval or denial, and FMLA designation if the leave is subject to FMLA:
- See Leave of Absence Request form (PDF).
Obtain medical certification of an employee's need for FMLA:
- See Family and Medical Leave Certification (PDF).
Obtain medical certification that an employee is able to return to work from FMLA:
- See Family and Medical Leave Return to Work Certification (PDF).
Provide a written record of an exempt employee's intermittent leave or reduced work schedule pursuant to 29 CFR 825.500(d)(2):
- See Record of Reduced Work/ Intermittent Leave Schedule for Exempt Employees (PDF).
Review and document the steps required when an employee requests a leave of absence subject to FMLA:
- See Family and Medical Leave (FML) Department Checklist (PDF).
Document relationships for family and "in loco parentis" medical leave purposes:
- See Family and Medical Leave Medical Leave Declaration of Relationship (PDF).

Questions? Contact Employee Relations, (858) 534-4115.

Notice: The information on this page summarizes provisions of university policies and/or collective bargaining agreements. Refer to the Personnel Policies for Staff Members (PPSM) or applicable collective bargaining agreement for full text of referenced information.