Read FMLA Flowchart Kay text version

The University of Texas Health Science Center at Houston Family Medical Leave (FMLA) Process Map

The process of placing an employee on Family Medical Leave may begin with either the supervisor or the employee.

Supervisor recognizes employee's possible need for FMLA Supervisor determines if employee meets FMLA eligibility requirements.

Employee turns in completed Request for FMLA to supervisor or verbally requests FMLA Leave.


Yes Within 5 business days, supervisor sends Notice of Eligibility and Rights and Responsibilities form to employee, notifying the employee of FMLA eligibility and requesting appropriate Certification form if not previously submitted. Supervisor sends Designation Notice to employee notifying employee that due to failure to return Certification, employee has forfeited FMLA protection.

If no, supervisor notifies the employee in writing of ineligibility for FMLA using Notice of Eligibility and Rights and Responsibilities Form

Employee or Employee or appropriate health care appropriatereturns care provider health provider returns certification to certification to supervisor by deadline supervisor by deadline Yes Certification complete?


STOP Process ends Supervisor sends Designation Notice to employee notifying their leave qualifies under the FMLA within 5 business days after receiving completed certification.



STOP Process ends

Approximately 30 days prior to employees return to work, supervisor sends FMLA Middle Letter and fitness for duty certification if applicable.

Incomplete or insufficient Certification returned to employee with Designation Notice form giving notice of additional information needed.

If applicable, employee returns a completed fitness for duty certification to the supervisor before returning to work.

Department maintains medical certification documents in separate file.

Supervisor tracks FMLA usage by TMS system (if paid sick, vacation, or other appropriate paid leave or if unpaid for less than a pay period) and/or by PeopleSoft if unpaid leave exceeds a pay period


No Employee provides complete form within 7 calendar days?


FMLA Flowchart Kay

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