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CONTINUED ON NEXT PAGE. Form WH-380-F Revised May 2015. DO NOT SEND COMPLETED FORM TO THE DEPARTMENT OF LABOR; RETURN TO THE ...

How to fill out wh 380 f

How to fill out WH 380-F:

1. Start by providing your personal information at the top of the form, including your name, address, and contact information.
2. Next, indicate the date of the leave request and the number of days or hours being requested.
3. Identify the specific type of leave you are requesting, whether it is related to your own serious health condition, the serious health condition of a family member, or a qualifying exigency.
4. If the leave is due to your own serious health condition, provide a brief description or explanation of the condition.
5. If the leave is due to the serious health condition of a family member, specify the relationship and briefly describe the condition.
6. Indicate the start and end dates of the requested leave period. If the leave is intermittent, specify the expected frequency and duration of the absences.
7. If you are able to perform some or all of your job responsibilities while on leave, indicate any known restrictions or limitations that may apply.
8. Sign and date the form to certify that the information provided is true and accurate to the best of your knowledge.

Who needs WH 380-F:

1. Employees who need to take leave under the Family and Medical Leave Act (FMLA) are typically required to fill out form WH 380-F.
2. This form is used by employees to formally request and document their need for FMLA leave due to their own serious health condition, the serious health condition of a family member, or a qualifying exigency.
3. Employers may also provide employees with form WH 380-F to gather necessary information and documentation related to the requested leave.
4. It is important to note that not all employees are eligible for FMLA leave, and employers may have specific criteria or requirements that must be met in order for an employee to be covered under the FMLA.

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What is wh 380 f?

WH-380-F is the Certification of Health Care Provider form that is used by employees to request leave under the Family and Medical Leave Act (FMLA).

Who is required to file wh 380 f?

Employees who are requesting leave under the Family and Medical Leave Act (FMLA) are required to file WH-380-F form.

How to fill out wh 380 f?

To fill out WH-380-F form, employees need to provide their personal information, details of the health care provider, information about the health condition, and the reason for the leave.

What is the purpose of wh 380 f?

The purpose of WH-380-F form is to certify that the employee or their family member has a serious health condition that requires them to take leave under the FMLA.

What information must be reported on wh 380 f?

The information that must be reported on WH-380-F form includes the employee's name, health care provider information, details of the health condition, and the need for leave.