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Certification of Health Care Provider for Family Members Serious Health Condition under the Family and Medical Leave Act. S. Department of Labor Wage Hour Division DO NOT SEND COMPLETED FORM TO THE

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How to fill out wh-380f

01

To fill out Form WH-380F, you need to follow these steps:

02

Start by entering the employee’s name and work location.

03

Indicate the employee’s job title and work schedule.

04

Provide the date when the employee’s serious health condition began or will begin.

05

Mention the earliest date the employee became unable to work due to the condition.

06

Specify the expected duration of the incapacity caused by the health condition.

07

If applicable, state the date when the employee returned to work or will return.

08

Describe the medical facts related to the employee’s condition briefly.

09

Attach relevant medical certifications or documents supporting the request for leave.

10

Sign and date the form, then provide your contact information as the employer or authorized representative.

Who needs wh-380f?

01

The Form WH-380F is needed by employers or their authorized representatives to manage employee leave under the Family and Medical Leave Act (FMLA). It is also required when an employee requests leave to care for a family member with a serious health condition. Employees who need to take leave due to their own serious health condition may also be required to fill out this form. It is important for both employees and employers to accurately complete and retain this form for record-keeping purposes.

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What is wh-380f?

WH-380F is a form used in the United States to apply for family and medical leave under the Family and Medical Leave Act (FMLA).

Who is required to file wh-380f?

Employees who are seeking to take leave for a serious health condition or to care for a family member with a serious health condition are required to file WH-380F.

How to fill out wh-380f?

To fill out WH-380F, the employee must provide their personal information, details about the medical condition, healthcare provider information, and the expected duration of the leave.

What is the purpose of wh-380f?

The purpose of WH-380F is to request family medical leave for personal medical reasons or to care for an immediate family member who has a serious health condition.

What information must be reported on wh-380f?

The information that must be reported on WH-380F includes the employee's name, the names of family members, nature of the serious health condition, and the healthcare provider's details.

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