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CERTIFICATION FOR SERIOUS INJURY OR ILLNESS OF CURRENT SERVICEMEMBER FOR MILITARY CAREGIVER LEAVE (FAMILY AND MEDICAL LEAVE ACT) Adapted from Form WH385 Revised June 2020 Expires6/30/2023SECTION EMPLOYER
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How to fill out certification for serious injury

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To fill out the certification for serious injury, follow these steps:
02
Start by entering your personal information, such as your name, address, and contact details.
03
Provide details about the injury, including the date and time of the incident, the location where it occurred, and a description of how it happened.
04
Include any relevant medical information, such as the diagnosis, treatment received, and the names of medical professionals involved.
05
If there were any witnesses to the injury, include their contact information and a brief statement of what they observed.
06
Attach any supporting documents, such as medical reports, test results, or photographs that can provide evidence of the seriousness of the injury.
07
Review the filled-out certification form for accuracy and completeness.
08
Sign and date the form to certify that the information provided is true and accurate.
09
Submit the completed certification to the appropriate authority or organization as required.

Who needs certification for serious injury?

01
Certification for serious injury is typically required by individuals who have suffered a severe injury and need to provide formal documentation of the incident and its impact. This may include injured individuals who are seeking compensation or legal action, individuals who need to report the injury to their employer or insurance company, or individuals involved in workplace-related incidents where certification is necessary for compliance or insurance purposes.
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Certification for serious injury is a legal document that verifies a person has suffered a serious injury.
The individual who has suffered a serious injury or their legal representative is required to file the certification.
To fill out the certification for serious injury, one must provide details about the injury, medical treatment received, and any other relevant information.
The purpose of certification for serious injury is to document the serious injury and provide proof for legal purposes, such as insurance claims or legal proceedings.
Information such as the nature of the injury, date of injury, medical treatment received, and any other relevant details must be reported on the certification for serious injury.
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