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Get the free WH-380-E Certification for Employee s Serious Health Condition. FMLA - 501ctrust

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FMLA Fitness-For-Duty Certification Attach current job description To Be Completed by Employee (please type or print) Name: (First, Middle Initial, Last) Position: Supervisor: Department: Date Leave
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The WH-380-E certification is a form used to certify an employee's need for taking leave under the Family and Medical Leave Act (FMLA).
Employers are required to provide the WH-380-E certification form to employees requesting FMLA leave, and employees are required to fill out and return the form to their employer.
Employees must provide detailed information about their medical condition and need for leave on the WH-380-E certification form, which may require input from a healthcare provider.
The purpose of the WH-380-E certification is to verify that an employee's need for FMLA leave is legitimate and falls under the criteria set by the FMLA.
Information such as the employee's medical condition, expected duration of leave, restrictions on work activities, and contact information for the healthcare provider must be reported on the WH-380-E certification form.
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