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Certification for Serious Injury or Illness of a Current Service member for Military Caregiver Leave under the Family and Medical Leave Act. S. Department of Labor Wage Hour Division DO NOT SEND COMPLETED

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How to fill out certification for serious injury

01

Obtain the necessary certification form for serious injury from the appropriate authority.

02

Fill out the personal information section including your name, address, contact number, and any other required details.

03

Describe the nature of the serious injury in detail, including when and how it occurred.

04

Provide any supporting documentation or evidence related to the serious injury, such as medical reports or witness statements.

05

Review the completed certification form to ensure all information is accurate and complete.

06

Submit the filled out certification form to the relevant authority for processing.

Who needs certification for serious injury?

01

Individuals who have suffered a serious injury and need to provide proof of the injury for legal, insurance, or medical purposes.

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What is certification for serious injury?

Certification for serious injury is a document that verifies the occurrence of a serious injury.

Who is required to file certification for serious injury?

Employers are required to file certification for serious injury.

How to fill out certification for serious injury?

Certification for serious injury can be filled out by providing details about the injured employee, the nature of the injury, and how it occurred.

What is the purpose of certification for serious injury?

The purpose of certification for serious injury is to ensure that proper documentation is provided for any serious workplace injuries.

What information must be reported on certification for serious injury?

Information such as the date of injury, the location where it occurred, a description of the injury, and any medical treatment received must be reported on certification for serious injury.

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