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Certification for Serious Injury or Illness of a Current Service member for Military Family Leave (Family and Medical Leave Act)U.S. Department of Labor Wage and Hour Division___ DO NOT SEND COMPLETED

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How to fill out certification for serious injury

01

Start by obtaining the necessary certification form from your employer or insurance company.

02

Fill out your personal information including your full name, address, and contact information.

03

Provide details about the date, time, and location of the injury incident.

04

Describe the nature of the injury and the symptoms you are experiencing.

05

Include any supporting documents such as medical reports, witness statements, or police reports.

06

Review the completed form for accuracy and sign it before submitting it to the appropriate party.

Who needs certification for serious injury?

01

Anyone who has suffered a serious injury that may require compensation or legal action should obtain certification for serious injury.

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What is certification for serious injury?

Certification for serious injury is a form that must be submitted by a healthcare professional to verify a serious injury.

Who is required to file certification for serious injury?

Employers are required to file certification for serious injury for their employees who have experienced a serious injury.

How to fill out certification for serious injury?

Certification for serious injury should be filled out by a healthcare professional and include details about the injury, treatment, and expected recovery time.

What is the purpose of certification for serious injury?

The purpose of certification for serious injury is to provide verification of a serious injury that may impact an employee's ability to work.

What information must be reported on certification for serious injury?

Certification for serious injury should include details about the nature of the injury, treatment received, and expected recovery time.

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