Human Resources / An FMLA Questionnaire To Keep You Compliant

An FMLA Questionnaire To Keep You Compliant

Employer coverage

– Is your business covered by the Family and Medical Leave Act (FMLA)? You must adhere to the FMLA if you employ at least 50 employees in 20 or more workweeks in the current or prior calendar year. The employees must also meet certain eligibility rules.

Notice requirements

– Is the FMLA poster displayed in a conspicuous area of your work site, where employees and job applicants are likely to see it?

– Does your employee handbook or written leave policy contain a general notice about the FMLA? More information on general notice provisions can be found in Section 825.300(a) of the FMLA regulation.

– Does your written leave policy state the method of calculation used to establish the 12-month period?

– Have you downloaded the required FMLA forms from the U.S. Department of Labor’s website? This includes Form WH-380-E, Certification of Health Care Provider for Employee’s Serious Health Condition; Form WH 380-F, Certification of Health Care Provider for Family Member’s Serious Health Condition; and Form WH-381, Notice of Eligibility & Rights and Responsibilities.

Employee leave

– Does the employee qualify for FMLA leave? Qualifying reasons include the birth of a child and caring for the newborn child, placement of a child through adoption or foster care and caring for the newly placed child, and a serious health condition that stops the employee from performing his or her essential job duties.

– Did you provide the employee with Form WH-381, Notice of Eligibility & Rights and Responsibilities, within five business days of his or her request to take leave?

– Is the employee requesting leave because of a serious medical condition? If so, ask the employee to complete the appropriate certification form and return it to you within 15 calendar days.

– Did you complete and give the employee Form WH-382, Designation Notice, within five business days of acquiring enough information to determine whether leave should be granted?

– Have you identified key employees and notified them of their key employee status and any potential impact it may have on them? For example, if certain conditions are met, you can choose not to reinstate key employees after their FMLA leave has ended.

– Do you require that employees on leave provide periodic updates regarding their status and intent to return to work? If so, have you effectively communicated this?

– Does the health care provider need to submit a release form, returning the employee to work?

– Will the employee be returning to the same or a nearly identical position?

Group health insurance and other benefits

– Does your written policy say how group health insurance coverage is handled when employees take FMLA leave? 

– How will outstanding premiums for group health insurance be collected from an employee who goes on leave?

– How does FMLA leave impact other benefits, such as paid time off, life insurance and disability insurance?


– Are FMLA records kept for at least three years?

– Does your benefits system facilitate accurate leave tracking and FMLA compliance?

Note that this questionnaire relates only to the FMLA, a federal law. Be sure to check for applicable state laws.

If you have any questions or concerns about the above information, please click here to contact a BlueStone representative.


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