FMLA Employee Leave Request with Tip Sheet - ComplyRight

Form Template

Updated to comply with the most recent FMLA regulations effective March 8, 2013

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Use this attorney-developed form to help collect important information necessary to determine whether an employee’s requested leave is covered by FMLA, without violating the FMLA and other privacy laws. Give the form to an employee as soon as he or she requests leave that may be FMLA-qualifying. Though not required by law, it is a good idea to distribute the form to ensure that the request is documented. For a similar mobile form, check out our leave request app.

Need printed FMLA Forms.

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