Colorado Family and Medical Leave Family Member Medical Certification Form
Author: Katherine Hinde, Littler
When to Use
A covered Colorado employer may use this form if it requires an employee to provide a medical certification supporting a request to take leave to care for a family member with a serious health condition under the federal Family and Medical Leave Act (FMLA) and/or the Colorado Family Care Act (FCA).
The FMLA and the FCA cover employers that employ 50 or more employees in 20 or more workweeks in the current or preceding calendar year and that are engaged in commerce or in any industry or activity affecting commerce.
Customizable Form
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