Oregon Family and Medical Leave of Absence Request Form
Author: Katherine Hinde, Littler
When to Use
A covered employer in Oregon can use this form to receive employee requests for a family and medical leave of absence covered by the federal Family and Medical Leave Act (FMLA) and/or the Oregon Family Leave Act (OFLA).
Employer coverage under these laws is as follows:
- The FMLA covers 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.
- The OFLA covers employers that employ 25 or more employees in Oregon each workday in 20 or more calendar workweeks in either the year in which OFLA leave will be taken or the preceding year.
Customizable Form
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