Updated to reflect Supreme Judicial Court decision clarifying benefit accrual during the paid family and medical leave period, effective September 13, 2024.
A covered Wisconsin employer may use this form if it requires an employee to provide a medical certification supporting a request to take family and medical leave for the employee's own serious health condition.
A covered Wisconsin employer may use this form if it requires an employee to provide a medical certification supporting a request to take family and medical leave for a family member with a serious health condition.
A covered Vermont employer may use this form if it requires an employee to provide a medical certification supporting a request to take family and medical leave for a family member with a serious health condition.
A covered Vermont employer may use this form if it requires an employee to provide a medical certification supporting a request to take family and medical leave for the employee's own serious health condition.