Step 1: If you expect to be out for at least 3 days for a serious health condition related to yourself or a family member, you will need to have your physician complete a Physician Certification form prior to your leave start date (when possible) and fax it to Human Resources at 507-786-3960.
Step 2: Human Resources will determine eligibility and send an FMLA packet containing required notices, a description of pay during leave, and any additional necessary information to the employee’s home address on file.
Step 3: Prior to returning to work, the employee must have a physician complete the Fitness for Duty form and return it to Human Resources prior to returning to work. Note: The employee may not return to work until this form is received by Human Resources.
Who to Notify
- Human Resources at firstname.lastname@example.org or 507-786-3068
- Provost Office (applies to faculty only) at email@example.com or 507-786-3004
- Physician’s Certification – Employee’s Serious Health Condition1,2
- Physician’s Certification – Family Member’s Serious Health Condition
- Fitness for Duty – Faculty
- Fitness for Duty – Staff
- Fitness for Duty – Non-FMLA (applies to employees who do not meet the FMLA eligibility requirements)
1 To allow the physician to better assess your condition, we advise you to provide them with a copy of your job description. Please email firstname.lastname@example.org to obtain a copy.
2 If your leave is related to maternity, you may provide a doctor’s note confirming the pregnancy and expected due date, in place of the Physician’s Certification form.