Free FMLA Policy Template
This Family and Medical Leave Act policy template covers everything US employers need -- eligibility criteria, qualifying reasons for leave, notice and certification requirements, job protection, intermittent leave, return-to-work procedures, and non-retaliation.
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What the Policy Covers
| Section | What it addresses |
|---|---|
| Purpose | Outlines FMLA rights and responsibilities |
| Scope | All eligible employees (full-time, part-time, temporary) |
| Eligibility | 12 months tenure, 1,250 hours worked, 50+ employees within 75 miles |
| Types of Leave | Birth/adoption, serious health condition (self or family), military family leave |
| Notice & Certification | 30 days advance notice; medical certification within 15 days |
| Job Protection | Restoration to same or equivalent position; health benefits maintained |
| Intermittent Leave | Available when medically necessary; must minimize disruption |
| Return to Work | Fitness-for-duty certification may be required |
| Non-Retaliation | Retaliation prohibited; report concerns to HR |
| Compliance | Policy defers to law where conflicts exist |
| Acknowledgment | Employee signature |
Full Policy Text
1. Purpose
This FMLA policy outlines the rights and responsibilities of eligible employees of [Company Name] who need to take leave for family or medical reasons. The policy ensures compliance with the FMLA and provides guidelines for managing leave requests.
2. Scope
This policy applies to all eligible employees of [Company Name], including full-time, part-time, and temporary employees who meet the FMLA eligibility criteria.
3. Eligibility
- Employment Duration: At least 12 months with [Company Name]
- Hours Worked: At least 1,250 hours during the 12 months preceding the leave request
- Employer Size: Applies to employers with 50 or more employees within a 75-mile radius
4. Types of Leave
Eligible employees may take up to 12 weeks of unpaid, job-protected leave in a 12-month period for:
- Birth of a Child: To care for a newborn within one year of birth
- Adoption or Foster Care: To care for a newly placed child within one year
- Serious Health Condition: To care for a spouse, child, or parent with a serious health condition
- Employee's Own Health Condition: When the employee is unable to work due to a serious health condition
- Military Family Leave: For qualifying exigencies related to a family member's active duty
5. Notice and Certification
- Notice: At least 30 days for foreseeable leave. If not possible, as soon as practicable.
- Medical Certification: May be required within 15 days of the request.
- Recertification: [Company Name] may require recertification every 30 days for long-term conditions.
6. Job Protection
- Restoration: Employees returning from FMLA leave are entitled to their original or equivalent position with equivalent pay, benefits, and terms.
- Benefits Continuation: [Company Name] will maintain health benefits during leave under the same terms as active employment.
7. Intermittent Leave
Available when medically necessary. Must be approved by the employer. Employees must make reasonable efforts to schedule planned medical treatment to minimize disruption.
8. Return to Work
[Company Name] may require a fitness-for-duty certification before return. Employees are expected to return on the first workday after the approved leave period ends.
9. Non-Retaliation
[Company Name] prohibits retaliation against employees who take or request FMLA leave. Report concerns to HR immediately.
10. Policy Compliance
This policy complies with the FMLA. Where there is a conflict between this policy and the law, the law prevails. [Company Name] reserves the right to amend this policy in accordance with legal changes.
Employee Name: ___________________________
Employee Signature: ___________________________
Date: ___________________________
FMLA Quick Reference
| Requirement | Details |
|---|---|
| Leave duration | Up to 12 weeks per 12-month period (26 weeks for military caregiver) |
| Paid or unpaid | Unpaid (employer may require substitution of accrued paid leave) |
| Job protection | Same or equivalent position guaranteed |
| Health benefits | Maintained during leave |
| Employee notice | 30 days for foreseeable leave |
| Employer size | 50+ employees within 75 miles |
| Employee tenure | 12 months, 1,250 hours |
For the form employees use to request FMLA leave, see our FMLA employee request form. For a compliance checklist, see the FMLA compliance checklist.
Frequently Asked Questions
Common questions about FMLA policies.
No. FMLA only applies to employers with 50 or more employees within a 75-mile radius. Smaller employers are not covered unless state law provides additional requirements.
Yes. Employers may require (or employees may choose) to substitute accrued paid leave (vacation, sick time, PTO) during the FMLA period. The leave still counts against the 12-week FMLA entitlement.
FMLA is federal law providing unpaid leave. Many states (California, New York, New Jersey, Washington, etc.) have their own paid family leave programs that may provide additional benefits. Check your state labor laws for details.
Yes. If both parents work for the same employer, their combined FMLA leave for birth or placement of a child may be limited to 12 weeks total. For their own serious health conditions, each parent gets their own 12 weeks.
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