Medical Leave in Progress - 15-Day Follow-Up Letter
(Date)(Employee Name)
(Employee Address)
Dear (Employee Name):
On (date) I sent you a letter provisionally designating your leave as covered under the federal Family Medical Leave Act (FMLA) and the state California Family Rights Act (CFRA). The designation was made in accordance with [PPSM, APM, or appropriate union contract], so please refer to that document for additional information.
At that time you were sent two forms: the Leave of Absence Request Form and the Medical Certification Form, and were requested to return them to me within 15 calendar days of the date of the letter. As of today I have not received the completed forms.
For your convenience, I have completed the Leave of Absence Request form based on the information we have to date, and enclosed a copy for you to review and complete. If any information is incorrect, please notify me immediately. A new Medical Certification Form is also enclosed. Medical certification must be completed by your health care provider and returned to me no later than 10 calendar days from the date on this letter.
Approval of your leave of absence is contingent on the receipt of medical certification. If medical certification is not received, your leave of absence may not be approved. You should be aware that unapproved absences may result in disciplinary action should the circumstances warrant.
If you have any questions, please call me at (telephone number).
Sincerely,
(Supervisor’s Name)
cc: DPM
DBC
Enclosures: [Manager/Supervisor: Be sure to list as enclosures any documents mentioned in this letter-including contract and policy sections-plus any additional information you believe will be useful to the recipient.]