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J. J. Keller protects people and the businesses they run. You can trust our expertise across a wide range of subjects relating to labor, transportation, environmental, and worker safety. Our deep knowledge of federal and state agencies is built on a strong foundation of more than 100 editors and consultants and 70+ years of regulatory compliance experience.

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J. J. Keller protects people and the businesses they run. You can trust our expertise across a wide range of subjects relating to labor, transportation, environmental, and worker safety. Our deep knowledge of federal and state agencies is built on a strong foundation of more than 100 editors and consultants and 70+ years of regulatory compliance experience.

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FMLA Employee’s Serious Health Condition Certification Form, WH-380-E - Bilingual, 8-1/2” W x 11” L Main Image

FMLA Employee’s Serious Health Condition Certification Form, WH-380-E - Bilingual, 8-1/2” W x 11” L

Use when employees request leave for their own medical condition.

Product Code:73591
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  • Use when employees request leave request for their own medical condition
  • Give it to employees to have completed and returned within 15 days absent extenuating circumstances
  • 4 pages
  • English and Spanish
  • Measures 8.5” x 11”
  • Made in the USA

Country Of Origin: USA

Format: Sheet

Advantage Savings: Advantage Savings

Compliance Topic: Family and Medical Leave Act (FMLA)

Language: English & Spanish

Size: 8.5” x 11”