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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 Family Member’s Serious Health Condition Certification Form, WH-380-F - Bilingual, 8-1/2” W x 11” L Main Image

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

Use when a leave request is due to the medical condition of the employee’s family member.

Product Code:73592
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  • Use when employees request leave to care for a family member with a serious health condition.
  • Give to employees to have completed and returned within 15 days, absent extenuating circumstances.
  • Family members include spouses, children, and parents.
  • 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”