FMLA Administration Select the 12-month period used for calculating FMLA leave (or the “leave year”) and con昀椀rm that it is accurately described in employee communications. Completed An employer’s options for the leave year are: • The calendar year (Jan. 1 through Dec. 31) • Any 昀椀xed 12-month period, such as a 昀椀scal year or a leave year beginning on the 昀椀rst day of an employee’s employment • A 12-month period measured forward from the 昀椀rst date an employee takes FMLA leave • A rolling 12-month period measured backward from the date an employee uses FMLA leave Implement a method for tracking employees’ use of FMLA leave throughout the year, Completed including leave taken on an intermittent or reduced schedule basis. Train managers on FMLA compliance, including how to identify leave requests that may Completed be for FMLA qualifying reasons and the law’s prohibitions on interference and retaliation. Download and use the DOL’s model forms for administering FMLA leaves or create your Completed own versions of these forms. The DOL’s model FMLA forms are available here. Determine how employees will pay health plan premiums during unpaid FMLA leave and Completed communicate this method to employees taking leave. Review how taking FMLA leave may relate to other types of employee absences, including Completed employer-provided paid time o昀昀, short-term disability, workers’ compensation and local paid leave law requirements, and run leaves concurrently when possible. Administering FMLA Leave Employee Name: Date of leave request: Dates of anticipated leave: Employee Eligibility Is the employee eligible for FMLA leave? Yes No To be eligible for FMLA leave, an employee must satisfy ALL of the following criteria: • The employee works for an employer covered by the FMLA; • The employee has worked for the employer for at least 12 months as of the date leave is to start (it does not need to be consecutive); • The employee has at least 1,250 hours of service for the employer during the 12-month period before the leave is to start; and • The employee works at a location where the employer has at least 50 employees within 75 miles of that worksite.