Please note - this document should be placed on dept. letterhead.


Employee Name


City, State Zip

Dear (name):

I hope this letter finds you recuperating and getting your strength back [tweak language as appropriate for the employee's or family member’s situation]. Regrettably, I am writing to inform you that you are about to exhaust your 12 weeks (480 hours) of leave under the Family and Medical Leave Act (FMLA) as of [date]. Your accrued vacation and sick leave are almost exhausted [ensure this statement is accurate by verifying with Admin Ast] and you are soon to be in an unpaid status.

In accordance with the University's policy on FMLA (3-0708), and as noted in your initial FMLA letter of [date], we require all employees on leave to provide notice of their intent to return to work. You will need to provide a certification statement from your healthcare provider releasing you for work.

Since we have not heard from you regarding your return date, we are writing for clarification of your intentions. Given the upcoming expiration of your FMLA, you have some options available:

1) contact me immediately about your return to work;

2) request an extended leave under the University's Leave of Absence Without Pay policy (3-0713) due to your inability to return to work because of your medical condition. If you elect to request an unpaid leave, please know that one may be granted to you if the department's workload permits and it is for your prolonged illness. Under this scenario, you will need to provide an updated physician's certification statement to support the leave and submit that to me by [date-7 days out]. We will then notify you if the unpaid leave has been approved in accordance with policy; or

3) resign due to your inability to return to work at this time.

If I do not hear from you by [date - 7 days out], I will assume you have abandoned your position and your employment with OSU will be terminated. In this case, information regarding your rights under COBRA will be sent to you separately from Faculty and Staff Benefits. You will also need to contact our office to arrange a time to return the keys [uniforms, credit cards, other applicable materials] in your possession and pick up any personal items you may have left here at work.

[employee's first name], I look forward to hearing from you very soon. You can reach me at [phone number] should you have any questions that I may assist with.



CC: Employee Services

Important Links:

• FMLA Policy 3-0708 Link

• Department of Labor FMLA Employee Guide

• ComPsych Employee Assistance Program – Resources and information for personal and work-life issues that is no cost to benefits eligible employees and their dependents.

• Long Term Disability


In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download