Sample Letter for Employee Absence

Date

Employee
home address
city, state zip

Dear Employee: Our records indicate that you were absent from work for at least 5 consecutive workdays, from July 17, 2XXX through July 23, 2XXX. According to University policy, any leave of 5 consecutive days or more may make you eligible for coverage under the Family and Medical Leave policy and may be counted against the twelve weeks ofjob protection provided by that policy. As such, I will assume that your absence beginning July 17, 2XXX is covered by Family and Medical Leave (FML) and will be counted against your annual FML leave entitlement.

Please complete and return the attached Request for Family and Medical Leave form to indicate, among other things, if you wish to use sick leave for these absences and to indicate how much more time you expect to miss from work due to this serious health. Also, please have your physician complete and return to me the attached Physician's Certification Form within the next 15 days so that we may determine if your absences were indeed eligible for FML. I would also like you to provide me with a re-certification from your physician every 30 days. Additional copies of the Physician Certification Form are enclosed for your files. Please let me know if I can provide any additional information or assistance.

Because you have used an unusual rate of sick leave over the last several months, effective immediately, you must submit a written physician statement substantiating illness or medical appointment for all future absences for which you request sick leave that are not associated with Family and Medical Leave. Failure to provide this information will result in your request for sick leave being denied and your absence being considered unauthorized and subject to corrective action.

The University provides several other programs that may be beneficial. The University's Employees Assistance Program provides employees and their family members with confidential, professional short-term counseling services when they have personal problems that may affect their work performance and general well being. You may contact them at 472-3107 for more information and details.

If you believe you may have a medical condition that does or will affect yourjob performance, I would strongly encourage you to contact Jill Flagel. the University's Director of Staff and Disability Services at 472-3417. Jill works with individuals with health problems that effect their ability to meet job expectations to determine what, if any, accommodations may be made available to them under the Americans With Disabilities Act.

I hope this information is helpful. Please let me know if you have any questions.

Sincerely,

 

 

 

cc:
ADAI5O4 Compliance Office
Employee Relations Program
Department of Human Resources