FMLA Checklist for Supervisors and Business Administrators

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Leave Requests

If an employee requests FMLA leave or has been out sick for more than 3 consecutive days:

  • Prepare the appropriate FMLA Provisional Letter, then send it to the employee and a copy to the FMLA Administrator in Human Resources within five days of the request or absence.

FMLA Administrator
600 Franklin Building
3451 Walnut Street
Philadelphia, PA 19104-6205
Fax: 215-573-7385
Send an email

  • Provide the employee with a copy of the:

FMLA Guide for Faculty and Staff

STD/FMLA Request Form

Certification of Health Care Provider Form

Employees approved for short-term disability are prohibited from working at the workplace or at any other location, including the employee's home, either for the University or otherwise. (Policy 404)

  • If the employee is taking leave for care of newborn (father of the child or spouse) he/she must submit the child’s birth certificate in lieu of the Certification of Health Care Provider Form.
  • Review and record the time balances for the employee on the STD/FMLA Request Form (Section D).
  • Sign the employee’s STD/FMLA Request Form and send it to the FMLA Administrator.

Getting Approval

The FMLA Administrator will send a letter to the employee’s home address and an email to you (the supervisor or BA) indicating whether the leave is approved, denied, or incomplete.

  • Review the determination email from the FLMA Administrator to make sure the FMLA leave start and end dates are correct.

While on Leave

Documentation the employee provides the FMLA Administrator:

  • Pregnancy: A note from the health care provider with the date and method of delivery. The leave dates will be adjusted based on the actual delivery date.
  • Care of newborn (father of the child or spouse): A copy of the child’s birth certificate.
  • Adoption or foster care: Court documentation.
  • Intermittent leave: A completed Intermittent Leave Tracking Form (which lists the dates/hours of leave taken) submitted monthly.

Payroll for Employees on Leave

Weekly Paid Staff

  • You must pay out sick time and PTO, in that order, for the first ten (10) days. After that you should end the distribution line, but don’t change the employee’s status. The Benefits Office will pay the employee under the STD policy for the balance of the approved medical leave.
  • If the employee is approved for STD for longer than 8 weeks, the Benefits Office will lower the employee’s hourly rate to reflect 75% of pay. However, if the employee has STD days available, these will be substituted for 75% pay allowing the employee to receive 100% pay until the earlier of the date the balance is exhausted or July 1, 2018.
  • In the case of pregnancy, the employee should use PTO after the disability period ends unless she notifies you that she would like to retain it and go unpaid.
  • The Benefits Office will stop the accruals of sick and PTO after the first ten (10) days and will enter the STD time each week until the approved period of disability ends.

Monthly Paid Faculty and Staff

  • You must reduce the employee’s sick or PTO days, in that order, for the first ten (10) days of disability. Do not change the employee’s status..
  • The Benefits Office will end the department’s distribution line on the date that the employee has been out more than 10 days, enter a new distribution line to reflect the STD pay, and email the department’s Business Administrator each month before payroll runs to state the dates of the STD payment for each employee.
  • If the employee is approved for STD for longer than eight (8) weeks, the Benefits Office will change the employee’s distribution line to reflect 75% of pay beginning in week 9. If the employee has STD days available, these will be substituted for 75% pay allowing the employee to receive 100% pay until the earlier of the date the balance is exhausted or July 1, 2018. In that case, the Business Administrator must reduce the employee’s STD balance.
  • If an employee uses sick and PTO for the first 10 days and has not yet been approved for leave, it is up to your department’s discretion whether or not to end the distribution line.
  • If the distribution line is left active and the employee is entitled to STD pay, the FMLA Administrator will reallocate funds from the STD budget to the department’s budget.
  • If the department’s distribution line is ended and the employee is entitled to STD pay, the FMLA Administrator will issue a late pay.


Note that STD balances may be used during weeks 9 through 26 in order for employees to be paid 100% of base salary. Balances will expire on June 30, 2018.

Normally, employees returning from leave will be reinstated to the same or an equivalent position, with equivalent pay, benefits and other terms and conditions of employment.

Returning to Work

  • Before the employee returns to work, make sure the treating physician submits a note to you* and the FMLA Administrator that includes:

    • The date he/she is eligible to return to work
    • The physician’s signature
    • Any medical restrictions

  • *Please instruct the employee that if the note contains medical information, it should only be submitted to the FMLA Administrator.
  • If the return-to-work note contains restrictions that last more than one week, a copy must be sent to:

Office of Affirmative Action and Equal Opportunity Programs
3600 Chestnut St., Sansom Place East Suite 228
Philadelphia, PA 19104-6106
215-898-6993 (phone)
215-746-7088 (fax)
Send an email

  • If you don’t expect the employee to return to work on time, notify the FMLA Administrator.
  • If the employee needs to extend the leave, make sure he/she provides the FMLA Administrator with one of the following:
  • If the employee’s serious medical condition becomes long-term in nature, he/she should consider contacting Melissa A. Smith, Human Resources Benefits Specialist via email or at 215-898-1326; or Geri Zima, Manager, Benefits Administration via email or at 215-898-1331. They can discuss the application process for Long-Term Disability should that become necessary.