Family Members - Family Medical Leave (FMLA) is for an eligible employee who needs to care for a family member who has a serious health condition. This leave provides an eligible employee 12 weeks of leave in a 12-month rolling calendar period.

*In this document, "Department Representative" can be the Employee’s Supervisor, Department Manager or HR Representative. The designated person is unique to each Department’s internal FMLA process.

Step 1: Eligibility Requirements

An eligible employee is one who meets both requirements:

  1. Has worked for the employer for at least 12 months, in the past 7 years, as of the date the FMLA leave is to start.
  2. Has at least 1250 hours of service for the employer during the 12 month period, immediately before the date the FMLA leave is to start.
  • Spouse
  • Registered same-sex partner
  • Parent
  • Son
  • Daughter

Step 2: If you are seeking EOHW review and approval determination

Please submit all required, completed, documents (1001, 1002-E/F, 1003, Absence Data) to:

For questions, please call or email the FMLA team at 919-681-0508 or 919-681-0507

You can email your questions to

For more information on FMLA, please see Leaves of Absence.

Step 3: Obtain the following paperwork from the staff member and review for completeness

Obtain the following paperwork:

Review for completeness:

  • Confirm the duration of the absence.
  • Confirm that a medical condition requires the attendance of a staff member as the caregiver and if the serious health condition is for a child, parent, spouse or registered same-sex partner (registered through Benefits).
  • Allow the staff member at least 15 days from the date of application or the employee's request to submit health care certification unless it is not practicable under the particular circumstances to do so despite the employee's diligent, good faith efforts.
  • Recertification from health-care provider may be requested every 6 months when associated with an absence (or missed scheduled work time) allowing at least 15 days from the date of the request for recertification.

Step 4: Determine if absence is an FMLA qualifying event

Qualifying Events Include:

  • Overnight Inpatient Facility
  • Absence Plus Treatment
  • For the birth and care of the newborn child of an employee; (b) for placement with the employee of a child for adoption or foster care; (c) to care for an immediate family member (spouse, registered same-sex partner, child or parent) with a serious health condition
  • Chronic Conditions Requiring Treatments
  • Permanent/Long-term Conditions Requiring Supervision
  • Multiple Treatments (Non-Chronic)

Step 5: Determine how FMLA will be taken - Consecutive or Intermittently

The way in which FMLA is taken will depend on medical guidance provided by the staff member's health provider and, if necessary, confirmed by Employee Occupational Health and Wellness.

Consecutive Leave (Full-time for a consecutive 12 week period):

Eligible staff members may take up to 12 weeks (the staff member's normal work week) or 480 hours of unpaid FMLA in a rolling 12-month period. Eligible FMLA hours are prorated based on a regular work schedule.

Intermittent Leave:

Tracking FMLA

If leave is intermittent, the "Department Representative" must manually track the number of hours used in a 12 month rolling period. The following tools are provided to assist in doing so:

Intermittent leave is leave taken on a reduced work schedule by decreasing the number of hours in a workday or workweek. It may be irregular based on medical needs, caregiver demands, appointments, etc.*Duke University and Health System Policy does not allow intermittent leave for adoption and paternity leave.

If Intermittent Leave is Disruptive to Operations:

  • Management may temporarily transfer the staff member to an alternate position for which the staff member is qualified and receives equal pay and benefits.
  • Consult Human Resources, Staff and Labor Relations prior to making such a transfer.

*NOTE: Recertification from health-care provider may be requested every 6 months when associated with an absence (or missed scheduled work time) allowing at least 15 days from the date of the request for recertification.

Step 6: Notice of Eligibility and Rights & Responsibility

If the employee does or does not meet the requirements for FMLA, the "Department Representative" will provide the Notice of Eligibility and Rights & Responsibilities (Form 1003) to the employee within 5 days of when the employee submitted the FMLA paperwork.

If the employee is eligible then the "Department Representative" forwards a copy of the Request Leave of Absence Form to the department payroll representative.

Step 7: Payroll Notification

The department payroll representative notifies Corporate Payroll by filling out Payroll Leave of Absence Form.

Direction on how to complete the HR Payroll LOA form can be found here.

Step 8: Designation Notice

"Department Representative" will provide the employee with Designation Notice (Form 95) indicating the appropriate outcome.

  • Employee needs to provide additional clarification to determine if the event qualifies under FMLA.
  • Approved with leave dates
  • Disapproved

Step 9: Record Keeping

The "Department Representative" keeps the Leave of Absence Request Form, Health Care Provider Certification and any other FMLA related information including attendance records in a secure and confidential location and not in the personnel file.

The following forms are maintained in a confidential file and NOT sent to Corporate Payroll:

  1. Personal Leave of Absence Request (Form 1001)
  2. Certification of Healthcare Provider (Form 1002-F)
  3. Eligibility and Rights Notice (Form 1003)
  4. Designation Notice (Form 95)
  5. Tracking Forms
  6. EOHW FMLA Approved Determination Form (1004) if EOHW was consulted.

Step 10: Return from Leave

If the staff member was out on leave for either the birth of a child (maternity) or the staff Member's own serious health condition, please ensure receipt of a "release to work" from the staff member's health care provider if the end date is modified. This should be obtained prior to the staff member's first day back to work.

After obtaining the doctor's release, complete the Payroll LOA form, returning the staff member from leave.

How to complete the Payroll LOA form:

  1. Check if the employee is exempt (monthly) or non-exempt (bi-weekly) in the box at the top right hand corner.
  2. Complete the RETURN from LOA effective date (this is the first day the employee returned to work), by filling out the "LOA Effective date" box.
  3. Insert First, Last Name information, as well as Duke Unique ID, Pay Point, Position Number information
  4. Check the "Return from Leave" box
  5. Process the necessary Payroll LOA form to transition the staff member to a non-FMLA leave.
  6. If not returning to work, the staff member should be informed that they will be considered to have resigned their position voluntarily. Process a Termination Form, and send the staff member a letter notifying them of this action.

Step 11: If the Employee Does Not Return From Leave

Sign the form and have it authorized by appropriate departmental personnel. It is advisable that you contact the staff member. If they intend to return to work, but need to be out of work for a period longer than the 12 weeks allotted to them by FMLA, the staff member should be informed that their leave will have to be transitioned to another type of non-FMLA leave. You can consult the following Personal Leave policy to determine which leave would apply.