The Certification for Family and Medical Leave Act (FMLA) Serious Military Injury form is required to be completed whenever an employee requests to take time away from work to care for a qualifying family member who has been injured as a result of military duty. The employee should complete the form in full in order to begin the process of requesting FMLA leave to tend to the covered family member.

Who is Covered for FMLA Leave

Since 1993, employees are covered by the FMLA if they need to take time away from work in order to care for their own medical conditions or for the medical conditions of a qualifying family member. In order to qualify for FMLA coverage, employees need to be employed by an employer that has at least 50 employees that work for 20 or more weeks per calendar year. Employees that wish to take FMLA leave must have worked for the employer for 1,250 hours out of the preceding year and request time off for covered conditions.

Who is Covered by FMLA Military Leave

Covered employees may now take time away from work to care for qualifying family members that have been injured as a result of their active military duty. The Military Injury Care-Giving leave opportunity is available to employees whose spouse, parent, child, or "next of kin" is either injured or recovering from an injury that they received during active military duty.

Employees who are eligible for Military Injury Care-Giving leave may take up to 26 weeks off of work during a 12-month period to care for their injured relative. However, they are only eligible for the leave once during a 12-month period.

The employee must combine the Military Injury Care-Giving leave with any other leave that he or she takes under the FMLA. For example, if an employee takes off six weeks for the birth of a child and her husband becomes injured during military duty, she can only take off an additional 20 weeks to care for her husband.

Employees may also take Military Injury Care-Giving leave if the injured family member is on a temporary disability retired list, but is recuperating, needing therapy, or undergoing medical treatment. However, the injured family member does not have to have a "Serious Health Condition" (according to the official FMLA definition) for the employee to be eligible for leave. Instead, the injured party needs to merely have been determined "unfit" to perform his or her military during. 

Employer Rights

Employers may require proof of injury when an employee requests time off to care for an injured family member.

FMLA Serious Military Injury Form

Employees must complete the FMLA Serious Military Injury Form and provide proof of the family member's injury, if requested by the employer. This FMLA Serious Military Injury Form package comes complete with 50 forms that have clearly marked fields. All forms are in accordance with FMLA and Department of Labor reporting guidelines.

• This form is 8.5" x 11"
• 50 Sheets/Pkg