FMLA Usage Tracker Form

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Product Specifications:
  • This form is 8.5" x 11"
  • 25 Sheets/pkg
Availability: In stock



According to the Family and Medical Leave Act (FMLA), covered employees should be eligible to take a total of 12 weeks off of work per year for a covered condition, such as an illness, childbirth, or to tend to the needs of a qualifying family member. As of January 16, 2009, employees may also be able to take military family leave. However, these FMLA leave days do not have to be taken consecutively and can be difficult for employers to accurately manage and track.

Our FMLA Usage Tracking form allows employers to record, track, and document the days that employees leave work under qualifying FMLA conditions. Using this form, employers will be able to ensure that they are compliant with their documentation of employee FMLA days and that employees take an excusable amount of time away from work for qualifying conditions.

Our form is easy to read and fill in, giving employers an at-a-glance analysis of days off and alerting them to possible FMLA abuse patterns. It is also available in Spanish and English to help employers meet possible state bilingual regulations.

Employers may also purchase the FMLA Usage Tracking form as part of the FMLA Administrator kit, which includes the FMLA Employer Guide, FMLA Administrator Worksheet, FMLA Employee Request for Leave Form, FMLA Employer Response for Leave Form, and more.

State Mandatory Updates

State Non-Mandatory Updates

Federal State Mandatory Updates

  • 06/2023 - EEOC Know Your Rights: Workplace Discrimination is Illegal - Revised with new information related to the new Pregnant Workers Fairness Act (PWFA) effective June 27, 2023 and a new revision date.
  • 05/2023 - Fair Labor Standards Act (FLSA) - Federal Minimum Wage - Revised the Nursing Mothers section of the poster with the PUMP for Nursing Mothers Act (PUMP Act) and more clarification on employer requirements to provide reasonable break time and accommodations for nursing employees.
  • 10/2022 - EEOC Know Your Rights: Workplace Discrimination is Illegal - Revised to use plain language and bullet points to summarize the laws for employees. Added a QR code that links to instructions on how to file a charge of workplace discrimination. This new version replaces the old Equal Employment Opportunity is the law poster.

Federal State Non-Mandatory Updates

  • 05/2023 - Family and Medical Leave Act (FMLA) - Revised with a new easy to read question and answer format and a new QR code to access more information.
  • 05/2023 -  - Revised with a new website and a new QR code for more information.
  • 07/2016 - Fair Labor Standards Act (FLSA) - Federal Minimum Wage - Update includes new regulation revisions as of August 2016 which includes text regarding nursing mothers and overtime rules.
  • 07/2016 -  - Update includes new regulation revisions as of August 2016 which includes the removal of penalty amount up to $10,000 against violators and revised contact numbers.
  • 05/2016 -  - Minor update includes a new QR code and contact information.
  • 05/2016 -  - Update includes minor reformatting and slight changes of verbiage regarding the usage of FMLA.