Family Medical Leave Act (FMLA)

General Information

• City of Milwaukee FMLA Policy for General City Employees (r. 05.01.23)
• City of Milwaukee FMLA Departmental Leave Administrators (r. 12.04.25)
• City of Milwaukee Payroll Codes for FMLA (r. 08.16.22)
• Federal FMLA Information 
• Wisconsin FMLA Information

Department of Employee Relations Contacts

Johnnie Nelson
Leave Administration Coordinator
[email protected]
(414)-286-2358

Katherine Holiday
Human Resources Compliance Officer
[email protected]
(414)-286-6210

Secure Fax Line for FMLA Medical Certifications
(833)-816-1918

Due to concerns regarding COVID-19 and the possibility of increased remote work, DER is requesting that FMLA medical certifications be delivered by fax only, for the foreseeable future. Certifications should continue to be faxed to the secure fax line at (833) 816-1918. Employees who do not have ready access to a fax machine should call Johnnie Nelson at (414) 286-2358 to discuss alternate arrangements for delivery of medical certifications.
 

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For Administrators

Administrator FMLA Checklist

Forms:

Note: Certain PDF viewers do not support features of the newest DOL forms. If you are having issues opening any of these forms, please update your browser setting to use Adobe Reader as the default PDF viewer. Alternatively, save a local copy of the PDF on your device and then open it using Adobe Reader or other PDF program.

• Notice of Eligibility Instructions
• Cover Letter Template – General
• Cover Letter Template – Birth or Adoption
• Affidavit of Hand Delivery (r.10.8.19)
• Affidavit of Mailing (r. 10.8.19)
• City of Milwaukee FMLA Payroll Form | Word / PDF (r. 07.12.22)
• City of Milwaukee FMLA Military Leave Payroll Form | Word / PDF (r. 07.12.22)
• Certification of Health Care Provider for Employee's Serious Health Condition (Family and Medical Leave Act) U.S. Department of Labor; Form WH-380-E (r. 08.20)
• Certification of Health Care Provider for Family Member's Serious Health Condition (Family and Medical Leave Act) U.S. Department of Labor; Form WH-380-F (r. 08.20)
• Certification of Serious Injury or Illness of Covered Servicemember for Military Family Leave (Family and Medical Leave Act) U.S. Department of Labor; Form-385 (r. 08.20)
• Certification for Serious Injury U.S. Department of Labor or Illness of a Veteran for Military Caregiver Leave (Family and Medical Leave Act) Form 385-V 
• Certification of Qualifying Exigency for Military Family Leave (Family and Medical Leave Act) U.S. Department of Labor; Form-384 (r. 08.20)
• Certification For Disabled Adult Child for Coverage under FMLA (Child Over 18)
• City of Milwaukee FMLA Designation Notice (r.01.28.20)
• City of Milwaukee FMLA Notice of Eligibility ( r.03.01.24)

Return to Work Forms:

• FMLA Return to Work- DPW
• FMLA Return to Work-General City
• FMLA Return to Work-MFD
• PM-8C Return to Work Certification
   

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For Managers

Eligibility Notice Instructions – Managers

Required Posters

• Employee Rights and Responsibilities under the Family and Medical Leave Act -- U.S. Department of Labor; Form WHD-1420
  • Derechos Y Responsabilibades Del Empleado Bajo La Ley De Ausencia Familiar Y Médica
• Notice of Military Family Leave -- U.S. Department of Labor
• Wisconsin Family and Medical Leave Act; Form ERD-7983-P
  • Ley De Derecho De Ausencia Familiar Y Médica De Wisconsin; Form ERD-7983-S-P
• Employee's Guide to the FMLA (WH-1506, 6/15)
• Employee's Guide to Military Family Leave under the FMLA (WH-1513, 2/13)
• Bone Marrow and Organ Donation Law poster
• FMLA Rights
• WI State Right
   

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