Information For Divisional Disability Representatives

Section B: Leave Template Letters and Other Leave Resources

B.1 Leave Options Status Memo

Guidelines

These template letters were created to assist DDRs with managing complex leave situations for either university or unclassified employees.

·     You’ll need to modify the introduction to the letter as necessary to meet the need in your situation.

·      We do not recommend deleting any of the sections of the letter.

·      For the employee, the letter outlines all the leave options and explains the employee’s status relative to each one. It creates a record of the leave used and the leave options remaining.  The letter also includes the consequences of unapproved absences.

·      For the HR office and supervisor, it records the status of a particular situation and helps keep them informed of the situation.

Suggestions On When To Send

Leave requests are unique.  Following are some times that we recommend using the leave options memo though it may be helpful in other situations not identified below.  Consult early and we can assist you.

·      When an employee is close to exhausting his or her FMLA

·      When an employee makes a request for leave and you know at the start they will exhaust FMLA

·      When an employee makes a request for leave and she or he is not eligible for FMLA

·      When you are approving leave under the LWOP policies – write the approval in the introduction??

·      When an employee has been out on leave and has exhausted leave under the first three steps and is at unpaid leave as a reasonable accommodation is it helpful to send an updated leave options memo.

Consult

·      The FMLA/Leave Coordinator for questions regarding FMLA, accrued paid leave and LWOP under university policies.

·      The Disability Coordinator/Employment for assistance regarding paid or unpaid leave as a reasonable accommodation.

Please note it is helpful when you consult to send an updated leave options memo or a written chronology of the leave to us. It gives a quick snap shot of the request in order to assist you more effectively.

University Staff Leave Options Status Letter
Unclassified Leave Options Status Letter

B.2 FMLA Template Memos

a) Index of Sample Memos

b) Sample Cover Letter

c) Family or Medical Leave (FMLA/WFMLA) Memo for an Employee Who Does Not Meet Eligibility Criteria

d) Request for Clarification Regarding FMLA Leave: Employee Meets Eligibility Criteria but Clarification Needed

e) Approval of Intermittent Leave

f) Approval of Leave on a Reduced Schedule

g) Approval of Leave for a Continuous Period

h) Role of the Supervisor in Managing FMLA Leave

i) Recertification of Family or Medical Leave Sample Memorandum to Employee

j) Recertification of Family & Medical Leave: Sample Memorandum to Treating Specialist

k) Notice of Rights and Responsibilities

l) Reasons for Recertification under FMLA

m) UW–Madison Certification of Family or Medical Leave Form

n) State of Wisconsin DER-DCC Leave Without Pay Request /Authorization Form
for Classified Employees and for Unclassified Employees

B.3 Guide to Tracking Absences

a) Example from SMPH (Word)

b) FMLA Usage Spreadsheet (Excel)

c) Example Leave Tracking Calendar (Word)

B.4 Leave Resources

a) Employee Leave Options: 4 Steps and Resources

b) Leave as a Reasonable Accommodation

c) Worksheet: Determining Employee Leave Options (excel file)

d) Comparison of FMLA and WFMLA

B.5 Employee Medical Leave Scenario

a) Employee Medical Leave Scenario

b) Example Cover Letter Memo
FMLA Certification Form
Notice of Employee Rights and Responsibilities

Reasonable Accommodation Letters

Accommodation Approval Letter
Accommodation Denial Letter
Accommodation Modify Letter
Follow-up to the Reasonable Accommodation Interview

Reassignment as an Accommodation Letters/Interview Sheets
Referral to Reassignment as an Accommodation
Follow-up to Meeting RE: Referral to Reassignment as an Accommodation
Reassignment to a Vacant Position
Interview Checklist
Interview Sheet

Temporary Work Adjustment Letters
Accommodation Temporary Work Adjustment Letter
Meeting Restrictions During the Workers Compensation

Other Letters
Genetic Information Nondiscrimination Act (GINA) Safe Harbor Language: Add to all requests for medical information
Memo to Managers and Supervisors
Performance Follow-up Letter

Introduction

Reasonable Accommodation

Family & Medical Leave (FMLA)

Worker’s Compensation (WC)

Income Continuation Insurance (ICI)

Long-Term Disability Insurance (LTDI)

WRS Disability Retirement (40.63)

WRS Duty Disability (40.65)

Additional Information

Allergy Animal Workflow

Allergy Animal Workflow Flowchart

Barrier Removal
Facility Modification/Barrier Removal Flowchart

Chemical/Fragrance Sensitivity Accommodations 

Chemical and Fragrance Sensitivity

Fragrance Sensitivity Power Point

Confidentiality

“Need to Know” Questions to consider before sharing confidential medical information
How do I Respond (for supervisors responding to requests for accommodation)
What to Say (For supervisors when co-workers inquire about an employee receiving an accommodation)
Case Studies and Discussion Notes

Ergonomics
Ergonomics Flowchart
Symptom survey

Interactive Process
What do disability-related employment laws, the EEOC and case law say?
Suggestions for the Interactive Process
Case Study: Keeping Your Eye on the Ball (with discussion notes)

Interviewing Employees
Job Interview Disability-Related Questions

Performance
Strategies for Addressing Performance Issues or Disruptive Behaviors

Position Description and Disability
Handout: Key Term & Information, Identifying Essential Functions, Outcome-Based Language, Attendance/Schedule/% FTE, Operating a Motor Vehicle/Getting around Campus, Physical Demands, Soft Skills and Cognitive Requirements, Environment Conditions, Resources
Definition of Physical Demands
Wording for Describing Physical Demands

Reasonable Accommodation
Modules (pdf, doc) and Talking Points
Themes to Cover in an Interactive Disability Accommodation Interview
Interview: Complicating Factors

Reassignment as an Accommodation
Reassignment as an Accommodation Flowchart
Reassignment Scenarios

Sign Language Interpreting and Captioning
How a UW Department or Unit Provides Interpreting Services

Travel and Reasonable Accommodation
Travel Related Accommodation

Requesting an Accommodation