Department of Administrative Services

Family Medical Leave Toolkit

Templates & Toolkit

Accrued Leave Payroll Letter - Paid Leave Oregon
Agency Designation

Agency Designation-Paid Leave Oregon

Agency Designation and Exhaust

Eligibility Notification

Eligibility and Designation Notification

Eligibility and Designation- Paid Leave Oregon

Insufficient Medical Certification

Medical Certification Reminder
Qualifying Purposes under FMLA and OFLA

Request for Medical Certification
24 Hour Report Email

Toolkit

Employee Rights Under FMLA

FMLA Military Healthcare Certification

FMLA Qualifying Exigency Certification

Health Care Provider Certification- Fillable

Health Care Provider Certification- Printable

Leave Options Chart

Optional Insurance Continuation Chart

Paid Leave Model Notice

Policy Attachments Effective 7/1/24

FMLA Serious Health Condition Attachment

FMLA Parental Leave Attachment

Sick Child Leave Attachment

FMLA Military Caregiver Leave Attachment

FMLA Qualifying Exigency Leave Attachment

OFLA Military Family Leave Attachment

OFLA Bereavement Leave Attachment

Templates & Toolkit Prior to 7/1/2024

Templates

Accrued Leave Payroll Letter - Paid Leave Oregon (prior to 7/1/2024)

Affinity Attestation Form

Bereavement Leave

Agency Designation (prior to 7/1/2024)

Agency Designation - Paid Leave Oregon (prior to 7/1/2024)

Agency Designation and Exhaust (prior to 7/1/2024)

Agency Designation and Exhaust - Paid Leave Oregon
Eligibility Notification (prior to 7/1/2024)

Eligibility and Designation Notification (prior to 7/1/2024)
Eligibility and Designation Notification - Paid Leave Oregon (prior to 7/1/2024)

Exhaust Notice (prior to 7/1/2024)

Insufficient Medical Certification (prior to 7/1/2024)

Medical Certification Reminder (prior to 7/1/2024)

Leave Continuous - Paid Leave Oregon

Leave Intermittent - Paid Leave Oregon

OFLA Sick Child Care Certification (docx)

OFLA Sick Child Care Certification (pdf)

Qualifying Purposes under FMLA and OFLA (prior to 7/1/2024)
Request for Medical Certification (prior to 7/1/2024)

Sick Child Non-Serious

24 Hour Report email (prior to 7/1/2024)

Toolkit

Concurrency Scenarios

Employee Information Packet A - Serious Health, Parental Leave

Employee Information Packet B - Military Caregiver

Employee Information Packet C - Qualifying Exigency and Military Family Leave

Family and Medical Leave Brochure

Optional Insurance Continuation Chart

Workday Additional Data Fields

Workday Family Leave Document

Policy Attachments Prior to 7/1/2024

A. Serious Health Condition Attachment 2023

B. Parental Leave Attachment 2023

C. Sick Child Leave Attachment 2023

D. Military Caregiver Leave Attachment 2019

E. Qualifying Exigency Leave Attachment 2019

F. Military Family Leave Attachment 2023

G. Bereavement Leave Attachment 2019

Health Care Provider Cert PD615A

PD Military Healthcare Certification PD615B

PD Qualifying Exigency Certification PD615C

Employee Rights Under FMLA

Addendum G - Family and Medical Leave

Webpage last updated: 10/25/2024

Quick links

Oregon Family Medical Leave Toolkit

Paid Leave Oregon Toolkit