b. Personnel policy amended (FMLA)

SUB.iECT: FAMILY MEDICAL LEAVE ACT iE} 5.02 PACE 1 U r7F 1 ci Cert~if.icatior°r of Health Care ]sravide~r for Employee's Serious; Health Condition (Family and Medical Leave Act.) Section I: For completion. by the GMPLGYER. TNST?Zt3C'T'It7Na to th!: EMI'I.~C)YER: '1'he Family and. Medical. Leave Act (H"MI,sA) provides that an emplayer may require an employee seeking FMLA pratections because of ~~ need far leave due t.o a serious health condition to submit a medical. certification. issued by the employee's health. care provider. t'lease complete Sect.iar> 1 before giving this form to your employee. Yaur response i.s vol.untar..y. While you are not x~e~uired to use this form, you may not ask the employee to provide rt~are inforrnation than allowed under the FMi.,A regulations, 29 C.F.R. § § f32~.3U6-f325.:3Uf3. k'ntplayee:~~ must generally maintain records and documents relating to medics:. certifications, recertifications, ar medical hi starie:s of ernplc~yees, created for i~'MiaA purpases> as confidential medical .records in separate fil.eslrecard:, from the usual personne:i files and in accordance with 29 C.F.R. §1G3().1~(C)(l), if the Americans with Disabilities Act applies. Employer name and contact: Cass County Government Department Head: Employee's job title (Department Head Signature) Employee's essential jab fut7ctions: Regular work schedule: Check iz job description is attached: Section II: For completion by the EMPLOYEE INSTRUCTIONS to the EMPLOYEE: !?lease complete Section II befo:c-e giving this form to }~aur medical pravidez:-. '1']Ye FMLA permits an employer to requix•e that you submit a timely, complete, artd sufficient medical certification t:o support a request for' FMLA leave due to your own scriaus health condition. If requested by your employer, your response is required t-a obtain or retain the benefit of FMLA protections. 29 U.S.C. §§ 2G13, 2r19fc)(3) Failure to provide a campletc and sufficient medicGil c~ertifica::ion may result in a denial of your fldLA request:. ?U C.E~'.ft. § E32~.:31:3. Yaur employer must give you at least:: 15 caiendar days t:a x•etu:"t7 ttzis form. 29 C.F.R. § 825.3U~ (b} Yaur Warne First Middle t.~east.