For Family Members

Are you needing to apply for Medical Leave to assist your family member? 

Below is a list of qualifying family members and directions to Washington County's Medical Leave application process.

  

Qualifying Family Members 

  OFLA

  • Spouse
  • Parent or Parent in-law
  • Person standing "in-loco parentis"
  • Biological, Adopted or Foster child
  • Same-sex Domestic Partner
  • Parent or Child of a Same-sex Domestic Partner
  • Grandparent or Grandchild of the Employee

  FMLA

  • Spouse
  • Parent (Biological or Legal)
  • Person standing "in-loco parentis"
  • Biological, Adopted or Foster child (under the age of 18)
  • Next of Kin* (For Military families only)
*Under FMLA only, A combined total of 26 workweeks during a single 12-month period to care for a family member who is serving in the military and has a serious injury or illness incurred in the line of duty while on active duty.  

 

 
There are three required steps to apply for Family Medical Leave:

 

87511609 

Please complete the Medical Leave Request form and forward it to your supervisor

1. Medical Leave Request Form  Updated 9-8-2011

Please forward the following forms to your family members Health Care Provider.  After completion send directly to Human Resources.

2. Release of Medical Information (The employee's family member completes this form and gives to their doctor to be retained in the doctors official medical file)

3. Medical Certification of Health Care Provider (This form is to be filled out by a physician or other licensed health care provider only)

 

If you are applying for "Parental leave" to care for your own newborn, foster or adopted child, the Medical Leave Request Form (1) is the only form that is required.

 

Timekeeping and Accrual Usage:

  • Use of accrued paid leaves runs concurrently with Family Medical Leave and Oregon Family Leave.
  • Employees must use all accrued paid leave, including any paid leave accrued during the employee's qualified leave, prior to commencing any period of unpaid leave, except for provision under parental leave
  • If leave for a Serious Health Condition (Employee or Family Member), employees must use all accrued sick leave prior to using any other accrued leaves.

Required Notice from Employee:

  • Foreseeable Leave (30 days or more) –notice required 30 days in advance of leave
  • Foreseeable Leave (less than 30 days in advance) –notice required as soon as possible/practical –typically within one or two business days of employee knowing
  • Unanticipated or Emergency leave –written or verbal notice required 24 hours prior, or –within 3 days of returning to work.
  • Family members may give notice on employee's behalf

 

 

If you have any question or concerns, Please contact Human Resources at 503-846-8606