(A) A request for Family and Medical Leave of Absence Form must be originated in duplicate by the employee. This form should be completed in detail, signed by the employee, and submitted to the immediate supervisor for proper approval. If possible, the form should be submitted 30 days in advance of the effective date of the leave.
(B) All requests for family and medical leaves of absence due to illness will include the following information attached to a completed Request for Family and Medical Leave of Absence:
(1) Sufficient medical certification stating:
(a) The date on which the serious health condition commenced;
(b) The probable duration of the condition; and
(c) The appropriate medical facts within the knowledge of the health care provider regarding the condition. In addition, for purposes of leave to care for a child, spouse, or parent, the certificate should give an estimate of the amount of time that the employee is needed to provide such care.
(2) For purposes of leave for an employee's illness, the certificate must state that the employee is unable to perform the functions of his or her position. In the case of certification for intermittent leave or leave on a reduced leave schedule for planned medical treatment, the dates on which such treatment is expected to be given and the duration of such treatment must be stated.
(Ord. 4-2008, passed 1-22-08)