Human Resources2001 South State Street N4-700PO Box 144575Salt Lake City, UT 84114-4575385 468-0570
For an overview
of eligibility requirements, definitions for immediate family, length of leave,
benefits, protections and other relevant information on the Family and Medical
Leave Act, please review to the FMLA Fact
Eligible employees are entitled to:
These forms must be completed by the health care provider
and the employee.
Employee's Serious Health Condition Certification of Health
Family's Serious Health Condition Certification of Health
Qualifying Exigency for Military Family Leave Certification
Serious Injury or Illness of Covered Service Member
Certification of Health Care Provider
This form must be completed by the employee.
These forms must be completed by the employee’s
Administrator and provided to the employee.
Notice of Eligibility and Rights and Responsibilities
Notice of Designation