Norristown Area School District Family & Medical Leave Forms Kit Page 2
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13NORRISTOWN AREA SCHOOL DISTRICT
Leave of Absence Checklist
The employee indicates the need for leave to his/her supervisor and the supervisor will direct
the employee to contact the HR/Benefits Administrator for further information. If the employee
is already out on leave due to an off-the-job injury, the employee should be directed to contact
the HR/Benefits Administrator immediately to obtain the required forms.
The HR/Benefits Administrator gives the employee the required notice and forms or the
employee may retrieve the required information from the District website (),
and will provide the HR/Benefits Administrator with the Request for Leave and the Physician’s
Medical Certification of the need for leave within 15 days.
The employee calls the HR/Benefits Administrator at 610-630-5014 to schedule an appointment
to review the effect of the leave on benefits plans, vacation and other time accruals, and obtain
disability claim forms if eligible.
The employee fills out the Staff Leave Request form and all other FML required documentation.
The employee will submit the medical certification and disability form to their physician for
completion and return the completed forms to the HR/Benefits Administrator.
If the employee is using any paid leave, this is indicated in the leave request.
The employee begins the leave.
Conversion to Leave Without Pay: If the employee uses up his or her paid leave, the payroll
division will process the employee’s conversion to leave without pay.
Please Note: this leave will be considered after the employee has utilized and exceeded the 12
weeks available under FMLA.
Conversion to Personal Leave: If available, the employee may utilize personal leave per their
bargaining unit contract and district guidelines.
Please Note: this leave will be considered after the employee has utilized and exceeded the 12
weeks available under FMLA.
The employee returns to work. If the leave lasted more than two weeks and was for the
employee’s own health condition, the employee must present the Return to Work Certification.
The employee must contact the Benefits Administrator to check enrollments and present the
return to work certification.
Medical certifications must be maintained as confidential medical records in a file separate from
the employee's personnel file. The department must maintain FML and PDL records for three
years.
FMLA instructions and checklist
Page 2
02/11
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