Page 39 - Employee Handbook 1-2015 rev9

 conditions involving more than three (3) full days of incapacity plus two (2) medical
visits. Both visits must be in person and within thirty (30) days. The first visit must be
within seven (7) days.
 any period of incapacity or treatment in connection with inpatient care in a hospital,
hospice, or residential medical care facility;
 any period of incapacity requiring absence from work, school, or other regular daily
activity of more than three calendar days, that also involves continuing treatment by a
health care provider; The first visit to a healthcare provider must be in person and
within seven (7) days of the beginning of the illness.
 continuing treatment by a health care provider for a chronic or long-term health
condition that is incurable or so serious that, if not treated, would likely result in a
period of incapacity of more than three calendar days; or for prenatal care. Chronic
conditions require at least two (2) medical visits per year.

Eligible employees are also entitled under the FMLA to:

 choose to maintain, while on FMLA leave, any health benefits provided by the City
(the employee must pay directly his/her share of premiums for any portion of unpaid
FMLA for which paid leave is not substituted);
 return to the same position or an equivalent position with equivalent pay, benefits and
working conditions at the conclusion of the leave unless the employee is unable to
perform the essential functions of the job, in which case the employee may be
covered by the Americans with Disabilities Act (ADA). Key employees (salaried
employees among the highest paid 10 percent of all employees) may not be entitled to
restoration if restoring them would cause substantial or grievous economic injury to
the City.

An "eligible employee" is one who:

 has been employed by the City for at least twelve months; and
 has been employed for at least 1,250 hours of service during the 12-month period
immediately preceding the commencement of the leave.

When the necessity for leave is foreseeable, the employee must give the City at least 30
days advance notice of the need for leave. If the need for leave is not foreseeable, the employee
needs to give the City such notice as is practicable. Requests for Family and Medical Leave Forms
may be made to the Human Resources Department.

Final approval of an FMLA leave request is contingent upon the Human Resources
Department’s confirmation of eligibility and receipt of a completed Certification of Health Care
Provider Form where required (provided by the department/division/office head). Certification
may be required when the request for unpaid FMLA leave is based on a serious health condition
of the employee or his/her spouse, child, or parent. Whenever accrued paid sick leave is substituted
for unpaid FMLA leave, certification may be required as provided by the City's sick leave policy.
Whenever certification is required, it must be provided within 15 days of the employee's request
for FMLA leave.

City of Winston-Salem Employee Handbook November 2014 Revision 30