FMLA Forms (Request and WHD-380-E)

Have you spoken to HR yet?

1. Please contact HR directly at (508)-764-5414
2. They will be happy to set up a meeting with you regarding any matters pertaining to FMLA
3. Below please find the attached documents that may be requested during your meeting.

The attached forms are a request for FMLA, and the Certification of Health Care Provider for Employee’s Serious Health Condition under the Family and Medical Leave Act (WHD-380-E).

FMLA Leave Request Form -Town of Southbridge

WH-380-E

If you would like more information regarding this matter before your meeting, you can check out the Mass State FMLA website HERE.