FMLA Worksheet: $25.00

This form may be used to track an employee's monthly use of leave under the Family Medical Leave Act (FMLA). It can be used to record dates leave was taken, number of hours taken and reason for the leave. This is a good method for keeping an accurate account of an employee's annual use of FMLA leave.

If you have not registered yet, please register with Tyler Lee Randolph, P.C.

First Name
Middle Initial
Last Name
Telephone
E-Mail
Address Line 1
Address Line 2 (optional)
City
State
Zip Code
How did you find out
about this site?
Create a Username
(at least 6 characters)
Create a Password
Confirm Password
Limited Services Agreement

If you have already created your account with Tyler Lee Randolph, P.C., please log in here.

Username
Password
Forgot your username or password?