Outagamie County provides family and medical leave in accordance with the Federal Family and Medical Leave Act (FMLA) and the Wisconsin Family and Medical Leave Act.
An employee qualifying for coverage under both Wisconsin and Federal acts may receive the greater of the two benefits. Federal and Wisconsin leave benefits are taken concurrently (at the same time). Entitlements are calculated on a calendar year, January 1 to December 31 for both state and federal purposes.
An employee who would like to request FML should review the policy found in the Employee Handbook located on the Human Resources main page on the MyOC Internal website. After reviewing, please follow the steps below to submit a request for leave.
Complete the FMLA Request Form (Fillable PDF or print and complete). This form should then be submitted to the Employee Administrator at monica.gosz@outagamie.org.
Complete the Employee section of the applicable Medical Certification and submit the entire form to the appropriate medical provider to complete. The medical provider will generally fax the form back to the Employee Leave Administrator.
Please note, you or your family member will generally need to complete a medical release with the medical provider in order for forms to be completed. The medical provider will supply that form to you.
If you are on leave for Self you will be required to provide a Return to Work slip before you return. The medical provider can use the form below or can submit anything on letterhead with any restrictions listed.