Protected Leave

Protected Leave – Family Medical Leave Act (FMLA), Oregon Family Leave Act (OFLA), and Oregon’s Sick Time Law

For questions about protected leave, contact Human Resources 541-726-3705.

Requesting Leave

Your first action should be to notify your supervisor that you need protected leave.  This request should be done as soon as you have knowledge of the need. (Please see the Family Medical Leave Admin. Reg.)

Your Own Illness or Injury

Print the following forms and take them to your attending physician for completion:

  1. Physicians Certification – Employee’s Illness/Injury
  2. Your job addendum
  3. Your classification
  4. WH-380-E (For Employees own Illness/Injury)

For a Family Member

Print the following forms and take them to your family member’s attending physician for completion:

  1. Physicians Certification – Employee’s Family Member Illness/Injury
  2. WH-380-F (For a Family Member of Employee)

Returning Required Documentation

The City requires that documentation be completed and returned within 21 days of requesting leave.

Please return all forms to Human Resources using the following options:

  1. Confidential Fax Line: 541-726-4614
  2. Drop off to Human Resources, Leave Administration
  3. Mail: 225 Fifth St., Springfield, OR  97477,  Attn: Human Resources- Leave Administration

Additional Resources

  1. Protected Leave Request Form – COVID-19 
  2. Employee rights under the Family and Medical Leave Act (FMLA)
  3. Employee rights under the Oregon Family Leave Act (OFLA)
  4. Employee rights under the Oregon Sick Time Law
  5. Family Medical Leave Administration Regulations
  6. Leave of Absence Administrative Regulations
  7. Paid Time Off (PTO) Administrative Regulations
  8. Sick Leave Administration Regulations
  9. Sick Leave Reserve (SLRP) Administrative Regulation
  10. Vacation Administration Regulations
  11. Short Term Disability (STD) – Telephonic Flyer (If an employee has STD and wants to submit a claim, while on FMLA/OFLA)

Contact Us

Confidential Email*Springfieldbenefits@springfield-or.gov
Confidential Fax in HR541-726-4614