Leave Documentation

PFMLI Documentation by Leave Type

Medical Leave

• Health Care Provider Certification. View form
  
  

Family Leave

• Family member’s own serious health condition
  • You will need to provide a Health Care Provider Certification. View form
    
    

Bonding

One of the following required documentation:

• The child's birth certificate or Consular Report or Birth Abroad
• A document issued by a health care provider of the child or pregnant parent
• Hospital admission form associated with delivery
• Another document approved by the Oregon Employment Department for this purpose

Bonding Adoption or Placement

One of the following required documentation:

• A copy of a court order verifying placement
• A letter signed by the attorney representing the prospective foster or adoptive parent that confirms the placement
• A document from the foster care, adoption agency, or social worker involved in the placement that confirms the placement
• A document for the child issued by the United States Citizenship and Immigration Services
• Another document approved by the Oregon Employment Department for this purpose

Documentation must show all of the following:

• The covered individual’s first and last name as parent or guardian of the child after birth or placement of the child through foster care or adoption
• The child’s first and last name
• The date of the child’s birth or placement

Safe Leave / Personal Protected Leave

One of the following documentation is required:

• A copy of a federal agency or state, local, or tribal police report, or a formal complaint to a school’s Title IX Coordinator indicating that the covered individual or the covered individual’s child was a victim of domestic violence, harassment, sexual assault, or stalking
• A copy of a protective order or other evidence from a federal, state, local, or tribal court, administrative agency, school’s Title IX Coordinator, or attorney that the covered individual or the covered individual’s child appeared in or was preparing for a civil, criminal, or administrative trial related to domestic violence, harassment, sexual assault, or stalking
• Documentation from an attorney, law enforcement officer, health care provider, licensed mental health professional or counselor, member of the clergy, or victim services provider that shows the covered individual or the covered individual’s child was undergoing treatment or counseling, obtaining services, or relocating as a result of domestic violence, harassment, sexual assault, or stalking

In cases where a covered individual can show good cause for not providing one of the above forms of documentation, the covered individual may provide a written statement attesting that they are taking eligible safe leave.

Good cause for not providing documentation is determined at the discretion of the company and includes, but is not limited to:

• Difficulty obtaining verification due to a lack of access to services; or
• Concerns for the safety of the covered individual or the covered individual’s child