FMLA Fitness-For-Duty Certification

An employee expecting to return from FMLA leave submits return-to-work certification from a health care provider.

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Completing the PDF Form

  1. Read through all pages of the document to find specific instructions if any
  2. Enter requested information into the form
  3. Print the form
  4. Get required signatures
  5. Scan a copy of the signed form for your records
  6. Send the original, completed, signed form to:         

        Human Resources
        120 Crofts Hall
        North Campus
        University at Buffalo
        Buffalo, NY 14260

Need help completing the form?

Send email, phone or submit a question

Claudia Samulski

Claudia Samulski

State Benefit Services

Phone: 716-645-4487


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Form Facts

Form Type: Downloadable, PDF Document

Requirements: PDF Reader

Updated: May 2010

Owner: Human Resources