FMLA Fitness-For-Duty Certification

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

Using Firefox with PDF forms?

Make Adobe Acrobat the reader.

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
University at Buffalo
Townsend Hall
205 Hayes Road
Buffalo, NY 14214

Need Help Completing the Form?


UB HR Leaves

State Benefit Services

Phone: 716-645-7777


Form Facts

Form Type: Downloadable, PDF Document

Requirements: PDF Reader

Updated: May 2010

Owner: Human Resources