FMLA Interference Complaint Template — Appeal for Denied or Retaliatory Leave
Use this detailed FMLA interference/retaliation complaint to document leave requests, employer responses, interference or retaliation, preservation requests, and to demand corrective relief including approval of leave, reinstatement, and damages.
Related topics: employment, FMLA, leave, retaliation, interference, medical, workplace
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FMLA INTERFERENCE / RETALIATION COMPLAINT — REQUEST FOR REMEDY Date: [date] To: [hr_department] From: [name] Position: [position_title], Department: [department] Supervisor: [supervisor_name] Re: Complaint of interference with or retaliation for exercising rights under the Family and Medical Leave Act (FMLA) 1. SUMMARY I requested or attempted to take FMLA-protected leave on or about [date_leave_requested] for the following reason(s): [type_of_leave_requested] . My employer has interfered with, ...