Family & Medical Leave

These forms are for U.S. active Dow employees for medical certification of a serious health condition as part of The Dow Chemical Company's Family & Medical Leave Process.

Employee Health Certification Form

This form is used (1) to determine whether an employee’s condition qualifies as a “serious health condition” under the Family and Medical Leave Act (FMLA) and for administration of Dow’s FMLA policy, and (2) to obtain information regarding an employee’s eligibility and administration of the requirements of Dow’s Paid Medical Leave Policy.

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Family Medical Health Certificate Form

This form should be completed and returned to the site Dow Health Services contact when an employee requests FMLA (Family and Medical Leave Act) leave to care for a family member with a serious health condition.

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