What is the purpose of the WH‑380‑E form?

The WH‑380‑E certifies that an employee’s serious health condition (or a family member’s condition) meets the eligibility criteria for FMLA leave.

Can I fill out WH‑380‑E on a mobile device?

Yes. The Formize PDF Filler works on smartphones and tablets, allowing you to complete the form on any modern browser.

Do I need to include a diagnosis on the form?

A diagnosis is optional unless your employer specifically requests it. The form’s instructions note that the provider may omit the diagnosis while still meeting FMLA requirements.

How many copies of the completed WH‑380‑E do I need?

Typically one completed, signed copy is submitted to HR. Keep a personal copy for your records.

Is the WH‑380‑E required for all FMLA leave types?

The form is required for serious health conditions of the employee or an immediate family member. Separate certification forms exist for newborn or adopted child care.

What if I make a mistake after submitting the form?

Contact your HR department immediately. You can submit a corrected WH‑380‑E with a note explaining the changes.

Is the WH‑380‑E a federal or state form?

It is a federal form issued under the Family and Medical Leave Act, but many states adopt the same version for their own leave programs.

Do I need a notary for the WH‑380‑E?

No. The health‑care provider’s signature and date satisfy the certification requirements.

WH‑380‑E Fillable PDF – Family & Medical Leave Act Medical Certification

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WH‑380‑E Fillable PDF – Family & Medical Leave Act Medical Certification

The WH‑380‑E is the official certification of a health care provider required under the Family and Medical Leave Act (FMLA). Employers use this form to verify an employee’s serious health condition, a newborn or newly‑adopted child, or a need for caretaker leave.

What Is the WH‑380‑E Form?

This government‑issued PDF collects detailed medical information, including diagnosis, treatment dates, and the provider’s certification that the condition qualifies for FMLA leave. It is used by federal, state, and private employers across the United States.

How to Complete the WH‑380‑E Online

Instead of downloading and editing the PDF in a separate editor, simply click the “Fill out this form” button on this page. The Formize PDF Filler app will load the fillable version instantly. Follow these steps:

Step 1: Click the “Fill out this form” button.
Step 2: The Formize filler loads – the document becomes interactive.
Step 3: Enter the employee’s information, health‑care provider details, and medical certification data.
Step 4: Review for completeness and accuracy.
Step 5: Click “Save & Download” to obtain a completed PDF you can print or email to HR.

Common Mistakes to Avoid

Leaving any required field blank – every asterisk (*) field must be completed.
Providing a diagnosis when the form states it is optional (unless your employer requests it).
Using illegible handwriting – the online filler ensures clear, typed text.
Submitting the form without the provider’s signature and date.

Where to Submit the Certified Form

After saving the completed WH‑380‑E, send it to your employer’s Human Resources or Benefits department according to your company’s leave‑request policy. Federal employees may also submit it to the agency’s HR office.

Download the Fillable WH‑380‑E PDF

If you prefer to keep a copy of the original document, you can download the official WH‑380‑E PDF from the West Virginia Legislature site. Our online filler uses the same version, guaranteeing compliance.

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FAQ

What is the purpose of the WH‑380‑E form?
The WH‑380‑E certifies that an employee’s serious health condition (or a family member’s condition) meets the eligibility criteria for FMLA leave.
Can I fill out WH‑380‑E on a mobile device?
Yes. The Formize PDF Filler works on smartphones and tablets, allowing you to complete the form on any modern browser.
Do I need to include a diagnosis on the form?
A diagnosis is optional unless your employer specifically requests it. The form’s instructions note that the provider may omit the diagnosis while still meeting FMLA requirements.
How many copies of the completed WH‑380‑E do I need?
Typically one completed, signed copy is submitted to HR. Keep a personal copy for your records.
Is the WH‑380‑E required for all FMLA leave types?
The form is required for serious health conditions of the employee or an immediate family member. Separate certification forms exist for newborn or adopted child care.
What if I make a mistake after submitting the form?
Contact your HR department immediately. You can submit a corrected WH‑380‑E with a note explaining the changes.
Is the WH‑380‑E a federal or state form?
It is a federal form issued under the Family and Medical Leave Act, but many states adopt the same version for their own leave programs.
Do I need a notary for the WH‑380‑E?
No. The health‑care provider’s signature and date satisfy the certification requirements.

HOW TO

How to fill out WH-380-E for free, online in 5 easy steps:

1
Open the Fillable Form
Click the “Fill out this form” button on the page. The Formize PDF Filler loads the WH‑380‑E as an interactive document.
2
Enter Required Information
Type the employee’s name, dates of care, and the health‑care provider’s details into the highlighted fields.
3
Complete the Medical Certification
Provide the diagnosis (if required), treatment plan, and any functional limitations. Ensure the provider signs and dates the form.
4
Review and Save
Double‑check all entries for accuracy, then click “Save & Download” to get a completed PDF you can print or email.
5
Submit to HR
Send the saved PDF to your employer’s HR or Benefits department following your organization’s leave‑submission guidelines.

ABOUT

Department of Labor (DOL) Forms

WH-380-E is one of the official forms that are used by the United States Department of Labor and its various agencies to collect information, administer programs, and enforce labor-related laws and regulations. The Department of Labor is a federal executive department responsible for promoting and protecting the welfare of workers, ensuring fair employment practices, and overseeing various aspects of labor and employment in the United States.

Here are some examples of Department of Labor forms:

Employment Eligibility Verification (Form I-9): While administered by the U.S. Citizenship and Immigration Services (USCIS), Form I-9 is often associated with the Department of Labor. It is used by employers to verify the identity and employment eligibility of individuals hired for employment in the United States.

Family and Medical Leave Act (FMLA) Forms: The DOL's Wage and Hour Division administers the FMLA, and various forms are used to implement and comply with the provisions of this federal law, including the Certification of Health Care Provider form and the FMLA Notice of Eligibility and Rights & Responsibilities form.

Occupational Safety and Health Administration (OSHA) Forms: OSHA, a division of the DOL, requires certain employers to maintain records of workplace injuries and illnesses using forms such as OSHA Form 300, OSHA Form 300A, and OSHA Form 301.

Unemployment Insurance Forms: The DOL's Employment and Training Administration oversees the Unemployment Insurance (UI) program, and various forms are used by state workforce agencies to administer and process UI benefits claims.

Wage and Hour Compliance Forms: The DOL's Wage and Hour Division enforces various labor laws, including the Fair Labor Standards Act (FLSA) and the Family and Medical Leave Act (FMLA). Employers may be required to use specific forms to maintain compliance with these laws, such as records of hours worked, wage rates, and other related information.

These examples represent some common categories of Department of Labor forms, but there are many other forms used by the DOL and its various agencies to carry out their responsibilities related to labor and employment. The specific forms required may vary depending on the program, regulation, or enforcement action involved. It's advisable to visit the official website of the U.S. Department of Labor (www.dol.gov) or consult with the relevant DOL agencies or legal professionals to obtain accurate and up-to-date information regarding the specific DOL forms relevant to your labor-related needs or compliance requirements.

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