Medical Leave and Accommodation Forms
WSU employees can find all required forms for medical leave, workplace accommodations, long-term health conditions, and workers’ compensation here. Use these forms to initiate requests and ensure timely processing of your needs.
Long-Term Health Condition
Medical Leave
Request a leave of absence (LOA) in Workday (workday.wsu.edu). Review the Workday reference guide Employee Request a Leave of Absence for instructions.
- Medical Leave Health Care Provider Statement
- Medical Leave Work Assessment Return To Work (Own Condition)
- Employee Rights under the Family Medical Leave Act – DOL Poster
- L&I Protected Leave Laws – L&I Table
Military Related Leaves
Request a leave of absence (LOA) in Workday (workday.wsu.edu). Review the Workday reference guide Employee Request a Leave of Absence for instructions.
- Military Caregiver Leave Health Care Provider Statement – Covered Veteran
- Military Caregiver Leave Health Care Provider Statement – Active Servicemember
- Military Leave Certification of Qualifying Exigency
- Your Rights Under Uniformed Services Employment and Reemployment Rights Act (USERRA) – DOL Poster
Modified Duties – Faculty
Occupational Exposure
- Vaccine Declination and Documentation Form (English)
- Vaccine Declination and Documentation Form (Spanish)
Reasonable Accommodation
- Accommodation Request for Disability or Serious Medical Condition
- Medical Release Statement for Reasonable Accommodation Requests
- Health Care Provider Statement for Reasonable Accommodation Requests
- Pregnancy Accommodation Request Form
Shared Leave
Request Shared Leave in Workday (workday.wsu.edu). Review the Workday reference guide Employee Request a Leave of Absence for instructions.
- Shared Leave Health Care Provider Statement – Medical Conditions
- Shared Leave – Employee Request Form – Domestic Violence, Sexual Assault, Stalking
State of Washington Shared Leave Pools
- Shared Leave Employee Request – Uniformed Services Shared Leave Pool – State of Washington
- Shared Leave Donor Form – Uniformed Services Shared Leave Pool – State of Washington
- Shared Leave Employee Request – Veterans’ In-State Service Shared Leave Pool – State of Washington
- Shared Leave Donor Form – Veterans’ In-State Service Shared Leave Pool – State of Washington
- Shared Leave Employee Request – Foster Parent Shared Leave Pool – State of Washington
- Shared Leave Donor Form – Foster Parent Shared Leave Pool – State of Washington
Domestic Violence, Sexual Assault or Stalking Leave and Protections
Washington Paid Family & Medical Leave
- Online Application
- Paid Family & Medical Leave – Statement of Employee Rights – ESD
- Paid Family & Medical Leave Poster – ESD
Worker Compensation
- Online Incident Report
- Supervisors Accident Investigation Report
- Activity Prescription Form
- Minor Volunteer Consent and Release
- Volunteer Monthly Report
- Witness/Injured Person Statement
- Workers’ Compensation – File a Claim
- Workers’ Compensation Benefits – A guide to inured workers L&I pamphlet
- Getting Back to Work: It’s Your Job and Your Future – L&I pamphlet
- Notice to Employees – If a Job Injury Occurs – L&I Poster
- Your Rights as a Worker in Washington State – L&I Poster