Extended Illness or Incapacity Analysis Checklist

When an employee has been continuously absent or otherwise physically unable to perform all of the essential functions of their job, every situation will be different.

Some of the elements that need to be reviewed by a supervisor include:

• Last date the employee was at work.
• Last date the employee performed all of the essential functions of their position. Review the list of the essential functions and note which ones the employee is not doing.
• Records of documentation or correspondence that has been sent or given to the employee regarding their absences or limitations and records of the employee’s responses, if applicable.
  • This documentation may include letters, emails, notes of phone conversations, performance reviews, counseling and/or disciplinary documents.
• Documentation from the employee’s medical providers regarding need for leave and/or physical limitations on the job, if any.
• Current status information from Risk Management, if applicable.
• Current status information from Employee Benefits, if applicable.
• Attendance report/records:
  • Employee’s last date of attendance (if applicable) prior to extended leave and/or last date the employee worked a full work day or full work week. If employee has been granted a reduced work schedule, review that documentation as well.
  • Employee’s first date of unauthorized absence (if applicable).
  • Employee’s number of paid actual working hours (and the timeframe) to determine FMLA eligibility.
  • Employee’s FMLA use for current and past calendar year.
  • Leave request information for the employee from OPUS.