FMLA Violation Information

If you believe your FMLA rights were violated as described in MEC Grievance #36-99-2-176-25, please complete this form.
Your report will assist AFA in protecting Flight Attendants’ rights under the Family and Medical Leave Act (FMLA) and our Collective Bargaining Agreement.
All information submitted will remain confidential and used only for Union and legal review purposes.

First Name

Last Name

Employee ID

Personal Email

Date You Requested FMLA Leave

(The date you notified Crew Scheduling, Leave Administration, or Benefits that you were using FMLA)

Date(s) the Company Applied Additional or Denied FMLA Time

(For example, the following day or leg coded as FMLA that you did not request)

Result

Counted as a Sick Occurrence

Written Warning Level One

Written Warning Level Two

Termination

Unsure/Excused

Describe What Happened

(Briefly explain what occurred — include whether you attempted to return to your trip, how you were notified of the denial or coding, and who you spoke with.)