FMLA 2026

personas/caregiver/files/documents/doc-fmla-approval.pdf

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2840 Amnicola Spur

Tannehill Mechanical, Inc.
Chattanooga, TN 37406
(423) 555-0160

Family and Medical Leave, Designation Notice
Company form HR-14. Given to the employee within five business days of a complete request for leave under the Family
and Medical Leave Act.

EMPLOYEE
NAME POSITION DATE OF HIRE
WALTER E. PRUITT JR. SENIOR ESTIMATOR 03/15/2004
REQUEST RECEIVED LEAVE YEAR HOW THE YEAR IS COUNTED
12/11/2025 01/01/2026 - 12/31/2026 CALENDAR YEAR

REASON FOR LEAVE
REASON FAMILY MEMBER MEDICAL CERTIFICATION
CARE OF A PARENT WITH A LORRAINE M. PRUITT, S. TOLBERT, MD, SIGNED
SERIOUS HEALTH CONDITION MOTHER 12/09/2025

DECISION
STATUS TYPE OF LEAVE ENTITLEMENT FOR THE LEAVE YEAR
APPROVED INTERMITTENT, AS NEEDED 480 HOURS (12 WEEKS)
EXPECTED USE ON THE CERTIFICATION APPROVAL ENDS RECERTIFICATION FOR 2027 DUE
APPOINTMENTS, 2-4 A 12/31/2026 12/01/2026
MONTH; EPISODES OF 1-5
DAYS

PAY AND BENEFITS
PAID TIME HEALTH AND DENTAL INSURANCE 401(K) MATCH
ACCRUED PTO IS USED CONTINUE. EMPLOYEE SHARE ON PAID HOURS ONLY
FIRST. LEAVE IS UNPAID IS STILL DEDUCTED.
AFTER THAT.

HOW TO REPORT
PLANNED ABSENCE UNPLANNED ABSENCE TIMESHEET
TELL YOUR SUPERVISOR AS CALL OR TEXT YOUR CODE FML, IN QUARTER
SOON AS THE APPOINTMENT SUPERVISOR THE SAME DAY HOURS
IS MADE

Hours taken are counted by the office from your timesheets, and you may ask for the count at any time. Leave taken
under this notice cannot be counted against you in attendance or performance reviews. When your need for leave ends,
tell the office in writing.

Shelly Ogle Office Manager, January 6, 2026

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Record

FMLA 2026 Document · saved Jan 8, 2026

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Planted

only_in_file The extra-furosemide rule, one sentence on page 5 of the ten-page January 2025 discharge packet (one extra 20 mg tablet for a gain of 3 lb in a day or 5 lb in a week, call cardiology the same day, not more than two days running); the POA clause that lets Walt sell her house only after a physician's written statement and 30 days' notice to Russ; the principal balance on the September 2026 mortgage statement ($171,717.32); the memory test score (19 of 30); next year's drug plan premium ($46.20); the long-term-care daily benefit ($150); the 401(k) balance ($318,406.12 on June 30, 2026); every number on the September labs, which exist only as a portal screenshot (eGFR 33, A1c 7.9); the wind and hail deductible on Walt's house ($3,180); the owner and the title number on the Buick's title, which is a scan with no text (WALTER E PRUITT, 14 177 406219, no lien); the FMLA entitlement (480 hours for 2026); the lease clause that makes renter's insurance a condition, with $15 a month charged until proof is given; what Gentle Ridge has billed this year ($17,284.00 through September); mortgage interest paid in 2025 ($6,912.51); Camille's immunization dates.

attachments.yaml

record: doc-fmla-approval
template: document
style: form
org:
  name: Tannehill Mechanical, Inc.
  lines:
  - 2840 Amnicola Spur
  - Chattanooga, TN 37406
  phone: '4235550160'
  color: '#1d3d5c'
title: Family and Medical Leave, Designation Notice
body: 'Company form HR-14. Given to the employee within five business days of a complete request for leave
  under the Family and Medical Leave Act.


  | Employee | |

  |---|---|

  | Name | WALTER E. PRUITT JR. |

  | Position | SENIOR ESTIMATOR |

  | Date of hire | 03/15/2004 |

  | Request received | 12/11/2025 |

  | Leave year | 01/01/2026 - 12/31/2026 |

  | How the year is counted | CALENDAR YEAR |


  | Reason for leave | |

  |---|---|

  | Reason | CARE OF A PARENT WITH A SERIOUS HEALTH CONDITION |

  | Family member | LORRAINE M. PRUITT, MOTHER |

  | Medical certification | S. TOLBERT, MD, SIGNED 12/09/2025 |


  | Decision | |

  |---|---|

  | Status | APPROVED |

  | Type of leave | INTERMITTENT, AS NEEDED |

  | Entitlement for the leave year | 480 HOURS (12 WEEKS) |

  | Expected use on the certification | APPOINTMENTS, 2-4 A MONTH; EPISODES OF 1-5 DAYS |

  | Approval ends | 12/31/2026 |

  | Recertification for 2027 due | 12/01/2026 |


  | Pay and benefits | |

  |---|---|

  | Paid time | ACCRUED PTO IS USED FIRST. LEAVE IS UNPAID AFTER THAT. |

  | Health and dental insurance | CONTINUE. EMPLOYEE SHARE IS STILL DEDUCTED. |

  | 401(k) match | ON PAID HOURS ONLY |


  | How to report | |

  |---|---|

  | Planned absence | TELL YOUR SUPERVISOR AS SOON AS THE APPOINTMENT IS MADE |

  | Unplanned absence | CALL OR TEXT YOUR SUPERVISOR THE SAME DAY |

  | Timesheet | CODE FML, IN QUARTER HOURS |


  Hours taken are counted by the office from your timesheets, and you may ask for the count at any time.
  Leave taken under this notice cannot be counted against you in attendance or performance reviews. When
  your need for leave ends, tell the office in writing.


  <span class="sig">Shelly Ogle</span> Office Manager, January 6, 2026

  '