To request job-protected leave at Costco, you’ll complete a Family and Medical Leave Act certification form: Form WH-380-E if the leave is for your own serious health condition, or Form WH-380-F if you’re caring for a spouse, child, or parent. You fill in the top section yourself, your healthcare provider completes the medical section, and you return the signed form to Costco’s leave-of-absence team within 15 calendar days of the company’s request.1eCFR. 29 CFR 825.305 – Certification The Costco FMLA form itself is the Department of Labor’s certification packet — Costco uses the federal optional-use forms rather than a proprietary one.2U.S. Department of Labor. FMLA Forms
Which Form You Need
Two forms cover most Costco leave requests:
- Form WH-380-E is for your own serious health condition. Your treating provider documents your diagnosis, the treatment plan, and how long you’re expected to be unable to work.
- Form WH-380-F is for a family member’s serious health condition. Your spouse, child, or parent’s provider completes the medical section.
Both are available as PDFs on the Department of Labor’s FMLA forms page.2U.S. Department of Labor. FMLA Forms You can also pick up copies from the payroll or personnel office at your warehouse. The Costco Employee Self-Service (ESS) portal at costco.com/employee-website.html may have electronic versions in the leave-of-absence section after you log in.
Different situations use different forms. Military caregiver leave and qualifying exigency leave have their own DOL certification forms; ask the leave-of-absence department which packet to use before you print anything if the reason for your leave involves a servicemember.
Filling Out the Employee Section
The top of the form is yours. It asks for your name, job title, and the reason you need leave. Keep it short and factual. If you’re not sure how to describe your position, use the exact title on your paystub or in ESS.
The rest of the form is for your healthcare provider, and this is where most delays happen. Before your appointment, write down a brief description of your job duties — the physical demands of warehouse work like lifting, standing for full shifts, operating pallet jacks or forklifts, and any repetitive tasks specific to your department. Hand that description to the provider along with the form. It gives them the context they need to assess whether your condition prevents you from performing the essential functions of your position, which is the exact question the form asks them to answer.
Ask the provider to fill in every field that applies, including:
- The diagnosis or a description of the condition
- The date the condition began and how long it’s expected to last
- Whether you’ll need continuous leave, intermittent leave, or a reduced schedule
- The frequency and duration of any treatments or flare-ups
- The provider’s signature and the date signed
Blank fields are the most common reason certifications come back as insufficient. If a section doesn’t apply, ask the provider to write “N/A” rather than leaving it empty.
The 15-Day Deadline
Once Costco asks you for certification, you have 15 calendar days to return the completed form.1eCFR. 29 CFR 825.305 – Certification That clock starts on the request date, not the date you saw the notice. Schedule the provider appointment as early as you can.
If your provider can’t see you inside that window, or if the form takes longer to process, the deadline can be extended when you’re making a good-faith effort. Document that effort: keep the appointment confirmation, any messages to the provider’s office chasing the form, and dates of calls. Missing the 15-day window without a legitimate reason gives Costco grounds to deny leave protection.
How to Submit the Form to Costco
Once the form is complete and signed, you have three delivery routes:
- ESS portal. Scan the certification and upload it through Employee Self-Service. The system creates a timestamped electronic record.
- In person. Hand-deliver the form to your warehouse manager or payroll clerk and ask for a signed and dated receipt, or a photocopy stamped with the date received.
- Mail or fax. Send the paperwork to the regional HR administrator for your warehouse district. If you fax, keep the transmission confirmation page.
Whichever route you take, keep a personal copy of the completed certification, any cover letter, and proof of the submission date. If a dispute later arises about whether you filed on time, that receipt is your evidence.
If the Form Comes Back as Incomplete
If Costco’s leave department finds your certification incomplete or insufficient, the company must tell you in writing exactly what’s missing. You then have seven calendar days to cure the deficiency.3U.S. Department of Labor. Fact Sheet 28G – Medical Certification Under the Family and Medical Leave Act
Common gaps: a provider left the diagnosis field blank, didn’t specify whether the condition requires intermittent leave, or didn’t state how long the incapacity is expected to last. A phone call to the provider’s office is usually faster than mailing the form back and forth. Ask the office to fax or email the corrected page directly to Costco and to you.
Before You Send the Form: Notice and Eligibility
The certification form is one step in a larger process. A few things need to be in place first.
Give Costco advance notice. If your need for leave is foreseeable — a planned surgery, an expected due date, a scheduled adoption placement — you must give at least 30 days’ advance notice before the leave starts.4U.S. Department of Labor. Family and Medical Leave Act Advisor If 30 days isn’t possible, give notice as soon as practicable. For sudden emergencies, contact your supervisor or the leave-of-absence department the same day or the next business day.
Confirm you meet the three eligibility thresholds:
- At least 12 months of employment with Costco, which don’t have to be consecutive.5U.S. Department of Labor. FMLA Frequently Asked Questions
- At least 1,250 hours actually worked in the 12 months before your leave begins. Paid vacation and sick time don’t count toward this — only hours on the clock.5U.S. Department of Labor. FMLA Frequently Asked Questions
- At least 50 Costco employees within a 75-mile radius of your worksite, which most warehouses easily meet.6U.S. Department of Labor. Fact Sheet 28 – The Family and Medical Leave Act
The 1,250-hour rule catches part-time employees most often. It works out to roughly 24 hours per week for a full year.
What Happens After You Submit
Costco has five business days after receiving your leave request to send an eligibility notice telling you whether you qualify.7eCFR. 29 CFR 825.300 – Employer Notice Requirements The same notice lays out your rights and responsibilities, including whether certification is required and how your leave will be counted.
After the certification is reviewed, Costco issues a designation notice stating whether the leave is approved, how much of it counts against your 12-week FMLA entitlement, and whether paid leave will be substituted. Watch your mailbox and any internal messaging system. Responding to any follow-up requests promptly keeps the process moving.
If Costco Questions the Certification
If the company has reason to doubt the validity of your medical certification, it can require a second opinion from a different healthcare provider at Costco’s expense.3U.S. Department of Labor. Fact Sheet 28G – Medical Certification Under the Family and Medical Leave Act If the second opinion conflicts with the first, Costco can request a third opinion, also at company expense. You and Costco must jointly agree on the third provider, and that provider’s conclusion is final and binding.
If Your Request Is Denied
If you believe Costco wrongly denied your leave, retaliated against you for requesting it, or failed to restore your job when leave ended, you can file a complaint with the U.S. Department of Labor’s Wage and Hour Division online at webapps.dol.gov/contactwhd or by calling 1-866-487-9243.8Worker.gov. Filing a Complaint With the US Department of Labors Wage and Hour Division The nearest field office will contact you within two business days.
You also have the right to file a lawsuit in federal or state court. The statute of limitations is generally two years from the date of the violation, or three years if the violation was willful. Many employees start with the DOL complaint, since an investigation that finds a violation can recover lost wages and benefits without a lawyer. If retaliation is involved or the facts are complex, an employment attorney can help you preserve your options.