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Free Medical Leave Denial Appeal Log PDF

Document your FMLA or medical leave denial and track appeals in a printable, compliant PDF.

Published December 4, 2025

If your employer denies FMLA or medical leave, tracking every appeal, doctor note, and HR response helps you enforce your rights and meet deadlines.

When to use this

  • Your FMLA or medical leave request was denied and you plan to appeal.
  • HR keeps asking for additional documents and you need a clean record.
  • You are working with a lawyer or regulator and need a timeline of actions and responses.

How to do it (fast)

  1. Open the medical leave denial appeal log tool.
  2. Enter your employer, requested dates, and reason for leave.
  3. Log each appeal step with the date, contact, documents sent, and outcome.
  4. Download the PDF to include with HR grievances or legal complaints.

Why this helps

  • Provides a dated trail that shows you met deadlines and sent the requested documents.
  • Captures HR responses and outcomes for appeals, grievances, or regulatory filings.
  • Creates a printable PDF you can share with doctors, union reps, or attorneys.

Related tools

Not legal advice. Courts set their own rules. Keep your original records.

What to record in a medical leave appeal log

Include the dates you requested, the reason for leave, and every appeal action. Add the contact, action taken, documents sent (doctor certifications, return-to-work notes), and outcome or next steps.

How this helps with HR grievances or regulators

A dated log shows whether HR followed timelines, requested extra information, or ignored your submissions. It can support a union grievance, internal escalation, or complaint to a labor agency.

How to use the free PDF builder

  1. Open the tool and add your employer, requested dates, and leave reason.
  2. Enter each appeal step with documents sent and the outcome.
  3. Download the PDF and attach it to your grievance or complaint.

Need to track your leave appeal?

Use the free medical leave denial appeal log to create a PDF timeline.

Open the Medical Leave Denial Appeal Log

Last updated December 4, 2025