CERTIFICATION OF HEALTH CARE PROVIDER - UTU Local 489 - utulocal489 2026

1. Click ‘Get Form’ to open the CERTIFICATION OF HEALTH CARE PROVIDER in the editor.
2. Begin with Section I by entering the employer information, including the name and contact details of Union Pacific Railroad.
3. In Section II, complete your personal details as the employee. Fill in your name, ID, phone number, and service unit or department.
4. Provide information about the family member you will care for, including their name and relationship to you. Specify the type of care needed and estimate how much leave you will require.
5. Sign and date the form at the bottom of Section II to confirm that all information is accurate.
6. If applicable, forward the form to your health care provider for completion of Section III. Ensure they provide detailed medical facts and care requirements.
7. Once completed, return the form to Union Pacific Railroad’s Health & Medical Department via mail or fax as indicated.

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