Absentee Form: WORD
This form includes sections to document information regarding an employee's attendance record and should be completed by an employee's supervisor. This form is simply used as an easy-reference tool to track an employee's attendance, including vacation and sick time used and available.
Counseling Session Memorandum: WORD
This form is used to document conversations held between employer and employee where counseling has been provided for a problem in the work environment. This form is often used in conjunction with the Written Plan Memorandum and the Decision-Making Leave forms, as the first step in the disciplinary process. If an employee's behavior or performance does not improve after this documented conversation, a supervisor then meets with the employee, explains that concerns still exist, outlines the concerns, and asks the employee to write a plan to improve their performance and/or behavior. The Written Plan Memorandum (below) is used to document this conversation. If, after writing a written plan, an employee's behavior and/or performance still does not improve, the supervisor may choose to give the employee paid time off of work to decide whether or not they wish to stay employed with the organization. The Decision-Making Leave (see below) form is used to document this conversation. All forms referenced within this paragraph are to be signed by an employee and their supervisor and maintained in an employee's personnel file.
Decision Making Leave: WORD
This form is to be used if an employee's written plan to improve their performance and/or behavior is not effective. It allows the employee a specified amount of paid time away from the job to decide whether they wish to continue their employment by making the requested improvements in their performance, or if they wish to terminate their employment. It includes: date of counseling session, reason for leave, date of leave, etc. This form is to be signed by the employee and the supervisor and maintained in the employee's personnel file.
Employment Application: WORD
This application form can be used by employers in the State of California.
Please Note: P•A•S ASSOCIATES CONSULTS ON A NATION-WIDE BASIS. PLEASE CONTACT OUR OFFICE TO OBTAIN AN EMPLOYMENT APPLICATION SPECIFIC TO YOUR STATE.
Employee Emergency Contact: WORD
This form is used to document all general information about an employee such as home address, phone number, and persons to contact in case of an emergency. This form should be completed by the employee with new hire paperwork and maintained in the employee's personnel file.
Employee Probation Memorandum: WORD
This form is used for those employees who have been given a written warning and whose performance and/or behavior has not improved, placing them on probation for a specific period of time. This form includes questions such as: reason for probation, means by which the supervisor will monitor progress during probation and steps employee must take to improve situation. This form is to be signed by the employee and the supervisor and maintained in the employee's personnel file.
Exit Interview Form: WORD
This form is used for those employees whose employment is terminated (voluntarily or involuntarily). It is maintained in the personnel file for easy reference of job and pay change history. This form should be completed by an employee’s supervisor.
This form includes several changes to the types of documents that can be accepted for purposes of determining identity and authorization to work.
The Spanish version of Form I-9 is for use in Puerto Rico only. Spanish-speaking employers and employees in the 50 states, Washington, D.C., and other U.S. territories may use the Spanish version for reference, but must complete and retain the English version of the form.
These forms assists the supervisor in documenting all necessary information during an employee's performance appraisal. One form is provided for Non-Exempt and Part-Time employees and another for Exempt Employees. This form should be signed by an employee, their supervisor and the appropriate manager and maintained in the employee's personnel file for future reference.
Notice to Employee - Labor Code Section 2810.5: WORD
Effective January 1, 2012, California Labor Code section 2810.5(a) requires that the following information be provided to each employee at the time of hire in the language the employer normally uses to communicate employment-related information.
Record of Conversation: WORD
This form should be used whenever a supervisor has a conversation with an employee that needs to be documented. It can be used for employee situations or for general use within the daily operations of a business. If the use is for an employee situation, a copy should always be filed in the employee's personnel file.
Payroll Status Change: WORD
This form is used to document job changes, pay changes, etc., and the reasons for those changes. It is maintained in the personnel file for easy reference of job and pay change history. This form should be completed by an employee's supervisor.
Request to Make Up Time: WORD
This form (or a form similar to it) is required when an employee wishes to request to take time off and make up the lost time within the same workweek, without incurring overtime. This form should be completed by an employee and approved by an employee's supervisor. The approval of make-up time is at the discretion of the supervisor.
Written Plan Memorandum: WORD
This form is used for employees who need to make specific improvement in their performance, after the above-referenced counseling session has taken place and has proven to be ineffective. It identifies why a plan is to be developed, outlines how to make the improvement, the specific improvement that is expected, the date improvement is expected, how the supervisor will assist the employee, and the consequences if improvement is not attained.
Written Warning: WORD
The verbal warning, written warning, and probation process is a second type of disciplinary action process. When using this more traditional form of disciplinary process, this form is to be completed by the supervisor and includes necessary documentation such as the reason for warning, improvement expected, and date improvement is expected. Both the employee and the supervisor should sign this form, which is to be maintained in an employee's personnel file.
Description of HIPAA Forms: WORD
This document explains the rest of the forms available below.
HIPAA Privacy Notice: WORD
This document is a sample Privacy Notice for employers to review and customize for their organization. This notice also details the procedures employees are to follow to file a complaint. This notice is to be placed where all employees can view it on a daily basis.
Privacy Officer Job Description: WORD
This document is a detailed job description outlining the official functions this individual should be performing on a daily basis. There is also verbiage that should be added to the Privacy Officer’s job description, as well as to any other individual’s job description that has access to protected health information.
Contact Person Provision Job Description Insert: WORD
This provision may be inserted in the job description of the employee assigned the duties of contact person under the HIPAA Privacy Rule. In a small plan, this person will likely also be the privacy officer.
Individuals Whose Duties Include Access to Health Information: WORD
This provision should be inserted in the job description of any employee who will have access to protected health information.
HIPAA Authorization to Disclose Health Information: WORD
This document is to be completed when a covered entity must obtain an individual’s written authorization for any use or disclosure of protected health information that is not for treatment, payment or health care operations or otherwise permitted or required by the Privacy Rule. Examples of disclosures that would require an individual’s authorization includes disclosures to a life insurer for coverage purposes, disclosures to an employer of the results of a post-offer physical or lab test, or disclosures to a pharmaceutical firm for their own marketing purposes.
Business Associate Contract: WORD
This contract is to be used when a covered entity uses a contractor or other non-workforce member to perform “business associate” services or activities. HIPAA requires that the covered entity include certain protections for the information in a business associate agreement/contract. This contract details specific written safeguards on the individually identifiable health information used or disclosed by its business associates.
US Department of Health and Human Services HIPAA Summary: WORD
This pamphlet, created by the United States Department of Health and Human Services, is a summary of key elements of the Privacy Rule including those covered and what information is protected, as well as the use and disclosure of protected health information. Because it is an overview of the Privacy Rule, it does not address every detail of each provision, but does contain links to detailed guidance documents.
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P•A•S Associates has expertise in human resources and other areas involving employment issues. P•A•S Associates, in providing this website, does not represent that it is acting as an attorney or that it is giving any form of legal advice or legal opinion. P•A•S Associates recommends that before making any decision pertaining to human resource issues or employment issues, including the utilization of information contained on this website, the advice of legal counsel to determine the legal ramifications of the use of any such information be obtained.