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2009 or Model Policies and Forms

2009 or Model Policies and Forms

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Sections

  • How to use this book
  • Introduction
  • Why have a handbook
  • Oregon courts approve of and enforce employee handbooks
  • What information must be included in an employee handbook
  • Job descriptions and applications
  • Job descriptions
  • Job applications
  • JOB DESCRIPTION
  • AT-WILL EMPLOYMENT APPLICATION
  • AT-WILL EMPLOYMENT APPLICATION (SECOND VERSION)
  • AT-WILL EMPLOYMENT APPLICATION (THIRD VERSION)
  • AT-WILL EMPLOYMENT APPLICATION (FOURTH VERSION)
  • FAIR CREDIT REPORTING ACT DISCLOSURE AND AUTHORIZATION
  • Candidate screening
  • Interviewing applicants
  • EMPLOYMENT INTERVIEW ANALYSIS
  • INTERVIEWER EVALUATION
  • Background and reference checks
  • REFERENCE RELEASE FORM
  • REFERENCE INQUIRY
  • EMPLOYMENT REFERENCE
  • AUTHORIZATION FOR RELEASE OF INFORMATION
  • Time of hire
  • Required documentation
  • New employee checklist
  • NEW EMPLOYEE CHECKLIST
  • General policies
  • Introduction to the handbook
  • SAMPLE POLICY
  • Employment status
  • Full and part-time employees
  • Exempt and non-exempt employees
  • Introduction period
  • General rules and regulations
  • Attendance policies
  • Unemployment compensation
  • ADA/Oregon’s disability law
  • FMLA/OFLA
  • Disability accommodation policy
  • INTERACTIVE PROCESS QUESTIONNAIRE
  • Safety and health policies
  • Substance abuse policy
  • Drug-free workplace policy – government contractors
  • No solicitation/distribution policies
  • Non-fraternization policy
  • Personal conduct policy
  • Policies prohibiting “bullying” in the workplace
  • Cell phone usage
  • EEO policies
  • Equal employment opportunity policy
  • Sexual harassment
  • Time off and leaves of absence
  • Vacation
  • When vacation can be taken
  • Accumulating vacation
  • Vacation pay
  • Sick days
  • Paid time off (PTO) Paid leave bank (PLB)
  • Holidays
  • Medical leave
  • Notice/certification requirements
  • Communicating with employees regarding leave
  • Form WH-1420 – Employee Rights and Responsibilities
  • Form WH-381 – Notice of Eligibility & Rights and Responsibilities
  • Form WH-382 – Designation Notice
  • OFLA
  • Pregnancy leave
  • Care for a sick child
  • OFLA, FMLA and workers’ compensation
  • FMLA and military leave
  • Qualifying exigency leave (QE leave)
  • QE leave categories
  • Military caregiver leave
  • New Form WH-385 – Certification for Military Caregiver Leave
  • EMPLOYEE RIGHTS AND RESPONSIBILITIES UNDER THE FMLA
  • CERTIFICATION OF HEALTH-CARE PROVIDER (EMPLOYEE)
  • CERTIFICATION OF HEALTH-CARE PROVIDER (FAMILY MEMBER)
  • NOTICE OF ELIGIBILITY AND RIGHTS & RESPONSIBILITIES
  • DESIGNATION NOTICE
  • CERTIFICATION OF QUALIFYING EXIGENCY
  • CERTIFICATION FOR SERIOUS INJURY OR ILLNESS OF COVERED SERVICEMEMBER
  • PHYSICIAN’S RELEASE TO RETURN TO WORK
  • Employers not covered by FMLA/OFLA
  • (if employer not covered by FMLA/OFLA)
  • REQUEST FORM FOR NON-FMLA/OFLA LEAVE
  • REQUEST FOR LEAVE OF ABSENCE (NON-FMLA/OFLA)
  • Domestic violence leave
  • Pregnancy Discrimination Act (PDA)
  • Personal leaves of absence
  • Bereavement leave
  • Military leave
  • Uniformed Services Employment and Re-employment Rights Act (USERRA)
  • Jury duty
  • Employee benefits
  • Health insurance
  • COBRA
  • COBRA INFORMATION
  • MODEL COBRA CONTINUATION COVERAGE ELECTION NOTICE
  • MODEL COBRA CONTINUATION COVERAGE SUPPLEMENTAL NOTICE
  • MODEL COBRA CONTINUATION COVERAGE ADDITIONAL ELECTION NOTICE
  • Short- and long-term disability plans
  • 401(K) plan
  • Continuing education
  • Hours of work and overtime
  • Hours of work
  • “UNDUE HARDSHIP” NOTICE TO EMPLOYEES REGARDING MEAL AND REST PERIODS
  • NOTICE TO EMPLOYEES REGARDING MEAL AND REST PERIODS
  • Restaurant and beverage service industries
  • Employees expressing breast milk
  • REQUEST AND AGREEMENT TO WAIVE MEAL PERIODS
  • Timekeeping requirements
  • Overtime
  • Direct deposit
  • PAYROLL DIRECT DEPOSIT FORM
  • EMPLOYEE PAYROLL CHANGE NOTICE
  • SALARY CHANGE RECOMMENDATION FORM
  • Payroll advances
  • Performance reviews, promotion and layoff
  • PERFORMANCE APPRAISAL
  • PERFORMANCE APPRAISAL SUMMARY
  • PERFORMANCE EVALUATION
  • Compensation reviews
  • Promotions and transfers
  • Layoff and recall
  • Confidentiality and conflicts of interest
  • Confidentiality of company information
  • Confidentiality of employee information
  • Protecting Social Security Numbers
  • Notification of a security breach
  • Safeguarding personal information
  • Conflicts of interest
  • Social security numbers
  • Complaint-reporting procedures
  • SAMPLE OPEN DOOR POLICY
  • Personnel records and recordkeeping requirements
  • Definition of “personnel records”
  • Employee access to personnel records
  • Record review policies
  • Recommended recordkeeping periods for employment records
  • Records related to discrimination claims
  • Payroll, wage and hour, overtime records
  • Occupational safety records
  • Affirmative action information
  • Immigration records
  • Employee benefits records
  • Miscellaneous records
  • Miscellaneous issues
  • Employee suggestions
  • EMPLOYEE SUGGESTION PROGRAM ENTRY FORM
  • Reference requests
  • Employment of relatives
  • Smoking
  • Dress codes
  • Telephone usage
  • Inspection of property
  • Use of electronic media
  • Arbitration agreements
  • Translation of employee handbooks into non-English languages
  • Providing access to employee handbooks in electronic format
  • Company and personal vehicles
  • Company and Personal Vehicles
  • Termination of employment
  • EXIT CHECKLIST
  • EMPLOYEE EXIT INTERVIEW
  • EXIT INTERVIEW
  • SEPARATION SUMMARY
  • EMPLOYEE SEPARATION CLEARANCE CHECKLIST
  • Acknowledgment- of-receipt of handbook
  • SAMPLE ACKNOWLEDGMENT FORM
  • Posting requirements
  • Federal posters
  • Oregon posters
  • Compliance thresholds
  • Index of forms and sample policies
  • Index

Model Policies and Forms for Oregon Employers

And How to Use Them

Copyright © 2009 by American Chamber of Commerce Resources, LLC. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including (but not limited to) photocopy, recording, or any information storage and retrieval system, without the express written consent of American Chamber of Commerce Resources. The information in this guide is being provided by the authors and publisher as a service to the business community. Although every effort has been made to ensure the accuracy and completeness of this information, the authors and publisher of this publication cannot be responsible for any errors or omissions, or any agency’s interpretations, applications and changes of regulations described in this publication. “This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering legal, accounting or other professional service. If legal advice or other expert assistance is required, the services of a competent person should be sought.” – from a Declaration of Principles jointly adopted by a committee of the American Bar Association and a Committee of Publishers and Associations.

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Copyright © 2009 by American Chamber of Commerce Resources, LLC. All rights reserved. No part of this book may be reproduced or copied in any form without permission from the publisher, except where expressly permitted. This publication presents a summary of information that is intended to be accurate and authoritative. The publisher and the authors cannot be responsible for any errors, omissions, or changes in the material presented, nor for any administrative or adjudicative body’s interpretation or application of the legal premises upon which this material is based. This publication is an attempt to summarize certain legal principles in the field of employmentrelated and labor laws and regulations, but should not be considered legal advice. Varying factual circumstances may require special consideration. Should you have any questions, you should contact legal counsel for advice related to specific topics and circumstances. This publication is available from: American Chamber of Commerce Resources, LLC 65 East Wacker Place, Suite 1804 Chicago, IL 60601-7296 (866) 439-2227 www.accr.biz Price: For information on ordering, including quantity discounts and distribution arrangements, contact American Chamber of Commerce Resources at (866) 439-2227.

ACCR Dedication: This book, and the entire Human Resources Library, is dedicated to Dick Apland, who spoke his piece, shared a piece and was at peace. Thanks Dad.

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Foreword from Associated Oregon Industries
2009 Model Policies and Forms for Oregon Employers
Published by Associated Oregon Industries Leading Oregon to Greater Prosperity

It is the goal of the 2009 edition of the AOI Model Policies and Forms for Oregon Employers guide to help you achieve a new level of efficiency and productivity in your workplace environment. This manual contains, as of the printing date, the most recent revisions to statutes and regulations. Employers, who keep current, are able to focus their time and effort on running their business – rather than dealing with personnel issues. With 16 chapters, 326 pages, an easy-to-use index, sample policies, and examples the 2009 edition of Model Policies and Forms for Oregon Employers minimizes the need to cull through multiple resources. You will find the information you need quickly in this manual. And, best of all, everything in this manual is written for Oregon businesses. This publication is made available by the members Associated Oregon Industries as a service to the Oregon business community. AOI has more than 1,600 member companies, in every region of Oregon, who employee over 200,000 people. This is a large, active and motivated membership. For over 113 years, AOI has been the organization Oregon businesses trust to work on issues the company can’t manage alone. To learn about AOI and how your company will benefit from membership visit www.aoi.org or call 503-588-0050.

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About Barran Liebman LLP
Barran Liebman LLP attorneys practice labor and employment law exclusively for employers. Our attorneys constantly study new developments in the laws and regulations that affect employers. Many of our attorneys have been practicing for almost three decades and have solidly established national reputations. Consequently, our attorneys are sought-after speakers in labor and employment issues, both locally and nationally. Our attorneys are called upon to help train judges and other attorneys on topics related to labor and employment law in seminars held throughout the year. Radio, newspaper and TV reporters frequently rely on our lawyers as sources of important information on labor and employment law issues. To learn more about any of our attorneys or our law firm, please get in touch with us using the contact information below:

Barran Liebman LLP 601 SW 2nd Avenue, Suite 2300 Portland, OR 97204-3159 Phone: (503) 228-0500 Fax: (503) 274-1212 Website: www.barran.com Client Services Director Traci Hopfe Phone: (503) 276-2115 Email: thopfe@barran.com

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” She received her J.” In 2008. vii . In June 2006. Russell – Tamara E. Russell is a frequent presenter on legal issues in the human resources field. She is admitted to practice in Oregon and Washington. from Boston University School of Law.D. Her practice focuses on representing management and employers in a full spectrum of employment law matters in state and federal courts and before state and federal administrative agencies. In 2007. State Superintendent of Public Instruction. Tamara was named in Oregon Super Lawyers as a “Rising Star. Oregon Governor Kulongoski appointed Tamara to serve as a management member of the Oregon Department of Employment’s Employment Advisory Council.” The same year.About the Editor Tamara E.. with honors. Susan Castillo. selected Tamara to serve on her “Business Advisory Team. Russell is a partner of Barran Liebman LLP. she was selected by the Portland Business Journal as one of Oregon’s “Forty Under 40.

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all employment policies should strive to be flexible yet compliant. Tamara E. We also considered and implemented significant legal requirements and practical employee relations issues every Oregon employer should consider before implementing. Second Avenue. adaptable. accessible and well-publicized. Oregon 97204-3159 www.com ix . you have questions regarding the policies or the accompanying legal discussions. Thus.barran. and not a one-size-fits-all (or out-of-state) employee handbook reference guide. We hope that as you begin to develop or revise your company’s employee handbook or employee policies that you will find this guide of benefit. welcome to the 2009 edition of the Model Policies and Forms for Oregon Employers. We hope you will agree that Oregon employers deserve a reference guide like Model Policies that appreciates the unique nature and scope of Oregon’s employment laws. At the same time. please contact me by phone at (503) 276-2182 or by e-mail at trussell@barran. We believe that successful (and mutually beneficial) employer-employee relationships start with employment policies and procedures that are clear. updating or deleting any personnel policy.W. In creating and updating the 2009 edition. in the process of using this guide. With best wishes for beneficial employee relations. you will emerge with a more complete understanding of the complexities of the employment relationship in Oregon. Russell Partner Barran Liebman LLP 601 S. we endeavored to create a user-friendly guide that took into account these principles. Suite 2300 Portland. and practical.Editor’s Foreword Dear Reader: On behalf of the Associated Oregon Industries and Barran Liebman LLP. A well-written employee handbook can assist in achieving all of that. If.com. changes in employment law can create uncertainty and add complexity to this vital relationship. We also hope that by using both the sample policies and legal concepts provided.

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................................................. 11.........................................................................239 Complaint-reporting procedures ................... 3...Chapter Table of Contents How to use this book............. 2...............247 Personnel records and recordkeeping requirements .......................................... 10...........................................................................39 General policies ...................281 Acknowledgment-of-receipt of handbook...... 13............................................................................153 Hours of work and overtime......... 16..... promotion and layoff ................................................................ 12......................51 EEO policies ............................................................................................. 8...............................................................................................................................261 Termination of employment.......................29 Time of hire .............. 7 Candidate screening... 3 Job descriptions and applications.............................................293 xi ....205 Performance reviews...................291 Posting requirements..................97 Employee benefits .......... Introduction....................... 15.................................................................................................. 9..............................221 Confidentiality and conflicts of interest............................................................................................ 7.................................... 4.... 1 1................................................................... 14.........................253 Miscellaneous issues......... A...................................... 6.....89 Time off and leaves of absence..................................................... 5..................................................................................................................

.........................305 Index of forms and sample policies.............313 xii .......................................................... Compliance thresholds ........................................................................................................B................................................. C...........309 Index....

....37 Chapter 4 Time of hire ..............................................................................................4 Chapter 2 Job descriptions and applications...............27 Chapter 3 Candidate screening ...................................................................................................................32 Background and reference checks...29 Interviewing applicants .......10 At-will employment application .............................................................................................14 At-will employment application (Third Version) ..........................11 At-will employment application (Second Version) ...................................................................................................................................................................................................................................................................................................................................................................................................................7 Job descriptions................................................................................................................................................................................................29 Employment interview analysis ..........................................................................................................................7 Job description ........................3 Oregon courts approve of and enforce employee handbooks......................1 Chapter 1 Introduction....................................................43 New employee checklist .....................................................................33 Reference release form ..........................................................................................40 W-4 form...31 Interviewer evaluation..................................................................................................................................................................................................................................................................4 What information must be included in an employee handbook ........................................................3 Why have a handbook ...........................................................34 Reference inquiry ........23 Fair Credit Reporting Act Disclosure and Authorization........................................................................................................41 I-9 form ...................................................................................20 At-will employment application (Fourth Version) ..36 Authorization for release of information.................Table of Contents Introduction How to use this book .............................................................................................................................................................................................................................................................................35 Employment reference.....48 xiii .................................................................................................................................39 Required documentation..............................................................39 New employee checklist ..........................................7 Job applications...........

..................................................................................75 Drug-free workplace policy – government contractors.............................................................................85 Policies prohibiting “bullying” in the workplace........................................................................64 Sample policy....................................................................................................................................................52 Employment status ............80 Sample policy..........................................................62 Disability accommodation policy ...................................................................................................90 Sample policy.........................................................................................................51 Sample policy.........................................................72 Substance abuse policy.93 xiv ......................................................................................................................................................................................................60 Unemployment compensation..................................................................................................................83 Non-fraternization policy......................................................................Chapter 5 General policies.................................................................................................74 Sample policy................................................................................................................................................................................................................................55 General rules and regulations..................................................................61 Sample policy.................66 Interactive process questionnaire ..........................................................................................................................................................................................................................................61 Sample policy.........................................................................57 Sample policy...................................................86 Sample policy..............72 Sample policy.............................................................84 Personal conduct policy.................87 Sample policy......87 Cell phone usage .............................................................................................................................................................82 Sample policy..................................................................................................................................................................................................................................55 Sample policy.....................................................................................................................................................................................................69 Sample policy.................................................................................................................89 Equal employment opportunity policy ......................................................................................................51 Introduction to the handbook..............................................................53 Exempt and non-exempt employees..........................................................................................................81 No solicitation/distribution policies .....................67 Safety and health policies ........................................................................85 Sample policy...............................................................................................60 ADA/Oregon’s disability law ...........................................................................................................................................................................................................................................60 FMLA/OFLA ...........................56 Sample policy.......................................................................................................................................................................................70 Sample policy.................53 Full and part-time employees.....90 Sexual harassment ...........................................................................................................................................................................................................................................................................53 Sample policy.....................58 Attendance policies ..................................83 Sample policy......................................................................................................84 Sample policy...........................................................................................................................................................................................................................................88 Chapter 6 EEO policies ..........................54 Introduction period...............89 Sample policy...........................

................................................................................. 143 Request form for non-FMLA/OFLA leave............................................................................................95 Complicated claims of sexual harassment ............................................................................................. 104 Communicating with employees regarding leave ................................... 106 Form WH-381 – Notice of Eligibility & Rights and Responsibilities.................................................................................................................................................................. 101 Medical leave .................................................................................................................................................................... 108 Care for a sick child......................................................................................................................... 124 Certification of Health-Care Provider (Family Member).............................. 128 Notice of Eligibility and Rights and Responsibilities ................... 114 Sample policy .......................................................................................................................................................................................................................................................................................................97 Sample policy................................................................................................................................................................................................ 113 Sample policy ....................................................99 Sample policy.................................................................. 108 Pregnancy leave....................................................................................................... gender.......... 142 Employers not covered by FMLA/OFLA ................ 135 Certification for Serious Injury or Illness of Covered Servicemember................ 109 Qualifying exigency leave (QE leave)....................................................................................................................................................................................... 107 OFLA . 102 Notice/certification requirements..........97 Vacation pay............ 115 Employee Rights and Responsibilities under the FMLA .................................................. 111 Military caregiver leave.......................................................................................................................................................... 143 Sample policy (if employer not covered by FMLA/OFLA)........................................................... 107 Form WH-382 – Designation Notice............................ 132 Designation Notice................................................................................................... age and other protected class statuses ........97 Vacation........................................................................................................................................................96 Chapter 7 Time off and leaves of absence............................................................99 Paid time off (PTO) / paid leave bank (PLB) .....................98 Sample policy..........................................................................................................97 When vacation can be taken...... 123 Certification of Health-Care Provider (Employee) ............................. 144 Request for leave of absence (non-FMLA/OFLA) . 110 QE leave categories............................................................................................................................................................................................................................................................99 Holidays.................................................... 109 New Form WH-384 – Certification of Qualifying Exigency for Military Family Leave ............................................ 101 Sample policy............. 134 Certification of Qualifying Exigency........................................................ color.. 109 FMLA and military leave.............95 Sample policy ........................................97 Accumulating vacation ....Harassment based on race.......98 Sick days......... 106 Form WH-1420 – Employee Rights and Responsibilities ...................................................................................................................... religion................................................................................................... 108 OFLA and workers’ compensation ..... 138 Physician’s release to return to work ............................ 113 New Form WH-385 – Certification for Military Caregiver Leave ......................................................................................... 145 xv ......................

................................................205 Hours of work ............... 147 Sample policy.................................................... 203 Sample policy.................... 152 Sample policy....... 152 Jury duty .................................................... 189 Short....... 153 COBRA ..................... 210 Sample policy ..................... 152 Chapter 8 Employee benefits .................... 168 Model COBRA Continuation Coverage Supplemental Notice............................................... 164 Model COBRA Continuation Coverage Election Notice......................................Domestic violence leave............................... 151 Sample policy.................................... 202 Sample policy......................................................................................................................... Oregon’s disability law and workers’ compensation .............. 149 Personal leaves of absence........................................................................................................................................................................................................................................................................... 208 Notice to employees regarding meal and rest periods ........and long-term disability plans ........................................................................... 202 Sample policy....................................... 150 Sample policy................................ 204 Chapter 9 Hours of work and overtime .................................................................................................................................................... 181 Model COBRA Continuation Coverage Additional Election Notice................................................................................................................................................................................................... 209 Restaurant and beverage service industries........................................................................................................................................... 203 Sample policy................ 207 “Undue hardship” notice to employees regarding meal and rest periods ................................................................................................................................................................................................................................................................................153 Health insurance.............................................................................................................................................................................................................................................................................................................................................................................................. 148 Pregnancy Discrimination Act (PDA)................................ 205 Sample policy ............................................................ 149 Sample policy.............................................................................................. 211 Request and agreement to waive meal periods ...... 150 Military leave ................ 150 Bereavement leave ..................................... 203 Continuing education ........................................................................ 153 Sample policy..... 210 Employees expressing breast milk.... 148 Americans with Disabilities Act (ADA)...................................................................................................................................................................................................................................................................................................... 205 Meal and rest breaks ......................................................................................... 156 Model COBRA Continuation Coverage (for use by single-employer group health plans)................................... 213 Sample policy ............................................................................................................................. 212 Timekeeping requirements........................ 153 COBRA information. 202 401(K) plan............................ 150 Uniformed Services Employment and Re-employment Rights Act (USERRA).................. 157 Model General Notice of COBRA Continuation Coverage Rights (for use by single-employer group health plans) ..................................................................................... 213 xvi ........................................................................................................................................................................................................................

......................................................................................................................... 245 Chapter 12 Complaint/grievance procedures..................................................................................................................... 213 Sample policy................................................................. 242 Conflicts of interest .............................................................................................................................................................................................................................................................................................................. 214 Direct deposit .............................................................................................................................. 244 Social security numbers............................................................... 236 Layoff and recall ..................................................................... 236 Sample policy........................... 227 Performance appraisal ................... 253 Employee access to personnel records .................Overtime ............ 254 Record review policies ................................................. 219 Chapter 10 Performance reviews.......................239 Confidentiality of company information ........................................................................................................................................... 241 Confidentiality of employee information ........................................................................................................................... 216 Employee payroll change notice . 217 Salary change recommendation form......................................................... promotion and layoff................................................................... 237 Sample policy......................... 233 Compensation reviews............................................................................ 239 Sample policy....... 215 Payroll direct deposit form ........................ 250 Sample open door policy ..........................221 Sample policy........................................................................................................................................................................... 222 Performance appraisal .................................................................................................................................................................................................................................................................. 251 Chapter 13 Personnel records and recordkeeping requirements ................................................................................ 249 Sample policy............................... 219 Sample policy..................................................................................... 236 Promotions and transfers ................................................247 Sample policy...................................................... 223 Performance appraisal summary........................................................................ 243 Sample policy...................... 241 Protecting Social Security Numbers.................. 238 Chapter 11 Confidentiality and conflicts of interest.................................................................................................................................................................................................................................................................................................................................................. 218 Payroll advances....... 236 Sample policy...................................................... 241 Safeguarding personal information ..................................................................................................................................................................................................................... 230 Performance evaluation ......................................................................................................................................................................................................253 Definition of “personnel records” ........................................................................................................................................................................................................................................................ 241 Notification of a security breach ................................................ 239 Sample policy...... 255 xvii ............................ 254 Sample policy.

.......... 286 Separation summary ............. 267 Sample policy..................................................................................................................................................281 Sample policy................................................................................................................ 265 Employment of relatives................................. 263 Sample policy................................................................................................................................................................................ 261 Sample policy..... 277 Sample policy............ 262 Reference requests......... 283 Exit checklist.............................................................................................................................................................. 257 Payroll......................................................................................................................................................... 259 Miscellaneous records ...................................... 258 Affirmative action information ..... 272 Sample policy.......................................................................................................................................................................................................................................................................................................................................................................................... 269 Telephone usage...................... 271 Use of electronic media ..................... 268 Sample policy........................... 271 Sample policy.......... 289 Employee separation clearance checklist ...........................................................................................................................................................................................261 Employee suggestions ......... 258 Occupational safety records ............................... 266 Sample policy.................... 269 Sample policy........................................................................................................................ 276 Providing access to employee handbooks in electronic format........ 274 Arbitration agreements ............. 261 Employee suggestion program entry form ........................................... 272 Sample policy.................. 268 Dress codes .............................................................................................................................. 284 Employee exit interview............ 269 Sample policy..................................................................................... 259 Employee benefit records ..... 276 Company and personal vehicles............................Recommended recordkeeping periods for employment records .............................................................................................................. 270 Sample policy................... wage and hour............................................................................................................................................................................................................................................................................. 285 Exit interview...................................................................................................................................................................................................................................... 256 Records related to discrimination claims........................................ 266 Smoking.......................... overtime records ................................. 270 Inspection of property........................................................................................................................................................................................................................................ 290 xviii ....................................................... 264 Reference release form .................................................................................... 263 Sample policy..................... 259 Immigration records ................................................... 276 Translation of employee handbooks into non-English languages ....................................................................................... 277 Chapter 15 Termination of employment........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ 260 Chapter 14 Miscellaneous issues.................................................................................................................

........................ 294 Appendix B Compliance thresholds..313 xix ...................... 293 Oregon posters .............................................................................. 292 Appendix A Posting requirements....................................................................................309 Index ............293 Federal posters .......................................................................................................Chapter 16 Acknowledgment-of-receipt of handbook ...........................................................................................................................291 Sample acknowledgment form ....................................................................................................305 Appendix C Index of forms and sample policies ....................................................................................

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Using the CD-ROM All of the policies and forms you find in the book can be found on the CD-ROM. and the risk of litigation is minimized. • • • 1 . • Introduction This chapter explains the importance of employee handbooks and carefully drafted policies. Using the index Turn to our comprehensive index and find the topic you’re looking for and the exact page(s) where you can find out more information. Read it straight through Once you’ve addressed your immediate needs. The comprehensive nature of our books will prepare you for what would otherwise be unexpected. Simply insert the disc into your computer. money.Introduction How to use this book Employment laws change every year and staying up to date on all the changes can be a full time job. There may be other areas you are overlooking and this is where the trouble can start. and personalize and print what you need. helping you make sure your policies and business practices are in compliance with the law. you’ll be prepared to jump into the rest of the book and begin creating a plan for your company that will save you time. find the file on your desktop. Once you understand the benefits of having handbooks and policies. and headaches. begin to explore other sections of the book. We’ve organized this book to fit your needs. making printing and copying policies incredibly easy. This is even a tall order for the experienced attorneys who write our books.

How to use this book 2 .

” For jurors who believe the Other “F” Word – fairness – is the benchmark for analyzing and valuing an employment law claim. Well-written and publicized handbooks can serve as an effective tool in defending against employment-related claims. jurors like to see policies in writing. On the other hand. and employee handbooks should not simply restate the law. locations. reduces the risk of a discrimination or “disparate treatment” claim. your company could find itself facing claims of discrimination or other types of employment-related claims. you may need to find another way to communicate with your employees. Remember: An employee handbook is a guide. rules and policies are predictable. a typical juror tends to favor and believe the written policy versus the intangible “practice. If you are unwilling to devote the time and attention to the handbook that it requires.Chapter 1 Introduction Why have a handbook Employee handbooks or policy manuals serve many valuable purposes. for example. clear and published. everyone benefits from an environment where the expectations. employers should be wary about providing too much information in an employee handbook. Even if an employer has a well-established practice. or information about the steps that may occur if an employee’s claim for workers’ compensation benefits is denied. Employers can use handbooks to communicate values and visions. They can be helpful in maintaining consistency among departments. could make the difference between a costly plaintiff’s verdict and a verdict for the defendant-employer. not an encyclopedia! 3 . handbooks can be valuable communication and employee relations tools. should not state or lay out every law or legal right available to an employee. Reducing policies and procedures to writing also reduces the level of tension in an uncomfortable situation. Even a well-written handbook serves little value if it is left on a shelf to collect dust. and let employees know about the company that employs them. A well-written handbook. or neglects to follow the policies as written. In sum. and types of employees. Further. because everyone is operating from the same set of expectations. Consistency and uniformity in applying policies. but they also carry risks and obligations. it is not recommended that employee handbooks include provisions regarding an employee’s “right” to seek unemployment benefits. For example. if your company issues a handbook but does not keep it up to date. either. a well-written and publicized policy known to the plaintiff-employee. For example. for example. yet not followed by the plaintiff-employee. Further.

In Yartzoff v. and any other place in the handbook where appropriate. the employee handbook in question stated that a new employee would be “on probation” for three to six months. an employee handbook provision can be construed as a contract. but that the employee could be terminated at any time during this period if he or she could not “properly handle his job or cannot become a productive member of the team. Democrat-Herald Publishing Co. retained the right to discharge employees at any time and for any reason and that the parties had not modified the at-will relationship. employee handbook provisions have been upheld. But.. and some are required by law (as noted). in Gilbert v.. even if the employer did not intend to do so..” The defendant-employer discharged the plaintiff-employee during this probationary period. via disclaimer language. claiming that she had been able to properly handle her job and had become a productive member of the team. the employee handbook at issue contained language stating that “either party may wish to terminate the relationship at some time. The Oregon Supreme Court ruled that the employee’s claims could be presented to the jury because the employee handbook set forth certain procedures that had to be followed prior to termination.Introduction Oregon courts approve of and enforce employee handbooks Oregon courts have had multiple opportunities over the years to assess and consider employee handbooks and the claims brought by employees who either rely on or disregard those policies. was justified.” The Oregon Court of Appeals held that the employer had. The employee handbook must include a statement that the employment relationship is at-will.” The handbook further stated that the employer “reserves the discretion to determine whether in our judgment the termination. meaning that the employer or the employee may end the relationship at any time. [Employer] intends to preserve the right of either party to do so. employers must evaluate the needs and culture of their individual workplaces to decide whether other discretionary topics – including some of those included in this book – should be included. with or without notice. or any other disciplinary action. and the employee sued the employer under a breach of contract theory. Inc. Oregon courts have held that an enforceable contract can be created through a policy in an employee handbook. • Statement of at-will employment. For example. On the other hand. if not carefully drafted. 4 . and the right to enforce an otherwise at-will employment status. Inc. Thus. and have given employers an extra “shield” against breach of contract claims. It is recommended that the handbook include this statement in the handbook receipt/acknowledgement form as well. What information must be included in an employee handbook The following are good. Tektronix. general subjects for an employer to include in a handbook. Because of these court opinions.

and internet access. including e-mail. A statement that the handbook supersedes any prior handbooks or policy statements. Faragher v. Miscellaneous issues for more information and sample electronic/systems use policy.S. Employers need proof that the employee received the handbook on a particular date and an acknowledgement that the employee had an opportunity to ask questions about it (and acknowledge the employee’s at will status). Ellerth. v. and it is recommended to include similar language if the employer is required to provide OFLA leave as well. may have an affirmative defense to a claim of sexual harassment if an employee handbook or other written publication includes these features. Information regarding an employee’s proper use of electronic information and other systems. Employee handbooks are not intended to cover every detail. Information regarding Oregon Family Leave Act and Family Medical Leave Act policies. EEO policies for more information and sample antiharassment policies. Boca Raton. A statement that the handbook is a guide. under certain circumstances. See Chapter 7. Acknowledgment-of-receipt of handbook for more information and a sample acknowledgement form. See generally Burlington Industries. It is effective on a certain date. Employers.Introduction • A disclaimer that the handbook does not create an employment contract of any kind. A statement that the company prohibits discrimination and harassment of all types. Supreme Court has held that an employer. The U. A statement that oral statements regarding any changes to the employee’s employment relationship will not be valid unless in writing and signed by one company representative. that may arise in the employment relationship. or cover every possible situation. and a clear statement that the company does not tolerate retaliation against those who make good-faith complaints of harassment. harassment can occur because of other protected statuses as well. Time off and leaves of absence for more information and a sample leave of absence form. and trumps any earlier versions or other statements regarding employee policies. such as the president or CEO. See Chapter 16. and to avoid contractual claims relating to other provisions in the handbook. An employee acknowledgement/receipt form. Oregon courts have held that a disclaimer in an employee handbook or personnel policy is sufficient to retain an employee’s at-will status. FMLA requires employers to include information about an eligible employee’s rights and responsibilities in their employee handbooks. regardless of the number of employees they employ. It is not enough to prohibit sexual harassment only. information about investigations. Do not assign this authority to more than one person. In some situations. voice mail. • • • • • • • 5 . must include a policy prohibiting harassment in the workplace that includes specific examples of prohibited activity. Inc. See Chapter 6. a complaint reporting procedure. express or implied. See Chapter 14.

Introduction 6 .

” Under the Americans With Disabilities Act and corresponding Oregon law. Information about an applicant’s marital status. (For more information. employers who wish to have employees returning from a “serious health condition” leave complete a fitness-for-duty examination must inform the employee of this requirement and provide the employee with a job description at the beginning of the leave.) Job applications It is important that the application only request information pertinent to the job at hand. Employers should consider identifying “attendance” as an “essential job function” for positions where attendance is. . A template for a job description is included in this chapter. Employers should not to request any information that would provide the employer with the age of the applicant. it could lead to claims of age discrimination by the applicant if he or she was not chosen for the position. . family background and the like should not be sought at any point during the advertising.2(n). thoughtful job description will also assist an employer who defends against a disability discrimination claim: “[I]f an employer has prepared a written description before advertising or interviewing . applications should include a statement indicating that if the employer discovers any 7 . because the person must be able to perform only the “essential” functions. When listing the functions of the job. according to new FMLA regulations that went into effect January 16.Chapter 2 Job descriptions and applications Job descriptions Before beginning the employment application and hiring process. See 29 CFR § 1630. in fact. This will allow the employer to pinpoint the exact qualifications required for the position and will assist greatly in the hiring process. screening or interviewing process.. whether a specific job function is an “essential” one is a necessary first step in determining whether someone with a physical or mental disability can adequately work at the job at hand. 2009. such as the applicant’s birth date. essential. If such information is provided. Finally. an employer should carefully consider whether the functions should are “essential” or “marginal. The ADA and the EEOC regulations suggest ten reasons or factors to be considered. this description shall be considered evidence of the essential functions of the job. an employer should write a job description for the position needing to be filled.” Employers may ask applicants about their ability to perform essential functions of a job. with or without a reasonable accommodation. A thorough. Finally.

employers are strongly encouraged to obtain legal counsel. One way to ensure that the applicant has notice is to include the following language above the line where the applicant certifies the accuracy of the contents of the application: “I understand that any job offer is contingent upon my successfully passing a pre-employment drug test. Employers may not use an application form that requests information about expunged juvenile criminal records. the employer can verify the applicant’s eligibility to work by completing the I-9 process and/or using E-Verify. using polygraph stress or brain wave tests during the application and hiring process. I hereby agree to such preemployment drug test if requested and authorize the testing facility to release the test results to the Company. Qualified public entities must include a notice of requirements for criminal records and fingerprinting checks on application forms (including mass transit). By doing so.Job descriptions and applications discrepancies or false statements in the application during the interview process or during the employee’s employment (if hired). Some other job application tips are as follows: • If you intend to do a pre-hire drug screen. if the applicant is hired. employers must proceed with caution when making inquiries regarding an applicant’s immigration status. An employer may not reject a candidate with an academic degree in theology if the degree requirement is not related to the job. notice must be provided to the applicant. See www. and the fines levied on employers who employ such individuals. Consult legal counsel if you intend to use any of these tests. The best approach is to simply ask if the applicant is lawfully authorized to work in the United States or whether the employee can provide proof of his or her eligibility to work. Then. Given recent publicity regarding the employment of illegal aliens or others who are not lawfully authorized to work in the United States.shtm.gov/ximgtn/programs /gc_1185221678150. an employer runs the risk of a discrimination claim (for example. “Are you a United States citizen?”).” • There are restrictions on obtaining genetic information. discriminatory failure to hire because of an applicant’s national origin). Employers should not ask if an employee has a visa or make inquiries regarding an applicant’s immigration status (for example.dhs. • • • Four employment applications have been provided in this manual. the employee may be subject to termination. 8 . Before inserting any additional information into any of these forms. the internet-based system operated by the Department of Homeland Security in partnership with the Social Security Administration that allows participating employers to electronically verify the employment eligibility of their newly hired employees.

which requires a company to disclose the information it obtains about an applicant if that information is relied upon in making an employment-related decision.Job descriptions and applications If a company intends on performing a criminal background check. This is required under the Fair Credit Reporting Act (FCRA). the employer must secure written permission from the applicant to do so. Fair Credit Reporting Act Disclosure and Authorization). or other background check on an applicant. A sample authorization is included at the end of this chapter (see page 27. 9 .

2. THIS JOB DESCRIPTION IS NOT AN EMPLOYMENT CONTRACT. IMPLIED OR OTHERWISE. 2. 4. INCLUDING ESSENTIAL DUTIES. MARGINAL JOB FUNCTIONS: 1. 2. INTERPRET.” THE AFOREMENTIONED JOB REQUIREMENTS ARE SUBJECT TO CHANGE TO REASONABLY ACCOMMODATE QUALIFIED DISABLED INDIVIDUALS. THIS JOB DESCRIPTION IN NO WAY IMPLIES THAT THESE ARE THE ONLY DUTIES. 5. 3. WEIGHT LIFTING (OR OTHER PHYSICAL) REQUIREMENTS TO PERFORM THE DUTIES OF THE JOB: 1. TO BE PERFORMED BY THE EMPLOYEE OCCUPYING THIS POSITION. 2. OR APPLY THIS JOB DESCRIPTION IN ANY WAY THE COMPANY DESIRES. LICENSING OR OTHER SPECIAL CERTIFICATIONS REQUIRED: 1. Job Description Approved by: ________________________________________________________ Signature/Title: ______________________________ Date: __________________________ ***THIS COMPANY RESERVES THE RIGHT TO MODIFY. THE EMPLOYMENT RELATIONSHIP REMAINS “AT-WILL. 2. EDUCATIONAL REQUIREMENTS NEEDED TO PERFORM THE DUTIES OF THE JOB: 1. 2.*** 10 .Job descriptions and applications JOB DESCRIPTION Job Title: ________________________________________________________________________ Date of this Description: ____________________________________________________________ Job Summary: ____________________________________________________________________ ESSENTIAL FUNCTIONS of the job: 1. SKILLS REQUIRED TO PERFORM THE DUTIES OF THE JOB: 1.

Job descriptions and applications AT-WILL EMPLOYMENT APPLICATION 11 .

Job descriptions and applications 12 .

Job descriptions and applications 13 .

color. religion. 14 . (PLEASE PRINT) Position Applied for: How Did You Learn About Us? □ Advertisement □ Friend □ Employment Agency □ Relative Last Name Address Telephone Number(s) Date of Application: □ Walk-In □ Other______________________________ First Name City Middle Name State Zip Code Social Security Number Can you provide required proof of your eligibility to work in the United States? (Proof of eligibility to work in the United States will be required upon employment. please explain  Yes  No Conviction will not necessarily disqualify an applicant from employment. marital or veteran status. national origin.)  Yes Have you ever filed an application with us before? Have you ever been employed with us before? Are you currently employed?  Yes  No  Yes  No  Yes  No  No If Yes. gender. sexual orientation or any other legally protected status. disability. give date If Yes. This application will remain active for 180 days.Job descriptions and applications AT-WILL EMPLOYMENT APPLICATION (SECOND VERSION) We consider applicants for all positions without regard to race. age. creed. give date  Yes  No May we contact your present employer? On what date would you be available to work? Are you available to work:  Full Time  Part Time  Shift Work  Yes  No  Temporary Are you currently on “layoff” status and subject to recall? Can you travel if a job requires it?  Yes  No Have you been convicted of a crime within the last 7 years? If Yes.

_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 15 . read. apprenticeship or skills. and/or write Course of Study Years Completed Diploma Degree FLUENT SPEAK READ WRITE GOOD FAIR Describe any specialized training. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Describe any job-related training received in the United States military.Job descriptions and applications Education Name and Address of School Elementary School High School Undergraduate College Graduate Professional Other (Specify) Indicate any foreign languages you speak.

color. 1. Employer Address Telephone Number(s) Job Title Reason for Leaving Dates Employed From To Work Performed Hourly Rate/Salary Starting Final 3. Employer Address Telephone Number(s) Job Title Reason for Leaving Dates Employed From To Work Performed Hourly Rate/Salary Starting Final If you need additional space. Include any job-related military service assignments and volunteer activities. Employer Address Telephone Number(s) Job Title Reason for Leaving Dates Employed From To Work Performed Hourly Rate/Salary Starting Final 2.Job descriptions and applications Employment Experience Start with your present or last job. religion. national origin. You may exclude organizations that indicate race. sexual orientation or other protected status. please continue on a separate sheet of paper. 16 . gender. disabilities. Employer Address Telephone Number(s) Job Title Reason for Leaving Dates Employed From To Work Performed Hourly Rate/Salary Starting Final 4.

sexual orientation or other protected status: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Additional Information Other Qualifications Summarize special job-related skills and qualifications acquired from employment or other experience. religion.Job descriptions and applications List professional. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Specialized Skills: Production/Mobile CRT PC Calculator Typewriter Check Skills/Equipment Operated Fax Lotus 1-2-3 PBX System Wordperfect PPP PPP _____________ _____________ Machinery (list): Other (list): ___________ ___________ ___________ State any additional information you feel may be helpful to us in considering your application. race. You may exclude memberships that would reveal gender. or civic activities and offices held. ancestry. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 17 . trade. national origin. business. disability. age.

WHICH MEANS THAT THE EMPLOYEE MAY RESIGN AT ANY TIME AND THE EMPLOYER MAY DISCHARGE EMPLOYEE AT ANY TIME AND FOR ANY OR NO REASON. IT IS FURTHER UNDERSTOOD THAT THIS “AT WILL” EMPLOYMENT RELATIONSHIP MAY NOT BE CHANGED BY ANY WRITTEN DOCUMENT OR BY 18 . _________________________________________( )________________ Name Phone # ___________________________________________________________________________________________ Address 2. IF HIRED. MY EMPLOYMENT RELATIONSHIP WITH THIS ORGANIZATION WOULD BE OF AN “AT WILL” NATURE. EQUAL OPPORTUNITY EMPLOYER* FOR PERSONNEL DEPARTMENT USE ONLY Position(s) Applied For Is Open: Position(s) Considered For:  Yes  No Date NOTES: ________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Applicant’s Statement I certify that answers given herein are true and complete to the best of my knowledge. _________________________________________( )________________ Name Phone # ___________________________________________________________________________________________ Address ___________________________________________________________________________________________ *WE ARE AN AT-WILL. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. _________________________________________( )________________ Name Phone # ___________________________________________________________________________________________ Address ___________________________________________________________________________________________ 3. I HEREBY UNDERSTAND AND ACKNOWLEDGE THAT.Job descriptions and applications References 1. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

Signature of Applicant Date *WE ARE AN AT-WILL. EQUAL OPPORTUNITY EMPLOYER* 19 . I understand. EQUAL OPPORTUNITY EMPLOYER* FOR PERSONNEL DEPARTMENT USE ONLY Arrange Interview  Yes  No INTERVIEWER Employed Job Title  Yes  No Hourly Rate/ Salary DATE Date of Employment Department By NAME AND TITLE DATE *WE ARE AN AT-WILL. In the event of employment. that I am required to abide by all rules and regulations of the employer. I understand that false or misleading information given in my application or interview(s) may result in discharge. also.Job descriptions and applications CONDUCT UNLESS SUCH CHANGE IS SPECIFICALLY ACKNOWLEDGED IN WRITING BY AN AUTHORIZED EXECUTIVE OF THIS ORGANIZATION.

Job descriptions and applications AT-WILL EMPLOYMENT APPLICATION (THIRD VERSION) 20 .

Job descriptions and applications 21 .

Job descriptions and applications 22 .

Name:__________________________________________ _____Social Security #:_____________ Last First Middle Present Address:___________________________________________________________________ Street City State Zip Permanent Address: ________________________________________________________________ Street City State Zip Telephone #: Home (_____)___________________ Work (_____)______________________ Are you 18 years or older?  Yes  No Are there any hours or days of the week you cannot work?  Yes  No If so. after which the applicant will need to reapply. MEANING THAT EITHER THE EMPLOYER OR EMPLOYEE CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.Job descriptions and applications AT-WILL EMPLOYMENT APPLICATION (FOURTH VERSION) The Company is an equal opportunity employer and will not discriminate against any applicant on the basis of any characteristic that is protected by state or federal law. THE COMPANY IS AN AT-WILL EMPLOYER. when? _______________________________________________________________ Salary Desired____________________ Type of Employment:  Full-time  Part-time  Yes  No Where? ____________________ Are your employed now?  Yes  No May we contact your present employer? Did you ever apply to this Company before?  Yes  No Under what name? _____________________________ When? ______________________ 23 . Position Applied For:_______________________________ Date of Application: ______________ Date You Can Start:_______________________________ Please note that this application will only remain active for six months.

please state citation.) If so. management experience. OF YEARS ATTENDED NAME AND ADDRESS OF SCHOOL DID YOU GRADUATE? SUBJECT/ MAJOR Elementary School High School College Specialized Training Are you lawfully entitled to be employed in the United States?  Yes  No Have you ever been convicted of a crime except a minor traffic violation?  Yes  No (Conviction of a crime will not necessarily disqualify an applicant from employment. Whom You Have Known For At Least One Year. equipment operation. training.Job descriptions and applications EDUCATION: NO. YEARS ACQUAINTED NAME ADDRESS & TELEPHONE RELATIONSHIP Emergency Contact ________________________________________________________________ Name/Street/City/State/Telephone 24 . date and place where offense occurred: ___________________________ ________________________________________________________________________________ ________________________________________________________________________________ Please provide any additional information such as special skills. or qualifications you feel will be helpful to us in considering your application: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ REFERENCES: Three Individuals Not Related To You.

Job descriptions and applications CURRENT AND FORMER EMPLOYERS: (Most Recent One First) DATE MONTH/ YEAR NAME. OF EMPLOYER SALARY: STARTIN G/ENDING LAST POSITION HELD/ RESPONSIBILITIES REASON FOR LEAVING From: To: From: To: From: To: From: To: From: To: 25 . ADDRESS & TELEPHONE NO.

I will so inform the Company prior to the administration of the test so that a reasonable accommodation can be made. I understand and agree that. In the event that I have a disability that will affect my ability to take the test. my employment is AT-WILL. EITHER THE COMPANY OR I CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON. IF HIRED. ________________ Date _______________________________________ Signature *THE COMPANY IS AN AT-WILL. I authorize investigation of all statements contained in this application for any employment-related purpose. I release the listed references and all employers to provide you with any and all applicable information they may have. if employed. I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that. I may be requested to undergo a pre-employment medical examination. falsified statements on this application may result in termination. including but not limited to any defamation claims I may now have or will have against them.Job descriptions and applications * * * * Please read the following statement carefully before signing to indicate your understanding: I understand that if I receive a conditional job offer. THIS MEANS THAT. and prior to beginning employment. The Company reserves the right to require medical documentation regarding the need for accommodation. EQUAL OPPORTUNITY EMPLOYER* For Employer Use Only Interviewed By:________________________ Date:_________________ Hired:  Yes  No Starting Date:____________________Position:_______________ Wage:______________ *THE COMPANY IS AN AT-WILL. EQUAL OPPORTUNITY EMPLOYER* 26 . if hired. I hereby release these references and former employers from all liability for any information they may give to you.

when deciding whether to continue your employment (if you are hired). which applies to you.” Authorization By signing below. and when making other employment related decisions directly affecting you. or on a cooperative nonprofit basis. hereby voluntarily authorize the company to obtain a “consumer report” about me from a “consumer reporting agency” and to consider that report when making decisions regarding my employment at the company.Job descriptions and applications FAIR CREDIT REPORTING ACT DISCLOSURE AND AUTHORIZATION Disclosure ABC Company. when making a decision whether to offer you employment.” These terms are defined in the Fair Credit Reporting Act (FCRA). for the purpose of furnishing “consumer reports” to others. general reputation. which is used or collected for the purpose of serving as a factor in establishing the consumer’s eligibility for employment purposes. oral. including the rights discussed above. or mode of living. regularly assembles or evaluates consumer credit information or other information on consumers. such as the company. including credit reports or criminal records. or other communication of any information by a “consumer reporting agency” bearing on a consumer’s credit worthiness. I (PRINT NAME). criminal arrest or conviction history. when considering your application for employment. If the company obtains a “consumer report” about you. may wish to obtain and use a “consumer report” about you from a “consumer reporting agency. you will be provided with a copy of the “consumer report” before the decision is finalized. and if the company considers any information in the “consumer report” when making an employment related decision that directly and adversely affects you. I understand that I have rights under the FCRA. credit capacity. credit standing. You also may contact the Federal Trade Commission about your rights under FCRA as a “consumer” with regard to “consumer reports” and “consumer reporting agencies. A “consumer reporting agency” is a person or business that. personal characteristics. _________________________________ Signature _________________________________ Witness’s Name ____________________________________ Date ____________________________________ Date 27 . ___________________________________. for monetary fees. dues. As an applicant for employment or employee of the company. A “consumer report” is any written. you are a “consumer” with rights under FCRA. character.

Job descriptions and applications 28 .

but one that also is filled with many legal pitfalls. or childcare arrangements sexual orientation age labor union activity credit references or indebtedness number of sick days at former job disability (unless related to an employee’s request for a reasonable accommodation) past workers’ compensation history. the Age Discrimination Act in Employment (ADEA).Chapter 3 Candidate screening Interviewing applicants The job interview is a process of candidate screening that is necessary. Laws such as the Americans with Disabilities Act (ADA). Oregon’s disability law. 29 . Title VII of the Civil Rights Act (Title VII) as well as corresponding Oregon law prevent employers from considering certain information during the screening process. To ensure compliance with these laws employers should not ask any questions that might solicit information in regard to: • • • • • • • • • • • • race or color national origin religion garnishments family status. The purpose of the interview is to gain only information that is essential to determining if the candidate meets the skill requirements of the position. pregnancy.

30 .Candidate screening Questions concerning any of these topics should be avoided at all costs. the interviewer needs to refocus the interview into jobrelated areas. If a candidate begins providing such unsolicited information.

Knowledge of specific job and jobrelated topics 2.Candidate screening EMPLOYMENT INTERVIEW ANALYSIS NAME OF APPLICANT ________________________________________________________ POSITION APPLIED FOR _______________________________________________________ NAME OF INTERVIEWER ______________________________________________________ DATE OF INTERVIEW _________________________________________________________ TRAITS 1. Insight and alertness COMMENTS & RECOMMENDATIONS: COMMENTS 31 . Interest in position and our organization 5. Experience 3. Overall motivation to succeed 6. Communication ability 4.

Candidate screening INTERVIEWER EVALUATION Interviewer Comments: 1. If offered and accepted. 7. 6. 5. who? ______________________________________________________________ Reactions by individual(s) who met with applicant:_______________________________ ________________________________________________________________________ ________________________________________________________________________ Response promised to applicant by (date): ______________________________________ Responded to applicant (date) Offered Position:  Yes  No by letter/telephone 4. Starting Salary:___________________________ 1st Evaluation Date:_______________________ 1st Salary Review Date:____________________ Accepted Position:  Yes  No 8. Overall Reaction (10 being most favorable) 1 2 3 4 5 6 7 8 9 10 Did anyone else meet with this candidate?  Yes  No If yes. 9. when will employment commence? Date: Time:_________________ 32 . 2. 3.

Inaccurate or incomplete information could subject the employer to unwanted claims at a later date. If the Fair Credit Reporting Act applies to your background check. (See page 37. Employers that thoroughly check every job applicant’s background can limit their negligent hiring liability. In addition. if education or licensure is a job requirement.Candidate screening Background and reference checks One potential lawsuit facing employers today is negligent hiring. Authorization for release of information. Such authorization can help protect former employers and others from defamation claims and thus might make them more willing to provide any requested information. transcripts. etc. It is extremely important that an employer verify all information provided by the applicant prior to offering him or her a position with the company. Employers who intend to do background checks on an applicant must provide an authorization on the application form permitting the employer to verify and investigate the information provided on the application by the candidate. employers should have candidates provide proof of any diplomas. licenses. The employer should then verify with the corresponding institutions or agencies that the information provided is accurate and/or current.) 33 . you must secure the necessary authorization from the applicant first.

3.Candidate screening REFERENCE RELEASE FORM Employee Reference Release I. 5. 4. Other information that may be requested (be specific)_____________________________ ________________________________________________________________________ ________________________________________________________________________ Signed: Employee_____________________________ Manager _________________________________ 34 . ___________________________________. Dates of Employment Job Title(s) Salary At Time of Termination Attendance Record Performance Review Ratings May Be Released __________________ __________________ __________________ __________________ __________________ May Not Be Released _____________________ _____________________ _____________________ _____________________ _____________________ Reason for Termination ❏ Resignation ❏ Resignation By Mutual Agreement ❏ Retirement ❏ Downsizing ❏ Discharged For________________________________________________________ ❏ Other (Be Specific) ____________________________________________________ Eligible for Rehire? ❏ Yes ❏ No 7. as may be requested by prospective employers: Job Reference Information 1. agree to the release of the following information concerning my employment with {Company Name}. 2. 8. 6.

Dear Madam or Sir: The above-named person has applied for employment with our company for the position of _________________and has authorized us to contact you as a reference. a self-addressed stamped envelope is enclosed. Very truly yours./Title) ______________________________________ (Date) 35 .Candidate screening REFERENCE INQUIRY REPLY TO: Human Resources Manager TELEPHONE:_____________________ TYPE OF REFERENCE: EMPLOYMENT OTHER APPLICANT’S NAME SOCIAL SECURITY NO. For your convenience in replying. Thank you for your assistance. ______________________________________ (Company Rep. We would greatly appreciate your furnishing the information requested on the attached form for the type of reference checked above.

5. 6. 2. 4. Employed from:____________________________ to __________________________ Reason for termination: _____________________________________________________ First job title:_______________________________________ Pay rate ______________ Last job title:_______________________________________ Pay rate ______________ Description of duties in last position: __________________________________________ Eligible for rehire: ❏ Yes ❏ No If no. 3. why not?____________________________________________________________ ________________________________________________________________________ PLEASE RATE THE FOLLOWING: Skills Quality of Work Quantity of Work Conduct Attendance OUTSTANDING ABOVE AVERAGE AVERAGE BELOW AVERAGE Date: ___________________ Signature: ____________________________________ Title: ________________________________________ Company: ____________________________________ 36 .Candidate screening EMPLOYMENT REFERENCE Name of applicant:_______________________________________________________________ Stated dates of employment: _______________________________________________________ 1.

Upon written request. The Fair Credit Reporting Act as amended by the Consumer Reporting Reform Act of 1996. character. During the application process and at any time during any subsequent employment. will be provided. a Consumer Report may be made which may include information about your credit standing. credit standing. personal characteristics or mode of living. credit capacity. credit capacity. Print Full Name: ________________________________ Date of Birth: _______________ Dates used: _______________ Address ____________________________________________________________ Street City State Zip Code Current Driver’s License Number: _________________________________ Issuing State: ________________ Any other States which have issued you a driver’s license: _____________ Sex: Male ( ) Female ( ) Social Security Number: ___________________ Print other names you have used: ____________________________________ 37 . in the event the Report contains information regarding your character. to the extent such investigation includes information bearing on my character. or copy form. any party or agency contacted to furnish the above mentioned information and release all parties involved from liability and responsibility for doing so. which I understand may include information regarding my credit worthiness. general reputation. I hereby authorize ABC Company to procure a Consumer Report. court record repositories. fax. It is confidential and will not be used for any other purpose. and any other source required to verify information that I have voluntarily supplied. character. general reputation. I authorize without reservation.) As part of the employment process. personal characteristics or mode of living. _________________________________________________________ Applicant’s Signature and Date The following information is required by law enforcement agencies and other entities for identification purposes when checking records. requires that we advise you that for the purposes of employment only. general reputation. past or present employers and educational institutions. additional information as to the nature and scope of the report. personal characteristics or mode of living. This authorization and consent shall be valid in original. general reputation.Candidate screening AUTHORIZATION FOR RELEASE OF INFORMATION (Another version of this authorization can be found on page 27. personal characteristics. business or personal references. if one is made. I understand that I may request a complete and accurate disclosure of the nature and scope of the background verification. ABC Company may obtain a consumer report and/or Investigative Consumer Report. departments of motor vehicles. governmental occupational licensing or registration entities. This report may be compiled with information from credit bureaus. or mode of living.

Candidate screening 38 .

Employers should not ask applicants to fill out Form I-9s. Department of Labor.uscis. employers are responsible for completing and retaining a Form I-9 for each individual they hire for employment in the United States.irs.S. 39 .S. Form I-9s must be kept by the employer either for three years after the date of hire or for one year after employment is terminated. Government officials (for example. The versions of both forms current as of the date of publication are included in this chapter.Chapter 4 Time of hire Required documentation At the time of hire.S.gov/i-9. whichever is later. Form I-9s must be “completed at the time of hire.gov www. The Form W-4 is utilized by the employer for payroll purposes in calculating both federal and Oregon tax withholdings.gov/formspubs/index. All U.” Some other facts about the latest version of the Form I-9 (OMB No. The form is also available in Spanish (at www. 1615-0047): • Do not file Form I-9s with U. employers are legally required to have the newly hired employee complete two forms: • the federal Form W-4 and • the federal Form I-9. Employment Eligibility Verification. Immigrations and Customs Enforcement (ICE) or the United States Citizenship and Immigration Services. Employers are encouraged to visit the websites of the Internal Revenue Service and the Department of Homeland Security to ensure that they are using the current versions of both forms: • • www.irs. Office of Special Counsel). The form must be available for inspection by authorized U. html). which is the actual beginning of employment. Department of Homeland Security.

Time of hire • Do not maintain Form I-9s in an employee’s personnel file. such as a Social Security card. be sure to use it for all new hires. may be beneficial to employers. If you do choose to use a checklist. An employee is not obliged to provide his or her Social Security number in Section 1 of the Form I-9. Documents presented during the eligibility verification process cannot be expired.S. Another reason is that a checklist can serve as a secondary record of when the new hire received this information (in case a dispute arises later). you may wish to refer to the Spanish version of the Form I-9. a “new employee checklist” like the sample provided at the end of this chapter (page 48). Employers may also now retain electronic versions of signed Form I-9s. including the Unexpired Employment Authorization Document (Form I-766). when completing the English version of the Form I-9. One reason to use a new employee checklist is to ensure that HR staff remember to give new employees all of the information they should receive as a new hire. Also. and be prepared to explain why some employees did not receive certain documents when other employees did (if applicable). be sure to use a checklist that is appropriate for your company – the sample checklist may have categories that are not related to your industry or company. employers may only complete the form in English to meet employment eligibility verification requirements. 40 . available at the USCIS web site. Some employers ask employees to initial each category in an effort to prevent an employee from stating later that he or she did not receive a particular document. An employer may not reverify the employee by completing Section 3. • • • • • New employee checklist Although not required. and eliminated other documents from the list. If you employ Spanish-speaking individuals. U. DHS has added new documents to the list. If a document does not contain an expiration date. Employers may only accept documents specified on the List of Acceptable Documents to evidence identity and employment authorization.. employers must use the revised Form I-9 and require documentation in accordance with the revised List of Acceptable Documents. of the previous version of the Form I-9. Form I-9s should be kept in a separate filing system. Updating and Reverification. unless he or she is employed by an employer who participates in E-Verify. including the Temporary Resident Card (Form I-688) and the Employment Authorization Cards (Forms I-688A and B). it will be considered unexpired. you may not use or maintain the Spanish version in the United States. When an employee must be reverified because his or her employment authorization has expired. Unfortunately.

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Time of hire NEW EMPLOYEE CHECKLIST NAME: POSITION: START DATE: DATE COMPLETED OR RETURNED TASK ARRANGE: Office/Cubicle Location Prepare Appropriate Supplies Telephone Post Phone Instructions Post Employee Extension List Voicemail Code/Password Computer Type Software for Computer PC Law Lexis/Nexis Word Excel StampPDFDE Redax 4.0 Dymo Softpro (Estate Info) Computer Passwords Phone Access Number E-mail with electronic signature Set-up Voicemail Security Procedures Press Release. if appropriate Add Employee Info to contacts in PCLaw DISTRIBUTE: New Employee Packet Leave Form/Timesheet Current Employee Manual DATE GIVEN TO EMPLOYEE 48 .

Time of hire TASK Employee Manual Acknowledgement New Employee Benefit Letter VERIFY BENEFITS: Health Insurance Dental Insurance Life Insurance AFLAC Coverage (optional) OR Waivers OBTAIN COMPLETED FORMS: Paytime Automatic Deposit Application Form I-9. Employment Eligibility Verification Verify I-9 documents and copy for file Form W-4 Health Care Enrollment Application Dental Enrollment/ Change Form Company Group Term Life Insurance AFLAC Coverage (optional) OR Waiver of Health Care PA New Hire Form File online with L&I Malpractice Coverage (for professionals) Employee Manual Acknowledgement MISCELLANEOUS TO-DOS: Notify Staff of hiring Add name to internal e-mail lists Revise phone directory and quick reference cards Set-up email/distribution lists Set-up internal IM Note Employee’s Birthday Set-up Scan folder on Copier and Desktop DATE GIVEN TO EMPLOYEE DATE COMPLETED OR RETURNED 49 .

com Overnight Delivery Local Delivery Service Local Copy Service Expense Recovery Scanning Procedure Time Sheets Leave Slips DATE GIVEN TO EMPLOYEE DATE COMPLETED OR RETURNED 50 .Time of hire TASK Set-up recurring appointments (For type of employee) Tie VM to email Check privileges on computer Add to “Duty” Lists Open Leave file in on computer and paper file TRAINING: Specialized Software Email Voicemail IM Reception Copier/Scanner/Counter Stamps.

First. such a provision is a good tool to use in litigation with a former employee. an introduction to a handbook can serve practical purposes. 51 . If the employee claims that he or she did not understand a particular policy. the introduction should include a statement to the effect that an employee’s employment is at-will is vital (unless it is governed by a written contract). Employers should avoid the use of phrases such as “permanent employment. A statement in the introduction that an employee with questions concerning the policies set forth in the handbook or manual should contact the human resources manager. This gives the employer additional leeway to react in the proper manner to any situation that is not specifically covered by a provision in the written policies and procedures. This is advisable because it is impossible to cover all possible future events or contingencies with a single document.” or “a promising career with the company. or other inconsistent policy or benefit statements. Additionally. or other specified management employee. the employer can show that the employee had an opportunity to have the provision explained. yet chose not to do so. It also may identify which employees are covered by the terms of employment contained in the handbook and which employees. with or without prior notice. manuals. Second. is important for two reasons.” “long-term employment. The introduction may include a statement to the effect that the employer may change any of the handbook’s provisions at any time. the use of such phrases may be viewed as inconsistent with the concept of at-will employment. The introduction to your handbook provides an opportunity to give employees an overview of the company’s history or philosophy. are excluded from coverage. it opens lines of communication between the employer and its employees.Chapter 5 General policies Introduction to the handbook Although not necessarily required by law. the use of the word “summary” prevents employees from claiming that every possible contingency is governed by the terms of the handbook. This forewarning gives the employer the flexibility to cope with unforeseen circumstances by amending the handbook or manual when necessary. if any. The introduction should at least state that the current handbook or manual supersedes any prior handbooks. Because Oregon recognizes the doctrine of at-will employment. as well as explain the purpose of the employee handbook.” While it is important that employees feel secure in their jobs.

Sincerely. If you have any questions about any of the provisions in the handbook.” That means that either you or the Company may terminate this relationship at any time. In fact. manager. in summary form. the personnel policies and procedures that govern the employment relationship between ABC Company and its employees. You may receive updated information concerning changes in policy from time to time. and those updates should be kept with your copy of the handbook. a statement in the introduction that no person other than the president (or other designated company representative) may modify either the at-will relationship or the terms of the handbook also is important. This handbook does not create a contract of employment between ABC Company and its employees. No supervisor. This provision also prevents anyone in the company other than the president from modifying an employee’s at-will status. President ABC Company 52 . with or without cause or notice. and maintain a motivated and productive workforce. Supervisors also should be instructed that they may not change the terms and conditions of employment for their subordinates. At ABC. All employment at ABC Company is “at will. we attribute our success as a company in significant part to our ability to recruit. please ask your supervisor or the Human Resources Manager. or representative of ABC other than the president has the authority to enter into any agreement with you regarding the terms of your employment that changes our at-will relationship or deviates from the provisions in this handbook. hire. The policies stated in this handbook are subject to change at any time at the sole discretion of the Company with or without prior notice. John Doe. It makes no sense to adopt a set of policies and procedures that may effectively be amended by nothing more than an offhand comment by a supervisor. Our employment relationship remains at-will notwithstanding any provision in this handbook. for any reason. SAMPLE POLICY Welcome to ABC Company – we’re glad to have you on our team. This employee handbook describes. This handbook supersedes any prior handbooks or written policies of the Company that are inconsistent with its provisions. we believe that our employees are our most valuable asset. We hope that during your employment with ABC you will become a productive and successful member of the ABC team.General policies Finally.

Employers are strongly advised to consult with an attorney regarding the exempt status of any employee. if the employer is covered by that statute and the employee is otherwise eligible.gov. Exempt categories.) Employers should note the specific minimum salary requirements and the exercise of independent discretion and judgment are required in most exempt positions. compensation. along with criteria relevant to each exemption. Full and part-time employees Employers may define part-time employment status at any level they wish. Exempt and non-exempt employees Employers must be careful in designating employees as either exempt or non-exempt under the federal wage and hour law (known as the Fair Labor Standards Act (FLSA)) and related state statutes. Employee classifications should be clearly defined and drafted to avoid any implication that employment is anything other than at-will. 53 . such classification will not affect an employee’s eligibility under the FMLA. or less than whatever maximum number of hours chosen by the employer. Part-time employment may be defined as any employee scheduled to work less than 40 hours per week. (For more information. and such periods may be better defined as “introductory” rather than “probationary. Similarly. part-time employees that have worked 180 calendar days may also be eligible for a job-protected leave of absence under the Oregon Family Leave Act (OFLA).250 hours in a designated 12-month period. For instance. While classification as a part-time employee may affect discretionary benefits.General policies Employment status Appropriate employee classifications are essential for every organization. Introduction period. can be found at www. and either the Department of Labor or the Oregon Bureau of Labor and Industries (BOLI) will perform its own analysis based upon the job duties performed by the individual employee to determine whether the employee has been properly classified (and paid) by the employer. Probationary periods can also be considered inconsistent with at-will employment. employers should never refer to as an employee’s status as “permanent” because this language is inconsistent with at-will employment. less than 32 hours per week. seq. The employer’s designation is not controlling. For instance. and affect eligibility for benefits.” See page 55. if a part-time employee works more than 1. and employment expectations. see also Oregon Administrative Rules 839-0200004 et. duration of employment. OFLA or federal/state overtime laws. the employee may still be eligible for a job-protected leave of absence under the federal Family and Medical Leave Act (FMLA).dol.

all employees are defined as either: 1. or for the duration of a specific project or group of assignments. will be established. company-observed official holidays. Exempt: Those employees who are employed in an executive. for a specific period of time. Normally a part-time schedule. Non-Exempt: Those employees who are not employed in an executive. such as portions of days or weeks. Participation in paid. or professional capacity. administrative. All employees. Regular Full-time: Employment in an established position requiring 40 hours or more of work per week. Full-time employees are eligible for full participation in benefit programs. Temporary employment can either be full-time or parttime. Additionally. or professional capacity. Participation in benefits programs for part-time employees is limited to: • Participation in the retirement plan. or other legally exempted categories of employees. and who are covered by the federal minimum wage and maximum hours law. if the employee works over 1.000 hours in a year and is at least 21 years of age. or other legally exempted categories of employees. 54 . Eligibility for workers’ compensation benefits. Regular Part-time: Employment requiring less than 40 hours of work per week. and who are not covered by the federal minimum wage and maximum hours laws. Temporary: Employment in a job established for a specific purpose. • • 3. Participation in benefits programs for temporary employees is limited to eligibility for workers’ compensation. or 2. 2. regardless of employment classification. are subject to all Company rules and procedures. administrative.General policies SAMPLE POLICY ABC Company classifies employees as follows: 1.

with or without notice and for any reason not prohibited by law. at any time. your status will be reviewed with you by your Supervisor. Upon successful completion of the introductory period. and you will be advised of any improvements expected from you. your supervisor will closely monitor your performance. your status will be changed to that of a regular employee and. during and after completion of the introductory period. After successful completion of the introductory period. Completion of the introductory period or continuation of employment after the introductory period does not entitle you to remain employed by ABC Company for any definite period of time. Employees are frequently not eligible for benefits during this period. If ABC Company finds your performance satisfactory. Rather than labeling this period as “probationary” or as an “orientation” which may be inconsistent with the at-will nature of employment in Oregon. SAMPLE POLICY New employees are subject to an introductory period of three months.” Any policy providing for an introductory period should emphasize that employment at the company remains at-will. An orientation program will be conducted during this time to give you a clear understanding of what is expected.General policies Introduction period Employers may establish orientation or introductory periods of employment in order to closely monitor a new employee’s performance to determine whether that employee is suited for the position. employers should characterize such periods by terms such as or “introductory. eligible employees receive additional benefits described in this handbook 55 . ABC Company will review your performance. Also. Both you and ABC Company are free to terminate the employment relationship. This is to give a new employee and ABC Company an opportunity to evaluate the employee’s interest in the job and the ability to perform the work. If at any time your work is unsatisfactory or you don’t appear to be suited to the position. during this time.

in any specific case. thereby allowing for the uniform implementation of rules throughout the facility. 56 . Employers should never designate a specific form of discipline for a particular infraction because the employer should reserve the discretion to impose whatever discipline it believes to be appropriate in each situation. as well as the company’s policy for administering discipline. the policy should contain an express statement that discipline is discretionary. While an employer may decide to provide a verbal warning. and clearly advise employees of the general rules. to preserve the principle of at-will employment. Maintaining employer discretion in deciding when and how to discipline employees is essential. The sample policy is intended for manufacturing settings. and/or suspension prior to termination. regulations and disciplinary procedures the employer intends to follow. treatment of similarly situated employees differently). written warning. and the employer retains its right to determine appropriate discipline. Supervisors are also provided guidance as to when to take disciplinary action. Thus. Nor should a policy provide that an employer will engage in “progressive discipline” prior to termination. employers should not include any provision stating grounds for discipline or discharge (for example. the employer should retain the discretion to immediately terminate any employee without prior utilization of lesser discipline. up to and including termination. These policies put employees on notice as to what behaviors will not be tolerated. Finally. It is important to individually tailor the provisions of this policy to meet each employer’s own business needs and objectives. Disciplined employees may be less likely to pursue a claim alleging that the employee did not know that his or her actions were improper or that the employer was inconsistent in applying its rules. is a vital part of any employee handbook or personnel manual.General policies General rules and regulations A statement of general rules and regulations. “for cause” or “just cause” terminations) because such a provision may be construed as limiting an employer’s discretion to terminate employees even without sufficient grounds or bases. The uniform application of these rules can also provide a strong defense against claims of discrimination based solely on circumstantial evidence (for example.

rules or procedures. or the property of any other employee or customer. Sleeping or malingering on the job. or refusing to work assigned overtime. Recording of work time of another employee of allowing any other employee to record your work time. employee welfare and Company’s operations may also be prohibited. including but not limited to failure or refusal to obey the orders or instructions of a supervisor or member of management. other types of conduct injurious to security. This list of prohibited conduct is illustrative only. Excessive personal telephone calls during working hours. Unlawful harassment or discrimination. security or Company policy. Theft or the deliberate or careless damage or destruction of any Company property. Unprofessional appearance during normal business hours. or allowing falsification of any time sheets. Carrying firearms or any other dangerous weapon on Company premises at any time. 57 . or when leaving work during normal working hours without permission from a supervisor to do so. Violation may result in discipline. including rest and meal periods. Engaging in criminal conduct while at work. with or without cause or notice. Insubordination. Unauthorized use of Company equipment. either your own or another employee’s. health. Either you or the Company remains free to terminate the employment relationship at anytime. creating or participating in a significant or substantial disruption of work during working hours on Company property. up to and including termination. personal safety.General policies SAMPLE POLICY (Option 1) Prohibited Conduct The following conduct is prohibited and will not be tolerated by the Company. customer or vender. • • Falsification of employment or other Company records. • • • • • • • • • • • • • • • • This statement of prohibited conduct does not alter Company’s policy of at-will employment. materials or facilities. Failure to notify a supervisor when unable to report to work. Failure to observe work schedules. Causing. Unauthorized overtime. Provoking a fight or fighting during work hours or on Company property. Failure to provide a physician’s certificate when requested to do so. Violation of any safety. or the use of abusive or threatening language toward another Company employee.

or using weapons on or in Company property Reporting to work under the influence of or possession or use of alcohol or drugs in violation of ABC Company’s drug and alcohol policy Violating conflict of interest rules Unauthorized removal or dissemination of ABC Company property or proprietary information Dishonesty or theft Violating applicable local. emotional or verbal abuse of coworkers. customers or suppliers Misusing.General policies SAMPLE POLICY (Option 2) ABC Company expects every employee to adhere to the highest standards of job performance and personal conduct. or obscene language. procedures and/or work instructions Falsifying an employment application or any other Company records or documents Failing to record working time accurately or recording time on a co-worker’s timesheet Insubordination or other refusal to perform Using vulgar. This expectation extends to interactions with ABC Company personnel and outside business contacts. entering with. profane. fighting or other acts of violence Engaging in physical. destroying or stealing Company property or another person’s property Possessing on or in. The following is a list of some examples of unacceptable performance or conduct: • • • • • • • • • • • • • • • • • • • • • • • • • • Unsatisfactory quality or quantity of work Repeated or unexcused absences or lateness Refusing or failing to do work assignments Failing to act respectfully towards others in the workplace Incompetence Careless or unsafe driving of vehicles on ABC Company premises or while on ABC Company business Failing to follow instructions or Company procedures Failing to follow established safety or work regulations and policies. welfare or safety of a co-worker Disclosing or using confidential or proprietary information without authorization Violating ABC Company’s computer or software use policies Being convicted of a crime that indicates unfitness for the job 58 . including any communication or action that violates ABC Company’s policy against harassment and other discrimination Any other violation of ABC Company’s policy against harassment and other discrimination Disorderly and/or disruptive conduct. or federal laws Conduct endangering the health. state.

are described elsewhere in this Handbook. Discipline may be in the form of a verbal warning. ABC Company retains sole discretion to determine the nature and extent of any discipline based upon the circumstances of each individual case. ABC Company retains the right to terminate any employee’s employment at any time and for any reason. or rule of conduct or for any other reason. In all cases. written warning. up to and including discharge. And at all times. with or without advance notice or other prior disciplinary action. suspension.General policies • • Abuse of ABC Company equipment or property Any other violation of any ABC Company policy The above list is not exhaustive but gives only some examples of unacceptable performance or conduct. practice. demotion. Other examples of prohibited conduct that may result in discipline. ABC Company may discipline or terminate the employment of any employee for violation of any of the above-listed or any other ABC Company policy. or other action. 59 . discharge.

which may not have to be relaxed as part of a reasonable accommodation. a uniformly enforced attendance policy may boost employee morale by minimizing resentment on the part of some employees toward co-workers who suffer no consequences for being chronically absent. Such a policy allows the employer simply to show that the employee violated the uniformly enforced policy and was discharged for doing so. employers should consider identifying 60 . consistent application is essential to avoid claims of favoritism or discrimination. uniformly enforced attendance policy may also provide a defense to employees protected by the ADA and Oregon’s disability law where the employee’s disability prevents regular and consistent attendance. On a practical level. An attendance policy can be a fairly simple statement that consistent attendance is expected of every employee to a more elaborate “no-fault policy.General policies Attendance policies An employer’s attendance policy is an important part of its written employment policies because it allows the employer to set fixed standards for attendance. Also. may be time consuming to administer. Again. if spelled out in advance and uniformly and consistently applied. and should be carefully considered prior to implementation. and in writing to be effective. uniformly enforced. with accumulated points or disciplinary warnings being dropped after 12 months have passed. Unemployment compensation An attendance policy can be an effective defense to an unemployment compensation claim by an employee terminated for excessive absenteeism. rewarding employees for good attendance is good for employee morale and ultimately may improve overall attendance.” Regardless of the type of policy adopted. Obviously. Finally. that differing policies may cause morale problems for those who are subject to the harsher attendance requirements. any attendance policy should be harsh enough to allow the employer to discipline those employees whose absences cause problems. however. yet. The employer’s reasonable attendance standards may be deemed an essential function of the job. ADA/Oregon’s disability law A well-written. encourage employees with prior absenteeism problems to improve their attendance. lenient enough that the employer does not have to terminate good employees who are absent infrequently. the employer may have different attendance policies for different departments so long as there is a legitimate business reason for doing so. the policy must be reasonable. These types of policies are not appropriate for all workplaces. good employee attendance is critical to business. It also should provide for varying treatment of different types of absences so as to encourage preferred absences (for example. however. It should be noted. These types of policies are usually calculated on a rolling 12-month period. Further. Further. They may. to achieve the goal of uniform enforcement. Some employers chose to implement more complicated point-based attendance policies. pre-approved leaves over spontaneous single-day absences).

depending on the circumstances. Where medically necessary. Employees are expected to report to work as scheduled. his or her work must be performed by others. 61 . and medical certification – employers covered by this law should not assess points to. however. In all cases of absence or tardiness. FMLA/OFLA The FMLA/OFLA specifically prohibits covered employers from disciplining or discharging an eligible employee for an absence caused by a protected reason under the leave laws. SAMPLE POLICY (Option 1) Punctuality and regular attendance are essential functions of each employee’s job at ABC Company. except for break periods or when required to leave on authorized Company business. Each situation of excessive absenteeism or tardiness will be evaluated on a case-by-case basis. Absent extenuating circumstances. such leave may even be taken intermittently or on a reduced hours leave schedule.” depending on the facts and circumstances. and prepared to start work. Employees also must inform their supervisor of the expected duration of any absence. early departure. discipline. even one unexcused absence may be considered excessive. Documentation of the reason may be required. or other absences from scheduled hours are disruptive and must be avoided. Although the FMLA/OFLA does impose certain requirements upon employees with respect to eligibility for leave – notice to the employer. Late arrival. employees must provide their supervisor with an honest reason or explanation. an employee must call in advance of his or her regular starting time on any day on which the employee is scheduled to work and will not report to work. Employees also are expected to remain at work for their entire work schedule. and the Company will not retaliate against an employee who has taken or is taking an FMLA/OFLA leave of absence. When an employee is absent. Note. on time.General policies attendance as an essential job function in all job descriptions. that absences from work may be viewed as a “reasonable accommodation. Any tardiness or absence causes problems for fellow employees and supervision. or discharge an employee absent on an FMLA/OFLA-protected leave. Any employee who fails to report to work without notification to his or her supervisor for a period of three consecutive days or more will be considered to have voluntarily terminated the employment relationship. However. Excessive absenteeism (excused or not) may be grounds for discipline up to and including termination of employment.

Each employee’s absenteeism and tardiness records are kept on file with the Human Resources Department. unexcused absenteeism or tardiness will not be tolerated and will be cause for disciplinary action up to and including discharge. Excessive. If only three points or less are accumulated during any rolling 12 month period by an employee. It is expected that everyone will accumulate some points under this system. Therefore. your attendance and punctuality are very important. This is why we have a no-fault system that allows you to accumulate some points before any disciplinary action will be taken against you. he or she will receive one day off with pay. that an employee need be concerned about his or her attendance practices. The absenteeism and tardiness records are kept on a point system basis. a certain number of points are accumulated by an employee on their personnel record. you are expected to properly notify your supervisor on duty at least one hour in advance of your scheduled work time. certain notice and disciplinary actions will be taken. Depending upon the nature of the absence. the employee will begin a new 12-month period for purposes of earning another day off under this program. An employee may receive a written notice.General policies SAMPLE POLICY (Option 2) You are hired to perform an important function at ABC Company. Any employee who accumulates 24 or more points in a 12 month period under this system will be discharged. On the first day of each month. When an employee reaches various point totals. it takes cooperation and commitment from everyone to operate effectively. You should be at your work station by the start of each workday at the time designated by the department. As with any group effort. that there are times when absences and tardiness cannot be avoided. points accumulated during that same month one year prior will be removed from the employee’s record for purposes of this policy. Good attendance is something that is expected from all employees. or will be discharged depending upon the number of points he or she accumulates. a final written warning. You should call every day that you are absent unless you are on an approved leave of absence. Unreported and unexcused absences of two consecutive work days will be considered a voluntary termination of employment with the Company. and warnings are issued. Absences from work will accumulate points in the following manner: 62 . We do realize. Lack of a telephone or absence from town is not an excuse for failing to notify your supervisor of absence or tardiness. a written warning. however. Regardless of the reason for your absence. It is only when points become excessive. Upon earning a day off with pay.

or the law. FMLA/OFLA leave. or any other absence expressly authorized by the Company. Late to work by more than 15 minutes for any reason not excused above. Car trouble is not excused. 2. lack of work. Leaving work two hours or less before the end of your scheduled work time for any reason not excused above after notifying your supervisor. Leaving work more than two hours before the end of your scheduled workweek for any reason not excused above after notifying your supervisor. Absence for any reason not excused above without proper call-in. scheduled vacation. 63 . 4. Late to work by 15 minutes or less for any reason not excused above. Off work due to jury duty. Absence for any reason not excused above with proper call-in. Off work because of adverse weather conditions resulting in the closing of schools and/or roads in this or the surrounding counties by the local authorities. One (1) Point 1. 2. Off work due to an accident in which you are involved coming to work and which you can verify through police records or other satisfactory evidence.General policies No Points 1. subpoenas. Twelve (12) Points 1. Three (3) Points 1. Off work due to a work-related injury with medical verification that the employee is unable to work. medical leave. 2. Two (2) Points 1. 3. the terms of Company policy. military leave.

16 Points: A written warning to the employee.General policies The accumulation of the following number of points will result in the following action being taken by the Company: • • • • 12 Points: A written notice that the employee has accumulated 12 or more points. If a job description is not up to date. EXAMPLE: Employee is late on one occasion by 30 minutes. due to passage of the ADAAA. each time you re-accumulate enough points to trigger a notice or warning. However. courts and fact-finders have still given deference to job 64 . it is recommended that employers work with that employee to create a job description that is accurate and complete. 20 Points: A final written warning to the employee. 24 Points: The employee will be discharged. employers are strongly encouraged to include some type of policy statement regarding the employer’s commitment to abide by the ADA and support the rights of its employees who are protected under it. The new laws. you will receive such notice or warning. and has three reported absences that are not excused. the ADAAA effectively broadened the coverage of the ADA and will likely increase the number of employees who ask for accommodation (and who are legally “disabled” under the law). and certain provisions of Oregon’s disability discrimination laws “shall be construed to the extent possible in a manner that is consistent with any similar provisions of” the ADA. 2 points + 1 point + 9 points = 12 points = Written Notice The Company will not notify you that through the passage of time you have lost points. and an employee currently holds the position. and given the greater spotlight placed on employees with disabilities. now. Although too detailed to explain here. leaves work 1 hour early on another occasion. Accordingly. Although the law specifies that a written job description must be prepared before advertising or interviewing for a job in order to be effective under the ADA/ADAAA. more than ever. Oregon employers with 15 or more employees became subjected to new laws affecting the Americans With Disabilities Act (ADA). job descriptions and lists of “essential functions” should be up-to-date and accurate. because Oregon’s disability discrimination laws closely follow the ADA. In light of the ADAAA. You also may check with the Human Resources Department at any time to determine your point status. will also likely affect Oregon employers who are covered by Oregon’s disability discrimination laws (employers with six or more employees). 2009. Disability accommodation policy Effective January 1. sometimes referred to as the ADA Amendments Act of 2008 (or ADAAA).

and utilize forms like the EEOC’s internal Form 557 for that purpose. Consult with legal counsel before initiating contact with an employee’s health care provider for any reason. Employers are strongly advised to document each stage of the interactive process. and include information such as: • • • • date accommodation was requested. if possible. In sum. and particularly if the job description was created with the employee’s input.General policies descriptions that were created after those two events occur. Not included here is a sample form by which employees can request a reasonable accommodation in writing. 65 . requests for accommodation should be in writing. simply because of the increased focus now on employees with disabilities. as long as the job descriptions accurately reflect a particular job’s duties and essential functions. and the like.” etc. the name(s) of the individual(s) who attended the meeting a list of issues addressed at the meeting (including what accommodations were proposed by both management and the employee) a list of date(s) on which contact was attempted or made with the employee to discuss the interactive process (and what was discussed during each conversation). such an approach is not advisable. This is still important to include in a handbook even if you have a general EEO policy that prohibits discrimination against. a sample “interactive process questionnaire” is included. accommodation. individuals with a disability.) that requests for accommodation should be made as soon as possible after an employee recognizes a need for an accommodation and • that. a “disability coordinator. Remember that the ADA (and the ADAAA) allows for communication with health care providers and medical inquiries under limited circumstances. although not a required or recommended form. even if the job description was prepared after-thefact. This is the type of document you may wish to use when consulting with an employee’s physician about essential job functions. Employers are better advised to specify in its policies: • • to whom requests for accommodation should be made (manager. Although some employers require this. it is better to create and have a job description listing accurate essential functions. among other protected classes. Finally. but that oral requests will be accepted if the employee’s requested accommodation makes clear that a written request is impractical (or impossible). and nature of accommodation the date on which the employer met with the employee to discuss the employee’s requested accommodation. The policy listed below is a general disability accommodation policy.

employers should document what efforts. All requests for accommodation should be made with the employee’s immediate supervisor [or designate a specific individual/title]. accommodations may be implemented to the extent that they are not an undue hardship for Company. an employee will need to secure medical verification of his or her need for a reasonable accommodation. providing readers and interpreters or making the workplace readily accessible to and usable by people with disabilities. In recognition of the barriers to full participation faced by this group. SAMPLE POLICY Accommodations Company will make reasonable efforts to accommodate a qualified applicant or employee with a known disability. unless such accommodation creates an undue hardship on the operation of Company. by contacting the Job Accommodation Network or referring to other resources). Employees should request an accommodation as soon as it becomes apparent that a reasonable accommodation may enable the employee to perform the essential duties of a position or participate in the employment process. to perform the essential functions of a job. Company is committed to complying fully with the Americans with Disabilities Act (ADA) and applicable Oregon disability discrimination/ accommodation laws. and in compliance with the ADA.General policies Additionally. Requesting an Accommodation The ADA provides protections to people with disabilities in employment. For example. adjusting or modifying examinations. reassigning an individual. job restructuring. A reasonable accommodation is any change or adjustment to a job or work environment that does not cause an undue hardship on the department or unit [or the Company] and which permits a qualified applicant or employee with a disability to participate in the job application process. Company is also committed to ensuring equal opportunity in employment for qualified persons with disabilities. if any. allowing part-time or modified work schedules. a reasonable accommodation may include providing or modifying equipment or devices. modifying training materials or policies. they took to research the employee’s accommodation request (for example. In most cases. or to enjoy benefits and privileges of employment equal to those enjoyed by employees without disabilities. and should specify which essential functions of the employee’s job cannot be performed without a reasonable accommodation. 66 .

or learned behavioral or adaptive neurological modifications. or oxygen therapy equipment and supplies. 3. equipment. Please respond to every question. so please feel free to include a more detailed narrative response to any and all questions if needed to answer more fully. 4. Thank you for your anticipated cooperation. prosthetics including limbs and devices. which major life activity or activities are limited? For each major life activity that is limited by the impairment. medical supplies. We need your complete medical opinion. you may consider ordinary eyeglasses or contact lenses but please do not take into consideration ameliorative effects of any other mitigating measures. reasonable accommodations or auxiliary aides or services. or duration under which that activity can be performed. please state the type of impairment: 2. Does [EMPLOYEE’S] impairment substantially limit any major life activities? Yes If so. manner. What is the duration or expected duration of [EMPLOYEE’S] impairment? 67 . hearing aids and cochlear implants or other implantable hearing devices.General policies INTERACTIVE PROCESS QUESTIONNAIRE To: [PHYSICIAN NAME] Name of Employee: [EMPLOYEE] Job Evaluated: [POSITION] Please answer and return the following questionnaire to your patient within the time frame indicated. low-vision devices. Does [EMPLOYEE] have a physical or mental impairment? If so. mobility devices. 1. please describe how [EMPLOYEE] is restricted as to the condition. IMPORTANT NOTE TO HEALTH CARE PROVIDER: When answering these questions. as compared to the way in which an average person in the general population can perform that activity: No Yes No 5. use of assistive technology. such as medications. or appliances.

please describe: • • • Which job function(s) would pose such a threat: The direct safety or health threat posed: Any reasonable accommodations that would eliminate the direct safety or health threat. which job functions can not be performed. Attached is a job description for the [POSITION NAME] position. 7.)? Yes No If yes. etc.General policies 6. 11. please provide an estimated duration for the leave: Would performing any of the job functions listed in the job description result in a direct safety or health threat to this employee or other people (co-workers. members of the general public. Please review the job description and assess whether [EMPLOYEE] can perform all job functions: Yes No If not. Signature: Title: Date: Printed Name and Address: 68 . Please describe any reasonable accommodations that would allow this employee to be able to perform the job functions identified in your response to Question No. If medical leave is one of the possible accommodations listed above. 7: 9. and why not? 8. or reduce it to an acceptable level: 10.

the employer may provide the employee’s personal physician with information regarding the types of work performed at the company. While the first sample policy is intended to apply to a manufacturing setting. The policy should also address under what circumstances documentation (including releases) from the employee’s physician will be required. 69 . all employers should at least adopt a short statement that demonstrates the employer’s concern for health and safety. the physician will not be able to properly assess the effect that the employee’s injury or illness on his or her ability to perform the required work. and workers’ compensation claims. Finally. and in particular the specific job functions performed by the individual employee in his or her job. thereby reducing the employer’s potential exposure to criminal. An alternative policy is provided for this purpose. civil. This policy also gives employees a mechanism for reporting safety concerns and on-the-job injuries so that the employer can respond promptly and appropriately. the employer may request clarification from the physician or a second professional opinion regarding the employee’s ability to perform essential job functions. Without this information. As to medical releases.General policies Safety and health policies Health and safety policies are important for all work settings to make employees more safety conscious and reduce the likelihood of injury to employees and visitors. This may be very helpful under the ADA and/or Oregon’s disability law in dealing with employees whose disabilities create such risks. the policy should provide a disciplinary point of reference for dealing with employees whose presence in the workplace may subject themselves or others to a significant risk of substantial harm. All such documents should be kept confidential and separate from the employee’s personnel file. Employers should be careful to ensure complete compliance with all applicable federal and state occupational safety and health laws throughout the facility. If the physician’s statement is ambiguous.

Physician’s Statement Upon Return to Work You must give your supervisor a physician’s statement releasing you to return to work following any injury or illness for which you received a doctor’s care or that resulted in your absence for three or more consecutive scheduled working days.General policies SAMPLE POLICY (Option 1) ABC Company will continue to make reasonable provisions for the safety and health of its employees at the plant during the hours of their employment. on the first Monday of each month. or (b) with limitations. must be reported to your supervisor immediately. listing them specifically. are required to establish safety committees or hold and administer safety meetings. safety and other equipment issued to them. and are responsible for. all Oregon employees subject to Oregon OSHA and regardless of size. not to exceed two hours unless otherwise agreed. 70 . Safety Committee* The Company is vitally concerned with maintaining and improving safety conditions in the work area. Equipment will be replaced only upon return of the item that needs to be replaced. 2008. The sole purposes of this meeting will be to conduct a safety walkaround in the work area and to discuss safety issues in the workplace. Protective Devices and Other Equipment Protective devices and other equipment necessary to protect employees from injury will be provided by the Company at its expense in accordance with applicable laws and safety needs. A safety committee comprised of two supervisors and three employees appointed by the health and safety office will meet on paid time. The doctor’s release must state that you are released to return to work either: (a) without limitation. Failure to do so may disqualify you from receiving workers’ compensation benefits or an excused absence and may result in disciplinary action. injuries. and illnesses. All employees are required to use properly. regardless of how minor. Note: Effective January1. Promptly Report Accidents and Injuries On-the-job accidents.

varnish. 2. please immediately notify the office or the Company official in charge of the work area at that time. we cannot allow non-business visitors (including family members and. oil. Safety Rules Safety rules will be formulated from time to time by the employee safety committee or management and posted in the work area. and glue). Employees who violate any of these rules or any aspect of the safety and health policy may be disciplined. Horseplay on Company premises is strictly prohibited at all times. Always use safety and protective devices and equipment as directed by the Company. Combustibles may be brought into the facility only in proper containers. 5. gas. 6. good health. You are expected to wear approved steel toe safety shoes while you are working at any location in the production or maintenance areas. any combustibles in any area where smoking is permitted without advance authorization from your supervisor. Visitors in the Work Area Because of potential safety and other problems. thinner. up to and including discharge. Observe common safety practices. 4. particularly. use a flame. Do not drive or behave recklessly or carelessly on Company premises at any time. All employees and visitors must wear approved safety glasses at all times while in the production or maintenance areas. in any working area at any time without advance permission of the plant manager. covered containers in designated areas. 7. even temporarily. children). Do not store. Dispose of cigarette butts and tobacco in the designated containers. solvents. Good housekeeping is part of safety.General policies Combustibles Combustibles must be stored in marked. and good work. or create sparks in areas posted No Smoking or in the vicinity of any combustibles (for example. the following safety rules must be observed by all Company employees: 1. If you observe any unauthorized non-business visitor in any working area at any time. paint. 3. In addition. Each employee is responsible for keeping his or her immediate working area clean. Do not smoke. 71 .

Use stairs one at a time. or report to work under the influence of alcohol or drugs. such as transportation). Substance abuse policy There is no legal requirement for Oregon employers to drug test its employees or applicants (with specific exemptions relating to certain regulated industries. Smoke only in designated smoking areas. such as cleaning fluids. use alcohol or illegal drugs at work. with caution. We want to protect our employees against preventable injury or illness in the workplace to the greatest extent possible. and a substance abuse and drug/alcohol testing policy puts employees on notice that the employer will not tolerate the use or possession of drugs and alcohol in the workplace. Report to your manager immediately if you or a co-worker becomes ill or is injured in the workplace. Safety must be a primary concern in every aspect of planning and performing all ABC Company activities. Keep cabinet doors and file and desk drawers closed when not in use. A substance abuse/testing policy must be drafted and administered to ensue that it applies only to those individuals who currently abuse drugs. But employers have legitimate concerns about the use of drugs and alcohol in the workplace. All injuries (no matter how slight) must be reported to management immediately. Employees also are expected to report promptly to management any apparent health or safety hazards. Ask for assistance when lifting heavy objects or moving heavy furniture. Below are some general safety rules. and not to those who have recovered from their 72 . Every employee is responsible for his or her own safety as well as for others in the workplace. • • • Employees who violate any of these rules or any aspect of the Company’s safety policies may be disciplined. and Oregon’s civil rights laws do not specifically address an employer’s right to drug test employees. Use flammable items. up to and including discharge.General policies SAMPLE POLICY (Option 2) Safety is everybody’s business. Each manager or department head also may post other safety procedures in specific departments or work areas: • • • • Avoid overloading electrical outlets with too many appliances or machines.

“To avoid charges of discrimination or wrongful discharge. be certain you can document that your selection methods are truly random. The policy includes provisions for pre-employment drug testing. 73 .oregon. If you test employees randomly. employers with certain federal contracts are required to adopt a “Drug Free Workplace” policy with certain provisions mandated by the government. or when an employee is involved in a workplace incident or accident. The next section addresses the Drug Free Workplace Act. however. The second policy is appropriate only for those employers who intend to require drug testing as a condition of employment. This policy does not address the testing issue. enforce your drug testing policy in a fair and consistent manner. Once the policy is prepared and given to the employees. randomized drug testing of all employees. Finally. The sample policies below are optional. the policy should advise employees how they can be selected for testing. because such individuals are not protected by the Americans With Disabilities Act or Oregon disability laws. employers may have an obligation to accommodate a disabled applicant or employee who lawfully utilizes medical marijuana during non-working hours. Employers are strongly encouraged to work with their legal counsel and a qualified laboratory testing service to ensure that the policy used clearly and fully advises employees that they could be subject to testing. If an employer does test employees in a proper. Employers may conduct pre-employment drug screens without violating the ADA or any Oregon law only after a conditional offer of employment has been made to the applicant. Obligations under the Drug Free Workplace Act do not recognize any obligations an Oregon employer may have under the OMMA.” See www.shtml. The first policy is appropriate for all employers. even if that employee shows the presence of marijuana in his or her system while at work. for “cause” testing (such as when the employer has a reasonable suspicion of drug use). As BOLI notes. If you test employees ‘for cause. such as pre-hiring testing. and suspicion-based testing of individual employees. the employer may discipline or terminate employees who test positive for current use of illegal drugs. and employers should consult their attorney for the latest laws applicable to accommodating OMMA-covered employees. regardless of whether the employer intends to conduct drug testing. random testing. apply it consistently. Employers are cautioned to adopt only those provisions of the policy which they intend to utilize. Under the Oregon Medical Marijuana Act (OMMA).’ be certain you can articulate the facts (not merely rumors or gossip) which gave you reasonable suspicion of an employee’s drug use. consistent manner.gov/BOLI/TA/T_FAQ_ Drugtesting. The law in this area is changing.General policies addictions or are otherwise protected by law. Further. but still contains strong language regarding prohibited conduct.

illegal drugs or controlled substances as it affects the workplace. controlled substance while on the job. (4) Distribution. The Company strictly prohibits the following: (1) Possession or use of alcohol while on the job (except at an approved Company function). even though off duty. An employee’s conviction on a charge of illegal sale or possession of any controlled substance while off Company property will not be tolerated because such conduct. (3) Driving a vehicle while under the influence of alcohol or drugs on Company business. sale or purchase of an illegal or controlled substance while on the job. safety and health and therefore seriously impair the employee’s value to the Company. 74 . the use of prescription drugs and/or over-the-counter drugs also may affect an employee’s job performance and seriously impair the employee’s value to the Company. whether on or off the job. can adversely affect an employee’s work performance. the use or possession of these substances on the job constitutes a potential danger to the welfare and safety of other employees and exposes the Company to the risks of property loss or damage. must notify a supervisor of such use immediately before starting or resuming work. (5) Possession or use of an illegal. Furthermore. (2) Being under the influence of alcohol or illegal drugs while on the job. In addition. efficiency. reflects adversely on the Company. Use of these substances. The following rules and standards of conduct apply to all employees either on Company property or during the workday (including meals and rest periods). or affect the safety or well-being of others.General policies SAMPLE POLICY (Option 1) The Company is concerned about the use of alcohol. Violation of the above rules and standards of conduct will not be tolerated. The Company also may bring the matter to the attention of appropriate law enforcement authorities. or injury to other persons. An employee who is using prescription or over-the-counter drugs that may impair the employee’s ability to safely perform the job.

To this end. cannabinoids. ABC Company will utilize every reasonable means to maintain a drug-free work environment for its employees. methaqualene. and coworkers should encourage anyone who has a drug problem to seek help. nor is the Company obligated to re-employ any person who has participated in treatment and/or rehabilitation if that person’s job performance remains impaired as a result of dependency. SAMPLE POLICY (Option 2) ABC Company recognizes that the future of the company is dependent on the physical and psychological health of its employees. from whatever source or by whatever process produced. Alcohol means ethyl alcohol. barbiturates. the supervisor should encourage such employees to seek help and advise them about available resources for getting help. Although it is not the supervisor’s job to diagnose personal problems. phencyclidine (PCP). the term: A. Rather. Everyone shares responsibility for maintaining a safe work environment. methadone. It is the responsibility of the company’s supervisors to counsel employees whenever they see changes in performance or behavior that suggest an employee has a drug problem. This policy on treatment and rehabilitation is not intended to affect the Company treatment of employees who violate the regulations described above. rehabilitation is an option for an employee who acknowledges a chemical dependency and voluntarily seeks treatment to end that dependency. or spirits of wine. Drug means amphetamines. B. and implementing substance abuse testing of employees and job applicants to detect use of illegal substances. or a metabolite of any such substances. hydrated oxide of ethyl. opiates. cocaine. however. 75 . including supervisor training.General policies The Company will encourage and reasonably accommodate employees with chemical dependencies (alcohol or drugs) to seek treatment and/or rehabilitation. methamphetamines. employee education. to continue to employ any person whose performance of essential job duties is impaired because of drug and alcohol use. The Company is not obligated. benzodiazepines. The company also recognizes drug and alcohol dependency as an illness and a major health problem. propoxyphene. Definitions As used in this policy. employees desiring such assistance should request a treatment or rehabilitation leave. providing employees access to information concerning drug and alcohol abuse programs.

or injuries. possess. Prohibited Conduct The primary goal of ABC Company is to maintain a safe. C. or other remuneration for ABC Company. F. G. 76 .General policies C. Substance means drugs or alcohol. Pre-Employment Drug Testing A. B. offer for sale. or offer to buy illegal drugs or otherwise engage in the illegal use of drugs on or off the job. Prior to an offer of employment being made. Employee means any person who works for salary. It is a violation of company policy for any employee to use. Job applicant means a person who has applied for a position with ABC Company and has been offered employment conditioned upon successfully passing a substance abuse test and may have begun work pending the results of the substance abuse test. wages. and drug-free working environment. B. Prescription medication means a drug or medication lawfully prescribed by a physician for an individual and taken in accordance with such prescription. Once a conditional offer of employment has been made. D. by signing a consent agreement. Nonprescription medication means a drug or medication authorized pursuant to federal or state law for general distribution and use without a prescription in the treatment of human disease. ailments. trade. will release ABC Company from liability connected to the pre-employment drug testing. productive. E. For this reason. sell. nothing in this policy precludes the appropriate use of prescription or non-prescription medications. the company has established the following policy: A. Job applicants will be required to submit voluntarily to a drug test at a laboratory chosen by this company and. It is a violation of company policy for anyone to use prescription medication illegally. the job applicant will undergo testing for the presence of drugs as a condition of employment. However. It is a violation of company policy for anyone to report to work under the influence of illegal drugs or alcohol. job applicants will be notified that they will be required to submit to a drug test as a condition of employment. Violations of this policy are subject to disciplinary action up to and including termination.

To ensure that the decision to test is reasonable. the supervisor will discuss with the appropriate departmental supervisor his or her reasons for believing that testing is warranted. E. B. D. at their option and expense. An applicant will not be allowed to submit another specimen for testing. F. the applicant will not be considered for employment. including whether illegal drug use has occurred. Applicants must present themselves drug-free as demonstrated by the drug testing selected by this company. G. If the physician. 77 . Individuals who have failed a pre-employment test may initiate another inquiry with the company after a period of not less than six months. a drug test may be required. the employee’s supervisor will first seek another supervisor’s opinion to confirm the employee’s status. or lab personnel has reasonable suspicion to believe that the job applicant has tampered with the specimen. the supervisor will consult privately with the employee to determine the cause of the observation. medical official. However. If a drug test is not immediately possible. the Company president will instead be consulted. the employee is considered impaired. the employee will be sent home or to a medical facility by taxi or other safe transportation alternative depending on the determination of the observed impairment) and accompanied by the supervisor or another employee if necessary. they must present themselves drug-free as demonstrated by the drug testing selected by this company.General policies C. in the opinion of the supervisor. An employee reporting to work visibly impaired will be deemed unable to properly perform required duties and will not be allowed to work. Employee Drug Testing – General Procedures A. If possible. ABC Company will not discriminate against applicants for employment because of a past history of drug abuse. An impaired employee will not be allowed to drive. H. If. Any applicant with a confirmed positive test will be denied employment. have a second confirmation test made on the same specimen. Refusal to submit to a drug test will be interpreted as a voluntary withdrawal of application for employment. If the employee is a departmental supervisor. Applicants with a confirmed positive test result may. Next. It is the current use of illegal drugs or unauthorized use of prescription medication that is prohibited.

When employees have caused or contributed to an on-the-job injury that resulted in a loss of worktime for any employee. Loss of worktime means any period of time during which an employee stops performing the normal duties of employment and leaves the place of employment to seek care from a licensed medical provider. Abnormal conduct or erratic behavior while at work or a significant deterioration in work performance. As part of ABC Company’s random drug testing policy. possessed. As part of a follow-up program of treatment for drug abuse. All employees are subject to random testing. Observable phenomena while at work such as direct observation of drug use or of the physical symptoms or manifestations of being impaired due to drug use. c. 5. 4. machinery. sold. When there is reasonable suspicion to believe that an employee is using illegal drugs. Evidence that an employee has used. When a drug test is conducted as part of a routinely scheduled employee fitnessfor-duty medical examination that is part of ABC Company’s established policy or that is scheduled routinely for all members of an employment classification or group. Evidence that an individual has tampered with any drug test during his or her employment with ABC Company. A report of drug use provided by a reliable and credible source. ABC Company has adopted testing practices to identify employees who use illegal drugs on or off the job. or transferred drugs while working or while on the company’s premises or while operating the company’s vehicle.General policies Employee Drug Testing A. 2. b. d. 3. Employees will be notified if they have been 78 . It shall be a condition of employment for all employees to submit to drug testing under the following circumstances: 1. or e. solicited. The following circumstances could cause reasonable suspicion: a. pending the results of the testing. or equipment. An employee who has been asked to undergo reasonable suspicion testing may be required to transfer to another position at the company’s discretion.

The employee must provide a confirmed negative test result. the employee is suspended without pay pending a confirmed negative test result. shall be guilty of misconduct and is subject to discipline up to and including termination. An employee will not be allowed to submit another specimen for testing. the employee is subject to disciplinary action up to and including termination. B. whether on duty or not and whether on ABC Company business or property or not. An employee shall be determined to be under the influence of alcohol if: 1. at the employee’s own expense. C. the employee’s normal faculties are impaired due to the consumption of alcohol. D. or lab personnel has reasonable suspicion to believe that the employee has tampered with the specimen. at any time while on company business or at any time during the hours between the beginning and ending of the employee’s work day. If a decision not to terminate is made. as defined in subpart B. ABC Company may terminate any employee with a confirmed positive test result.General policies randomly selected for substance abuse testing. B. An employee will be suspended without pay pending the results of the second confirmation test. E. within 30 days from the date of the positive test result. Employees must provide a specimen within 12 hours from the time of notification. An employee who is under the influence of alcohol. medical official.05 or higher. Employees unable to provide an acceptable urine sample within a three-hour time period after arrival at the testing location will be deemed as “refusing to test. have a second confirmation test made on the same specimen. If the physician. Alcohol Abuse A. or 2. the employee has a blood alcohol level of . by means of the drug testing method selected by the company. 79 . at their option and expense. Employees with a confirmed positive test result may.” Employees needing an accommodation because of a disability or other medical condition should contact the company sufficiently in advance so that alternate testing procedures can be developed and agreed upon.

Confidentiality ABC Company shall treat as confidential all information received by the company through its drug and alcohol testing program. and local laws. release of such information shall be solely pursuant to a written consent form signed by the person tested.000 or more must publish and distribute to all employees a drug-free workplace policy such as the sample policy. consistent with the provisions of the Drug-Free Workplace Act. In addition.General policies Employee Assistance ABC Company offers resource information on various means of employee assistance in our community. 80 . and should be included in the employee handbook The Drug-Free Workplace Act requires that employees working on the government contract receive a copy of the policy and abide by its terms as a condition of employment. all supervisory personnel shall be required to participate in a minimum of two hours of supervisory training each year on how to recognize signs of employee substance abuse. including but not limited to drug and alcohol abuse programs. and how to refer substance abusing employees to the proper treatment providers. Each year. and other applicable federal. Employers should therefore have employees sign the acknowledgment and consent form. how to document and collaborate signs of employee substance abuse. In addition. Except as provided therein. which is located in the administrative department of each of the divisions of ABC Company. all employees including supervisory personnel shall be required to participate in two one-hour educational programs on substance abuse and its effects on the workplace. Drug-free workplace policy – government contractors Employers who have federal or state government procurement contracts in the amount of $25. Such a policy serves purposes similar to the substance abuse policy discussed previously. we will distribute this information to employees for their confidential use. B. Employee Education and Supervisor Training A. state. Employees are encouraged to use this resource file.

possession.General policies SAMPLE POLICY Purpose ABC Company is committed to providing a safe and productive work environment. Abide by the terms of this policy. To meet these objectives. we have established a Drug-free Awareness Program to inform employees about: 1. The dangers of drug abuse in the workplace. as well as our obligations under applicable federal and state laws. Any available drug counseling. Drug-free Awareness Program To assist in ensuring compliance with the Company’s Drug-free Workplace Policy. distribution. up to and including discharge. Notify the Company of any criminal drug statute conviction for a violation occurring in the Company’s workplace no later than five days after such conviction. 3. Participation in our Drug-free Awareness Program by all employees is mandatory. The Company’s policy of maintaining a drug-free workplace. rehabilitation. 81 . We also expect our employees to report to work each day fit to perform their jobs. we must take a firm and positive stand against substance abuse. depending on the nature and seriousness of the offense. and/or a requirement of satisfactory participation in a drug abuse assistance or rehabilitation program. and employee assistance programs. Policy Statement The unlawful manufacture. As a condition of continuing employment with the Company. and 2. or use of a controlled substance while on the Company’s premises or in the performance of services for the Company is strictly prohibited. and 4. each employee must: 1. The penalties that may be imposed upon employees for drug abuse violations. 2. This policy is intended to ensure a drug-free work environment for the benefit of our employees and customers. dispensation. Any violation of this policy will result in either discipline.

2. ___________________ Date: ________________________________ Employee’s Signature ________________________________ Employee’s Name (Printed) No solicitation/distribution policies A no solicitation/distribution policy serves several important purposes. I agree. A no solicitation/distribution policy must be enforced uniformly to be effective. with or without notice. religious or otherwise – try to recruit or solicit employees at work. however. It helps ensure that employees will use their working time for company business and not for personal solicitations such as selling raffle tickets for their kids or distributing sales catalogues. without reservation. The employer must prohibit even such minor solicitations as candy and cosmetic sales. Once the employer has deviated from the policy. 82 . 1. 3. or expand upon this policy in whole or in part. the overall benefit of uniform enforcement may well be worth the price. Acknowledgment and Consent I hereby acknowledge having received a copy of ABC Company’s Drug-free Workplace Policy. the employer may be prevented from relying upon it to prevent subsequent organizing efforts.General policies Reservation of Rights The Company reserves the right to interpret. The sample policy is carefully tailored to meet the requirements for curtailing union solicitations. Nothing in this policy alters an employee’s at-will status. to abide by the policy. Its uniform application can help avoid a discrimination claim if some organizations – whether political. Although this may seem petty. It can help prevent union organizers from attempting to organize employees during company time. modify.

Do not solicit or distribute any printed material to any other employee for any purpose at any time during your working time or that employee’s working time. common-sense policies. please tell your supervisor when you ask him or her to post it. As the policy itself suggests. If you would like a posted item returned to you. or remove from the premises. Do not post on the premises. 1. but does not include break periods and meal times or other similar specified periods during the workday when an employee is properly not engaged in performing his or her work tasks. Additionally. of course. ticket. or printed material. By maintaining a non-fraternization policy. Because they are consensual in nature. Off-duty employees should not visit any working area during their off-duty hours (except that an employee may report for work a reasonable time in advance of the start of his or her scheduled work time). Non-fraternization policy Consensual romantic relationships present many potential problems in the workplace. catalog. Postings will be removed after a reasonable period. charitable or union solicitations during working time. these types of relationships do not generally fall under the policy concerning sexual harassment. any notices. these risks include possible sexual harassment or wrongful discharge claims that may result from the souring of relationships between supervisors and their subordinates. without limitation. pictures. 5. 3. these relationships can create a whole host of legal and practical concerns. The Company cannot permit solicitations or distributions during working time. Non-employees are prohibited from soliciting or distributing any written or printed material of any kind for any purpose on the Company premises at any time. which should be dated and submitted to your supervisor for posting. the employer may minimize the risks associated with relationships between employees. raffle. and want/sale ads. (Working time includes any time that an employee is on the clock. Prohibited solicitations include. for work. collections for other employees during working time.General policies SAMPLE POLICY Working time is. Nonetheless. or other sales during working time. Do not invite or encourage any non-employee to violate this rule. signs. The Company maintains an employee bulletin board exclusively for personal announcements. 4. and distribution of literature of any kind during working time. such a policy should assist in 83 . Do not distribute any written or printed materials in any working area at any time.) 2. Each employee should strictly observe the following basic.

Because Oregon remains an at-will employment state. extending such a policy to relationships between lower level (for example. then the employer may safely discipline the employee in a manner fitting with the employee’s misconduct. or lower-level employees of ABC. The second policy prohibits employees from having a job outside of work under specific circumstances. please consult the Company’s Human Resources Manager. non-supervisory) employees might prove to be problematic. if the employer is unable to demonstrate a legitimate business justification for such a rule. However.General policies maintaining positive employee morale by ensuring that employees do not feel that supervisors have favorites among them. Human Resources should be advised so that it can determine whether a change in reporting structure is warranted. many employers are reluctant to take disciplinary action against employees on the basis of their conduct during non-working hours. Personal conduct policy With an ever-increasing sensitivity to employee privacy concerns among policy-making bodies and courts at both the federal and state levels. particularly criminal activity. This policy is intended to supplement our existing sexual harassment policy. certain types of off-duty conduct and relationships may interfere with the Company’s legitimate business interests. business reason for disciplining the off-duty conduct at issue? If so. If a romantic or sexual relationship develops between a manager and/or supervisor and another employee. particularly for employees in positions such as outside sales or other capacities in which the nature of the job is to represent the employer to the public. may reflect negatively upon an employee’s character and fitness to perform a job with the employer’s full confidence. uncomfortable working relationships. and even the appearance of impropriety. employers may take appropriate disciplinary action against employees who engage in inappropriate off-duty conduct as contemplated by the sample policy. SAMPLE POLICY While ABC Company does not wish to interfere with the off-duty and personal conduct of its employees. To prevent unwarranted harassment claims. nondiscriminatory. an employee’s inappropriate off-duty behavior may reflect poorly on the employer’s business. supervisors. even if the relationship is consensual. Two sample policies follow. The touchstone in every case should be business-relatedness: Does the employer have a legitimate. If you have any questions concerning the intent of this policy or its application to any existing or contemplated relationship. Regardless of whether an employer uses a policy regarding 84 . managers and supervisors of the Company are strictly prohibited from engaging in romantic or sexual relationships with any managers. morale problems among other employees. An employee’s off-duty misconduct. Still. All such inquiries will be treated confidentially and consistently with the legitimate business needs of ABC.

including termination of employment. While employed by the Company. In addition. all employers should consider whether a policy prohibiting off-duty employment jobs is appropriate or necessary. SAMPLE POLICY (Option 2) While the Company does not seek to interfere with the off-duty and personal conduct of its employees. employees should keep in mind that. employees who engage in unprofessional or criminal conduct or other serious misconduct off-duty may be subject to disciplinary action by the Company. Illegal off-duty conduct on the part of an employee that adversely affects the Company’s legitimate business interests or the employee’s ability to perform his or her job will not be tolerated. inconsistent with expectations of our employees. SAMPLE POLICY (Option 1) ABC Company respects the privacy interests of its employees and recognizes their right to conduct their personal lives free from interference from the Company. 85 . For this reason. employees should be aware of the following policies: Employees are expected to conduct their personal affairs in a manner that does not adversely affect the Company’s integrity. Nonetheless. second jobs are strongly discouraged. The following types of outside employment are strictly prohibited. reputation or credibility. certain types of off duty conduct may interfere with the Company’s legitimate business interests. (1) Employment that conflicts with an employee’s work schedule. For this reason. employees are expected to devote their energies to their jobs with the Company. duties and responsibilities. if such conduct is determined by management to be harmful to our corporate image. (2) Employment that creates a conflict of interest or is incompatible with the employee’s employment with the employer. or otherwise adversely affects our legitimate business interests. they represent the Company to the public and should strive to preserve the Company’s reputation. even while off-duty. Therefore.General policies off-duty conduct. certain types of off-duty conduct may reflect poorly upon an employee’s character and judgment and thereby influence his or her standing as an ABC employee. unless the employee received prior approval.

Authorization to engage in outside employment can be revoked at any time. Policies prohibiting “bullying” in the workplace Companies often consider whether to include a policy that prohibits workplace bullying in the workplace. A sample policy follows. This is a valid consideration. Employees who wish to engage in outside employment that may fall into one of the categories listed above must submit a written request to the employee’s immediate supervisor and Company Human Resources representative explaining the details of the outside employment. 86 . depending on the facts and circumstances of the case. the Company assumes no responsibility to the outside employment. (4) Employment that directly or indirectly competes with the business interests of the Company. If the outside employment is authorized. At a minimum. because even the “equal opportunity offender” can result in liability to a company. thereby decreasing their productivity. Further. Some employers may also wish to include a policy prohibiting violence in the workplace. even minor incidents of workplace bullying can create a hostile and intimidating environment for employees.General policies (3) Employment that requires the employee to conduct work or related activities on the Company’s property during working hours or using the employee’s working hours or using the Company’s facilities and/or equipment. The Company will not provide workers’ compensation coverage or any other benefit for injuries occurring from or arising out of outside employment. the handbook should contain language that required all employees to treat each other with respect.

and any actions that cause others to feel unsafe in the workplace. members. Some employers have faced claims and lawsuits by third parties who were injured when an employee was involved in an accident while using a cell phone. or is connected to Company employment. but is not limited to. reassignment of job duties. employers should also be careful about allowing camera phones at work. Even without an actual threat. In order to provide some protection to the employer. when that behavior is job-related or might be carried out on a Company-controlled site. Company will initiate an appropriate response that may include. As part of this policy. 87 . or have been told that another person has witnessed or received. and others mandate the use of “hands free” devices while driving. some companies have adopted policies which limit the use of cell phones. and/or criminal prosecution of the person(s) involved. students. or engages in violent acts on Company property or premises will be removed from the premises as quickly as safety permits. sensitive documents or working conditions. or the human resources department. Cell phone usage Cell phone use while driving may distract the driver and may lead to an increased risk of accidents. Just as employers would not allow an employee to bring a regular camera on the worksite and photograph other employees. All Company personnel are responsible for notifying a supervisor or manager. and generally prohibit the use of cell phones while driving. employees are prohibited from bringing weapons of any kind to work or on Company premises Any person who makes substantial threats. the employer can attempt to limit liability by arguing that the employee was violating company policy. verbal and physical threats. and shall remain off Company premises pending the outcome of an investigation. employees should also report any behavior they witness which they regard as threatening or violent. This includes verbal and physical harassment.General policies SAMPLE WORKPLACE VIOLENCE POLICY Prohibition of Work Place Violence/Weapons Company has a “zero tolerance” policy for any actions that threaten its employees. These policies advise employees that such use of a cell phone is contrary to Company policy. If an accident occurs while an employee is talking and driving. Use of such phones can be misused by employees to invade other employee’s privacy or to misappropriate employer and customer information. A newer problem faced by some employers is the presence of camera phones in the workplace. received. exhibits threatening behavior. or vendors. suspension and/or termination of any business relationship. verbal or physical confrontations. of any threats that they have witnessed. Some states have banned the use of cell phones while driving. suspension or termination of employment.

Camera phones. however. Accordingly. texting. Consult with your attorney regarding the status of these bills and the law. Employees may use hands-free cell phones to make business calls. Employees must adhere to all federal. but only in emergency situations. Accordingly. Cameras are prohibited in the workplace. The use of a cell phone while driving may present a hazard to the driver. Employees are allowed to bring cell phones to work with them. the Oregon Legislature was contemplating several bills that would prohibit a driver from most forms of cell phone use. Should an employee need to make a business call while driving. the Company has adopted to following rules regarding cell phones in the workplace. SAMPLE POLICY Cell phones are a common method of communication. etc. please check with Human Resources. Violation of this policy will subject an employee to disciplinary action up to and including immediate termination. regulation or other ordinance. he should locate a lawfully designated area to park and make the call. however. employees must not use cell phones if such conduct is prohibited by law. Employees should not use hand held cell phones for business purposes while driving.General policies Note: At press time. 88 . can have a disruptive effect on the smooth operation of the Company. including camera phones. Cell phones in general. heavy traffic. Such calls should be kept short and should the circumstances warrant (for example. bad weather). the employee should located a lawfully designated area to park to continue the call. The use of cell phones while at work. Cell phones while driving. This policy is meant to ensure the safe operation of company vehicles and the operation of private vehicles while an employee is on work time and conducing business. If an employee’s cell phone or other electronic device includes a camera or video device. that function must be disabled while at work or on company business. If you are not sure whether the use of a cell phone while driving is prohibited in a particular area. employees are not permitted to use their cell phones for personal use except in an emergency or during a rest or meal period. The use of any camera or video equipment while at work is strictly prohibited. During working hours. state or local rules and regulations regarding the use of cell phones while driving. other employees and the general public.

For more information. Although not required by law. sex. In Oregon. religion. All employers in Oregon are subject to certain equal employment opportunity laws. The Executive Order also requires Government contractors to take affirmative action to insure that equal opportunity is provided in all aspects of their employment. who do over $10. and a statement to employees that the employer takes equal employment issues seriously. go to www. color. See generally Oregon Revised Statutes Chapter 659A.htm 89 . Other equal employment laws applicable to Oregon employers are identified elsewhere in this chapter. employers with one or more employees must comply with the laws that prohibit discrimination because of an employee’s: • • • • • • • • race religion color sex sexual orientation national origin marital status age. from discriminating in employment decisions on the basis of race.Chapter 6 EEO policies Equal employment opportunity policy Employers are highly advised to include one or more general statements in its employee handbook regarding its commitment to equal employment opportunity.dol. Employers who are covered by Executive Order 11246 should consult with legal counsel about equal employment opportunity requirements. or national origin.gov/esa/regs/compliance/ofccp/ca_11246.000 in Government business in one year. Executive Order 11246 prohibits federal contractors and federally-assisted construction contractors and subcontractors. such statements are further proof of an employer’s commitment to lawful employment practices.

any policy regarding equal employment opportunity or prohibitions of harassment must include a catch-all phrase to encompass all the protected classes recognized by law. age. recall. For that reason. All employees are expected to comply with Company’s EEO policy. and termination of employment. evaluation. Occasional compliments of a socially acceptable nature (for example “You look nice today” or “That’s a pretty dress you have on”) are generally not considered examples of sexual harassment. financial status. or any other status protected by applicable federal. demotion. Sexual harassment is defined as unwelcome. This includes. disciplinary action. transfer. or other aspects of employment or • the conduct interferes with an individual’s employment or creates an intimidating.EEO policies Oregon’s laws also prohibit discrimination based on certain diverse categories of protected classes that are not covered under federal employment laws. 90 . color. for example. hostile. disability. We are also committed to ensuring equal opportunity in employment for qualified persons with disabilities. Disability accommodation policy Company is committed to complying fully with the Americans with Disabilities Act (ADA) and applicable state disability discrimination laws. recruitment. Any employee’s failure to do so may result in discipline. sexual orientation. or local law. layoff. promotion. SAMPLE POLICY Equal employment opportunity (EEO) policy Company provides equal employment opportunity to all qualified employees and applicants without unlawful regard to race. transfer. or unwanted conduct of sexual nature. Sexual harassment Sexual harassment refers to behavior having sexual overtones that is unwelcome and offensive. up to and including. promotion. a prohibition against employees who lawfully use tobacco products during off-hours. Further. or offensive work environment. This EEO policy applies to all aspects of the employment relationship – including but not limited to. gender. termination. state. hiring. compensation. some city and county ordinances prohibit discrimination on bases that are not included under state or federal laws. religion. marital status. whether it is verbal or physical when: • submission to or rejection of the individual’s conduct is used as a factor in decisions affecting the hiring. national origin.

cartoons. Similar behavior (for example. Under current law. the employer may be liable (regardless of whether anyone other than the alleged harasser knew about the conduct) unless it can prove what is called an affirmative defense. whistling. or non-employees. assault. derogatory comments. 91 . age. religion. national origin. Harassment based on race. etc. physical aggression.) when based on race. color. and should be addressed in a separate policy. age and other protected class statuses. after learning of the alleged conduct. disability or any other protected status are also prohibited by the law. religion. that the employer exercised reasonable care to prevent and correct promptly any sexually harassing behavior and 2. only if the employer knew or had reason to know of the harassment and failed to remedy it. If there is no evidence of a tangible adverse employment action culminating from the alleged hostile environment. touching. If an employee alleges that a supervisor or managerial employee caused the harassment. color. advances or propositions verbal abuse of a sexual nature graphic verbal commentary about an individual’s body. In a recent case. sexual or suggestive acts. the court stated that an employer is liable for a co-worker’s sexual harassment only if. gender. that the plaintiff unreasonably failed to take advantage of any preventive or corrective opportunities provided by the employer or to avoid harm otherwise. flirtations. jokes.EEO policies The following is a non-exclusive list of examples of sexual harassment: • • • • • • demands for sexual favors in exchange for favorable treatment or continued employment repeated sexual jokes. the employer “fails to take adequate remedial measures. sexual prowess or deficiency leering. the employer must prove two things: 1. See page 95.” These measures must include immediate and corrective action reasonably calculated: • to end the current harassment and • to deter future harassment from the same offender or others. insulting or obscene comments or gestures displaying in the workplace any sexually suggestive objects or pictures. an employer can be liable for any unlawful harassment caused by a nonsupervisory or non-managerial employee.

92 . This enables the employer to take action to stop the harassment and thereby accomplish its goal of eliminating workplace harassment. An effective sexual harassment policy should also contain a clear statement that the employer will not retaliate against any employee making such a claim or for cooperating with any sexual harassment investigation. The Civil Rights Act of 1991 and Oregon law have exposed employers to punitive and compensatory damages and jury trials for unlawful harassment. conduct internal investigations of such incidents. the employer may be liable for not only statutory civil rights claims but also for physical torts such as battery. Obviously. an employer can monitor possible incidents of harassment in the workplace. thoroughly and. A written sexual harassment policy staunchly condemning this type of conduct is a necessary first step: • It should require employees to notify the employer that sexual harassment is occurring. it is imperative that employers identify and eliminate acts of sexual harassment (harassment of a sexual nature) and sex-based harassment (harassment based on a person’s gender) in the workplace. If the employer concludes that improper conduct has occurred. Additionally. With a policy in place that encourages employees to request that any perceived harassment be stopped. to the greatest extent possible. and remedy problems before they result in litigation. confidentiality may be difficult if not impossible to maintain in many situations. Therefore. An employee who is being harassed and is aware of the policy is less likely to resign employment (and later file a suit) if he or she knows that complaints of sexual harassment are taken seriously by the company and that there are procedures within the company to resolve such problems.EEO policies Whether the employer has a stated anti-harassment policy is relevant to the first element of the defense. • • When facing specific complaints of sexual harassment. courts have found that when sexual harassment has a physical component. confidentially. And an employee’s failure to use a complaint procedure provided by the employer will normally be enough to satisfy the employer’s burden under the second element of the defense. Complaints should be investigated and resolved promptly. employers must consider each claim with the utmost seriousness. then the alleged harasser should be disciplined accordingly.

whistling. Sexual harassment Sexual harassment has been defined as unwelcome sexual advances. demands for sexual favors in exchange for favorable treatment or continued employment. sexual prowess. requests for sexual favors. Some examples of conduct that could give rise to sexual harassment are unwanted sexual advances. national origin. hostile. display in the workplace of sexually suggestive objects or pictures. such as epithets. slurs. or threatening. however. flirtations. sexually suggestive. Other forms of prohibited harassment include harassment against an individual based on the individual’s race. verbal commentary about an individual’s body. Such harassment may include verbal or physical conduct that denigrates or shows hostility or aversion toward an individual because of any protected status. it is extremely important to include consistent complaint reporting procedures and prohibitions against retaliation for those who make good-faith complaints. color.EEO policies SAMPLE POLICY The following sample policy combines yet distinguishes between prohibitions against sexual and other forms of harassment. sexual orientation. or offensive work environment. 93 . intimidating. graphic. leering. as it is done so here. Other forms of harassment This policy covers and prohibits other forms of harassment as well. when: (a) (b) (c) submission to such conduct is made either implicitly or explicitly a term or condition of employment. protected activity. verbal abuse of a sexual nature. or other verbal or physical conduct of a sexual nature. or any other status protected by applicable law. or deficiency. or it may keep them separate (see next section). or discriminatory treatment based on sex. sexual jokes. assault. or obscene comments or gestures. The foregoing list is not exhaustive. age. If the policies are separated. advances or propositions. Employers may combine the policies. negative stereotyping. or such conduct has the purpose or effect of unreasonably interfering with an individual’s work performance or creating an intimidating. touching. disability. religion. marital status. insulting. or hostile acts that relate to a protected class or written or graphic material that denigrates or shows hostility or aversion toward an individual or group because of the protected status. submission to or rejection of such conduct by an individual is used as the basis for employment decisions affecting such individual.

you may bypass your immediate supervisor and report the matter directly to any manager or supervisor. Further. If discrimination or harassment in violation of this policy is found to have occurred. appropriate corrective action. at any time if they have questions relating to the issues of discrimination or harassment. employees are responsible for respecting the rights of their coworkers and strictly adhering to the letter and spirit of this policy. Any employee who is found to have retaliated against another employee in violation of this policy will be subject to disciplinary action up to and including termination of employment. If you believe that it would be inappropriate to discuss the matter with your immediate supervisor or if you are uncomfortable discussing the issue with your supervisor. including the President.EEO policies Complaint Procedure Each member of management is responsible for creating an atmosphere free of discrimination and harassment. or the President. any employee who observes any conduct that he or she believes constitutes harassment or discrimination must immediately report the matter to his/her supervisor. up to and including termination of employment. the Company will take prompt. or has participated in an investigation of such conduct. All employees are encouraged to discuss this policy with their immediate supervisor. Protection Against Retaliation Company prohibits retaliation in any way against any employee because the employee has made a good-faith complaint pursuant to this policy. consistent with the Company’s need to investigate the complaint and address the situation. If you believe that you have experienced any harassment or discrimination. you are expected and required to bring the matter to the attention of your immediate supervisor as soon as possible. sexual or otherwise. and any employee found to have violated this policy will be subject to disciplinary action. In addition. 94 . any supervisor or manager. or the President. has reported harassing or discriminatory conduct directed at others. Investigation All complaints and reports will be promptly and impartially investigated and will be kept confidential to the extent possible. Confidentiality All complaints under this policy will be treated as confidentially as is possible under the circumstances and as is consistent with Company’s need to investigate and respond to the complaint. any member of the management team.

It is against Company policy for any employee. disability or sexual orientation. religion. or coworker. national origin. • 95 . or that of the individual’s relatives. hostile. many courts have recognized claims of harassment based on an employee’s use of the Family Medical Leave Act or Oregon Family Leave Act leaves of absence. national origin. age and other protected class statuses While sexual harassment is the most well-known form of prohibited harassment. color. The same types of damages available to a successful plaintiff alleging sexual harassment claims are available to successful plaintiffs alleging harassment based on some other form of protected class status. religion. whether a manager. color. or that is circulated in the workplace. It is ABC’s policy to provide an environment free from such harassment. which relate to race. or threatening. bulletin boards. to harass another employee. national origin. Prohibited harassment occurs when verbal or physical conduct that defames or shows hostility toward an individual because of his or her race. color. supervisor. or elsewhere on the Company’s premises. federal and Oregon law prohibit harassment based on race. or associates. gender. age. but is not limited to: • Epithets. color. ABC Company believes that its employees should be able to enjoy a workplace free from all forms of discrimination. color. slurs. gender. religion. SAMPLE POLICY In providing a productive working environment. age. disability or sexual orientation and that is placed on walls. national origin. negative stereotyping. color. intimidating or hostile acts. gender. religion. creates or is intended to create an intimidating. religion. In addition.EEO policies Harassment based on race. gender. gender. sexual orientation. policies prohibiting harassment based on employee’s protected status may limit an employer’s potential liability – if the policy is known to employees and consistently followed by employers. interferes or is intended to interfere with an individual’s work performance. Harassing conduct includes. national origin. including harassment on the basis of race. age. religion. Written or graphic material that defames or shows hostility or aversion toward an individual or group because of race. as well as claims for a hostile work environment due to an employee’s use of a complaint reporting procedure or because of that person’s protected class status. disability or sexual orientation. or offensive working environment. age. gender. age. disability and sexual orientation. and any other status protected by law. or otherwise adversely affects an individual’s employment opportunities because of the applicant or employee’s inclusion in any legally protected category. And as with sexual harassment policies. friends. disability as well as other protected statuses.

EEO policies

Any employee who believes he or she has been harassed in violation of this policy should report the conduct immediately to his or her supervisor; or, if that person is responsible for the harassment, to the Human Resources Department. The employee always has the option of reporting the conduct directly to the Human Resources Department if he or she prefers, or to the company’s president or any other manager with whom he or she feels comfortable. A thorough and impartial investigation of all complaints will be conducted in a timely and thorough manner. Confidentiality will be maintained during the investigation to the extent possible without jeopardizing the thoroughness of the investigation. Any employee of the Company who has been found, after appropriate investigation, to have harassed another employee in violation of this policy will be subject to disciplinary action up to and including termination. Retaliation against the individual reporting the harassment is expressly prohibited.

Complicated claims of sexual or other forms of harassment
Employees who make good-faith complaints of harassment, sexual or otherwise, should not be punished or disciplined for it. In fact, in the sample policies above, a strong statement about no retaliation against people who make good-faith complaints of harassment is included. What, however, should an employer do if it discovers during the course of investigating a hostile work environment complaint that the employee was contributing to the harassment? This question must be answered on a case-by-case basis. Generally speaking, if the employee’s complaint was corroborated, then the alleged harasser should be disciplined in accordance with your policy. If the employee’s complaint was corroborated and the complainer turns out to be a contributor to a hostile work environment, discipline may be appropriate. It is difficult, however, to argue to a jury that a company responded promptly and appropriately to a complaint of harassment when part of that “response” includes discipline to the complainer, even if the discipline was legitimate. It is recommended that employers consult with legal counsel any time it appears that discipline should be issued to the complainer.

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Chapter 7

Time off and leaves of absence
Vacation
Employers are not required by federal or state law to provide vacation benefits to their employees. There are no laws that require an employer to give an employee a specific amount of vacation time, and there are no laws that specify how vacation time is accrued. But if your company offers vacation benefits, ensure that your handbook clearly states the employee’s eligibility for vacations and vacation pay policies are communicated to all employees.

When vacation can be taken
The employer may place reasonable limitations on when employees can take vacation, as, for example, by requiring employees to take one week of vacation during an annual plant shutdown.

Accumulating vacation
Employers may prohibit employees from accumulating vacation over time rather than taking it. Although an employer should never require an employee to forfeit earned vacation, the employer may prevent the accumulation of vacation from year to year by providing that no further vacation will be earned until previously earned time has been taken.

Vacation pay
Oregon courts, and the Oregon Bureau of Labor and Industries, recognize vacation pay as an example of a wage agreement which may be made between employers and employees as part of an employee’s total compensation package. Under Oregon law, an employer is required to honor any established policy or agreement relating to the payment of benefits such as accrued vacation upon termination. If an employee qualifies for payment of benefits under the employer’s policy, the employee should be paid for these upon termination. Oregon law also recognizes, however, an employer’s right to specify when vacation pay will not be paid upon termination, such as when an employee is terminated for gross misconduct. Again, the vacation pay policy must be clear, communicated, and consistently enforced so that an employer may enforce it.

97

Time off and leaves of absence

SAMPLE POLICY
It is the policy of ABC Company to provide each full-time employee with vacation time on a periodic basis. The amount of vacation to which an employee becomes entitled is determined by the employee’s length of service as of his or her employment anniversary date. For full-time employees, vacation accrues as follows: 1. At the end of the first year of service, one week, or 40 hours, of vacation. 2. Two years or more but less than five years of service, two weeks, or 80 hours, of vacation per year. 3. Five years or more but less than 10 years of service, three weeks, or 120 hours, of vacation per year. 4. Ten years or more of service, four weeks, or 160 hours, of vacation per year. Regular part-time employees earn vacation on their employment anniversary date in the proportion that their normally scheduled number of hours bears to 40 per week. For example, a regular, part-time employee who usually works 20 hours per week would earn 20 hours of vacation upon completing his or her first year of service. Vacation does not accrue between employment anniversary dates and may not be taken until it is earned. Vacation time must be used in the anniversary year after which it is earned and may not be carried over past the employee’s next anniversary date. For example, an employee with two weeks’ vacation as of his or her third anniversary date must use the two weeks prior to his or her fourth anniversary date. If an employee fails to take his or her earned vacation time before the employee’s anniversary date in violation of this policy, the employee will not earn any further vacation until that unused vacation has been taken. Earned vacation must be taken. Employees are not entitled to pay in lieu of taking time off for vacation.

Sick days
As with vacation pay, there is no legal requirement in Oregon to offer employees paid sick days. However, the employer should consider the possible loss of the salaried exemption under the FLSA if an otherwise salaried-exempt employee loses pay for sick days without an opportunity to have those days paid (by accrual or otherwise) under the employer’s benefit or compensation policies. If the employer does elect to have paid or unpaid sick days, the policy should be spelled out in clear and detailed terms so that employees understand the nature and limitations of the benefit.

98

Time off and leaves of absence

SAMPLE POLICY
ABC Company recognizes that an employee’s inability to work because of illness or injury may cause economic hardship. For this reason, the Company provides paid sick days to full-time employees. The days are provided only for the employee’s own illness or injury. Eligible employees accrue sick days at the rate of one-half day per month to a maximum of six days per calendar year. Unused sick days may be accumulated to a maximum of 30 days. Sick days may be used as they are earned, following the Company’s regular call-in policy. Any more than two consecutive days of absence due to illness must be supported by a doctor’s statement. Employees are not entitled to be paid for earned but unused sick days, either before or when their employment is terminated for any reason.

Paid time off (PTO) Paid leave bank (PLB)
With an ever-increasing emphasis on flexibility and accommodation in the workplace, many employers are beginning to offer paid time off (PTO), paid leave bank (PLB), or similar benefits to employees instead of paid vacation, sick days, and personal days. Such a policy offers employees greater freedom to enjoy PTO in a manner that reflects their own personal values, commitments, and lifestyle choices. More importantly, the policy eliminates the need for the employer to police – and the incentive of the employee to fabricate – the reasons an employee uses to take time off. The decision to use a conventional vacation/sick days/personal days policy or to adopt a more progressive PTO or PLB policy must be made by each employer based upon the particular human resource philosophy and management style of the business. The law does not prefer one approach more than another. However, if an employer does elect to use a PTO or PLB policy, the employer needs to consider, in advance, whether terminating employees will be paid for earned but unused days in their PTO or PLB banks. Please consult with an attorney if your company decides to switch from paid vacation/sick days to a PTO or PLB policy. To avoid confusion, do not offer a PTO or PLB policy and a paid vacation/sick days policy, unless it expressly excludes the paid vacation/sick days policy or eligibility.

SAMPLE POLICY
ABC Company provides its employees with paid time off (PTO) benefits in lieu of the traditional benefits of paid vacation, personal days, and sick days. PTO may be taken by employees, with prior supervisory approval, at such times and in such increments as best accommodates each employee’s own schedule. PTO is intended to allow employees paid time off from work for reasons such as vacation, personal illness, family illness, medical

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appointments, religious or ethnic holidays, or personal or family business. Employees who are absent from work for any reason are required to take any accrued but unused PTO before taking unpaid time off. For full-time ABC employees, PTO accrues according to the following schedule: 1. During the first year of service, one day (eight hours) of PTO per month. 2. During the second through fifth years of service, one and one-fourth days (10 hours) of PTO per month. 3. During the sixth through 10th years of service, one and one-half days (12 hours) PTO per month. 4. After completing the 10th full year of service, two days (16 hours) of PTO per month. Regular part-time employees accrue PTO benefits at a rate of one day (eight hours) of PTO per 175 hours worked. PTO benefits are not earned until the final day of the month, and may not be taken until the month after the PTO is earned. Neither full-time nor part-time employees begin to accrue any PTO until they have completed one full month of employment with ABC Company. Part-time employees do not earn the benefit until the 175th hour has been worked. No subsequent PTO benefits for part-time employees are earned until the 175th hour has been worked each interval. PTO may be taken in four hour increments only. Employee absences that occur after all available PTO has been used will be unpaid and may be subject to appropriate disciplinary action by the Company. Only 10 days (80 hours) of earned PTO may be carried over from one calendar year to the next. [All additional earned PTO will be paid out during the first payroll period of January each year.][PTO will not be paid out at the termination of employment.

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Holidays
There is no obligation under either federal or Oregon law to pay employees extra for working on holidays or to pay them premiums for work performed on holidays. Nor does the law require an employer to recognize one holiday versus another. If the employer does choose to provide the benefit to employees, it makes good practical sense to put the policy in writing to avoid confusion and enhance employee morale. Employers should designate in advance: • • • • • who is entitled to holiday pay which holidays will be recognized any conditions for the receipt of holiday pay the rate of holiday pay the employer’s practice regarding the observance of holidays occurring on weekends, normal days off, and during vacations or other approved times off.

SAMPLE POLICY
ABC Company recognizes seven holidays each year. All full-time employees will receive their regular straight-time compensation for each holiday. Regular part-time employees receive pay for each designated holiday in the proportion that their normally scheduled number of hours equals 40 hours per week. The holidays celebrated are: • • • New Year’s Day Memorial Day Independence Day • • • Labor Day Thanksgiving Day Day after Thanksgiving • Christmas Day

A holiday that falls on a weekend will be observed on either the preceding Friday or the following Monday to coincide with local custom. To be eligible for holiday pay, an employee must have worked his or her regularly scheduled hours the workday before and the workday after the holiday, or have been on an approved vacation day or any other excused absence under Company policy. If an employee is on vacation when a holiday is observed, the employee will be paid for the holiday and will be granted an alternate day of vacation at a later date. Any hourly, non-exempt employee required to work on a holiday will receive double-time payment for the hours worked.

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an eligible employee may take up to 12 weeks of unpaid leave within a 12-month period (and sometimes more. under certain circumstances) for the following purposes: • to care for a newborn.250 hours during the 12 months preceding the date leave is to begin. Eligible employees must be employed for at least 12 months (which may be based on separate stints of employment) and have worked at least 1. an eligible employee may take up to 12 weeks of unpaid leave within a 12-month period for the following purposes: • to care for a newborn. child. including an illness. Under OFLA. parent. Under FMLA. FMLA also provides leave for members of the Armed Services and their guidelines. injury or condition related to pregnancy or child birth that disables the employee or • “call to active duty” or “qualifying exigency” leave (12 weeks). or to care for an injured servicemember (up to 26 weeks). Employers with 25 or more employees in Oregon are covered by the Oregon Family Leave Act (OFLA).Time off and leaves of absence Medical leave A covered employer under the Family and Medical Leave Act (FMLA) has at least 50 employees within 75 miles of an employee’s work site. but not seriously ill. grandparent or grandchild with a serious health condition or • to care for the employee’s own serious health condition or • to care for a sick. newly adopted. FMLA and military leave. newly adopted. child. or parent with a serious health condition or • to care for the employee’s own serious health condition. parent-in-law. or newly fostered child (parental leave) or • to care for a spouse. 102 . same-sex domestic partner. or newly fostered child or • to care for a spouse. child. For more information. see page 109.

FMLA. this change adds a category that is not addressed under federal law. 103 . 2008. Employees are eligible to take OFLA-protected leave if they have been employed for the preceding 180 calendar days and for an average of at least 25 hours per week. the definition of “family member” expanded to include a grandparent or a grandchild of an eligible employee. this provision does not extend coverage to grandparent-inlaws. something that further complicates the administration of this already complicated law. It has to be a grandparent or grandchild of the employee. Unlike other provisions of OFLA.Time off and leaves of absence Effective January 1. Employees need not meet the hourly requirement to be eligible for parental leave. In addition.

” Note that under both OFLA and FMLA. including an explanation of the need for leave. when an authorized period of OFLA leave has ended and an employee does not return to work. the employee is not required to specify that the leave is for OFLA or FMLA in order to be eligible for leave. and may not treat a continuing absence as unauthorized unless requested information is not provided or does not support OFLA qualification. an employer may require an employee to provide notice of intent to take a leave of absence under the following guidelines: Nature of leave Anticipated leave OFLA – Notice employee may be required to give Employers may require up to 30 days’ advance written notice. Leave anticipated less than 30 days in advance Employees must give notice as soon as practicable. Employees or someone acting on their behalf must give verbal or written notice within 24 hours of starting leave. an employer having reason to believe the continuing absence may qualify as OFLA leave must request additional information. Any written notice requirements should be flexible.Time off and leaves of absence Notice/certification requirements Under OFLA and FMLA. 104 . Federal regulations allow an employer to deny or delay the start of FMLA leave because of improper notice. Unanticipated or emergency situations Employee should give as much notice as practical “within the time prescribed by the employer’s – usual and customary notice requirements applicable to such leave. Employee must follow employer’s policy. Employees should give as much notice as practical. Employer may require written notice within three days after employee returns to work FMLA – Notice employee may be required to give Same. Under OFLA. and employers may ask the employee to give reasons why 30 days notice is not practicable. If an employee fails to give notice as required by law or the employer’s policies. the employer may reduce the period of unused OFLA leave by up to three weeks in that one-year leave period and discipline the employee if the employer has posted the required BOLI family leave act notice (or can establish that the employee had knowledge of the notice requirement).

the employer may use the Forms WH-380E and WH-380F. no medical verification may be required until after three occurrences of sick child leave. an employer may ask an employee in writing to provide a medical certification from the employee’s health care provider to clarify what assistance the employee needs as a result of the employee’s condition. unless: • circumstances have significantly changed or • the employer receives information that casts doubt upon the employee’s stated reason for the absence. no medical certification is required. an employer may request additional information to determine that a requested leave qualifies for designation as OFLA or FMLA leave. For the purposes of both laws. Note: Employers may require employees to use: • any accrued paid sick leave or • any paid accrued vacation leave 105 . Note: Recertification. Department of Labor (DOL). Employers may require additional medical certifications for pregnancyrelated disabilities. the employer may treat any absences as unexcused and unprotected by FMLA/OFLA (and therefore subject to the employer’s absenteeism policy). that in cases of OFLA parental leave.Time off and leaves of absence Under both FMLA and OFLA. however. The employee must generally return the certification either before she takes leave (if the leave was foreseeable) or within 15 calendar days of the employer’s request. available on the DOL web site. created by the U.S. Under both FMLA and OFLA. If the employee fails or refuses to provide a certification. Note. But an employer may do so no more often than every 30 days (except in the case of intermittent leave. the employer may also request recertification if the employee requests an extension of the leave. chronic conditions. to request medical certification (see pages 124 and 128). If the leave is intermittent or for any other kind of covered serious health condition. and under OFLA sick child leave. provided that the employer advised the employee of these consequences at the time it requested the certification. or permanent/long-term conditions requiring the continuing supervision of a health care provider. and then no more often than the minimum period specified on the certification as necessary for such leave) and only in connection with an absence.

replacing the one issued in 1995 (Form WH-1420) 2. Form WH-1420 – Employee Rights and Responsibilities A covered employer is required to post and distribute a general notice. an employer’s notice obligations under FMLA changed significantly. the various FMLAapproved forms described below may or may not be suitable for OFLA-only. replaces the current Form WH-381 3. or if employers do not maintain handbooks or policy guides. The DOL has drafted a revised general notice form. a new poster. a new Notice of Eligibility and Rights and Responsibilities form. Posting requirements may be satisfied through an electronic posting.”). by providing the notice to new employees at the time of hire.Time off and leaves of absence or • “any other paid leave that is offered by the employer in lieu of vacation leave” (such as paid time off) during an OFLA or FMLA leave of absence. As of press time. Although OFLA’s laws and regulations do not contain similar requirements. Communicating with employees regarding leave Under new federal regulations that became effective January 16. There are two important points to keep in mind: 1. of these notice requirements can apply to leaves running concurrently under OFLA and FMLA. 2009. qualifying leaves – consult with legal counsel before using one of the forms described below for an OFLA-only qualifying leave. which is Form WH-382. a new form called a Designation Notice. BOLI has publicly taken the position that most. which along with portions of new Form WH-382. if not all. In all circumstances. even if its employees are not eligible to take FMLA leave. OFLA/FMLA covered employers must apply the regulation or law that is most beneficial to the employee’s circumstances for leave under both OFLA and FMLA. Thus. Covered employers with eligible employees also must distribute the general notice either by including it in an employee handbook or other policy guides. the only FMLA forms expressly approved by BOLI are the Forms WH-380E and WH-380F (medical certification forms for an employee’s own or a family member’s “serious health condition. There are three employer notices: 1. titled “Employee Rights and Responsibilities Under the Family and Medical Leave Act” for employers to use. 106 . 2.

and explain what additional information is needed. This information is contained in the DOL’s new Form WH-381 (see page 132). if an employer advises the employee that he/she is not eligible for FMLA leave. The DOL has drafted a new form. notably. Along with the eligibility notice. the employee’s eligibility status has changed. the designation 107 .gov/esa/whd/fmla/finalrule/fmlaposter. instead of two days. and is available for download at: www.gov/ esa/whd/forms/wh-381.” that employers may use.Time off and leaves of absence It replaces the current form.dol. the employer must notify employee of the change within five days of the leave request. however. If an employee provides notice of a subsequent need for leave during that year for a different reason and the employee’s eligibility has not changed. an employer must provide the employee with a notice containing his or her FMLA rights and responsibilities (for example. It is available for download at: www.dol. the employer need not provide a new eligibility notice. An employee’s eligibility is determined the first time such leave is requested in the applicable 12-month period. the employer has to provide at least one reason why the employee is not currently eligible for such leave. maintenance of benefits. that additional information is needed in order to determine whether the leave is FMLA qualifying. (Previously. The DOL’s new Form WH-381 satisfies an employer’s eligibility and rights and responsibilities notice obligations. titled “Designation Notice. If.qualifying. an employer now has five business days (absent extenuating circumstances). submitting medical certification. to provide the employee with a notice stating that the leave (specifying the amount) has been designated as FMLA qualifying or.pdf.” Form WH-381 differs from the original form.) Form WH-381 replaces a DOL form with the same publication number and titled “Employer Response to Employee Request for Family or Medical Leave. which goes by the same publication number. employers were required to provide such notice within two business days. in the alternative. Form WH-381 – Notice of Eligibility & Rights and Responsibilities An employer is required to provide an eligibility notice within five business days (absent extenuating circumstances) of being advised by the employee that he/she needs to take FMLA leave or has been made otherwise aware of the employee’s need for such leave.pdf. etc.). This poster is located on page 123. requiring substitution of paid leave. If an employer requires the substitution of paid leave. Form WH-382 – Designation Notice Once an employer has sufficient information to determine whether an employee’s leave is FMLA.

domestic partner.gov/ esa/whd/forms/wh-382. An employee who takes the full 12 weeks of parental leave under OFLA is entitled to up to 12 weeks of sick-child leave within the same 12-month period.” It is available for download at www.oregon. Care for a sick child OFLA provides that an employee is entitled to leave to care for a child of the employee who is suffering from an illness. boyfriend. and BOLI has not yet formally approved the use of the revised FMLA forms described above with leaves of absence that qualify under OFLA only. and of any requirements regarding use of paid leave. a husband of a female “eligible employee” may take FMLA leave to care for his expectant spouse if she is incapacitated (which includes providing “psychological comfort and reassurance”). In the revised FMLA regulations.pdf (see page 302). along with a list of the employee’s essential job functions.dol. which will be provided to the physician responsible for completing the FFD certification (see page 134). The form also advises the employee of the right to request the amount of FMLA leave that will be counted against the FMLA entitlement once in a 30-day period if leave was taken in the 30-day period. a female employee is entitled to use up to 12 weeks’ of leave for any period of disability related to her pregnancy or childbirth. or condition that is not a serious health condition but that requires home care. Such leave is not available to a nonspouse father of the child (for example.pdf. The leave can commence before actual birth or placement. if appropriate) the latest version of BOLI’s OFLA “Notice to Employees and Employers. Covered employers must also provide notice to the employee of the designation of leave as OFLA-covered. unmarried father of the child). 108 .Time off and leaves of absence form must include a statement to that effect. Pregnancy leave Under OFLA. It is available for download at: www. An employee who uses up to 12 weeks for pregnancy-related leave under OFLA may also use up to 12 weeks for any other qualifying family leave. If an employer wants an employee returning from FMLA leave to provide a fitness-for-duty (FFD) certification. fiancée. OFLA Employers covered by OFLA must post in English (and Spanish. Not particular form is required. injury. Both male and female employees may also take up to 12 weeks’ OFLA or FMLA leave for the birth of a child or to care for a newly placed adoptive or foster child under 18 years of age or over 18 years of age if incapable of selfcare because of mental or physical disability.gov/BOLI/TA/2009_OFLA_English_ poster. a statement to that effect must be included in the designation notice.

Time off and leaves of absence Note: An employee must use all of his or her 12 weeks of parental leave to qualify for this additional benefit. The term “active duty or a call to active duty status” is specifically defined in the new regulations as duty under a federal call or order to active duty. new federal laws and regulations expanded FMLA to create two new categories of protected leave: 1. Thus. but if he takes only 8 weeks of parental leave. OFLA and FMLA leave cannot run concurrently with leave for a workers’ compensation injury. OFLA. he may take only 4 weeks of additional leave for any other purpose. employees will still have a full OFLA “bank” after a workers’ compensation-related absence. BOLI and/or the DOL regarding the leave of absence laws. Employers are strongly encouraged to consult with legal counsel. even if the work-related injury might also be considered a “serious heath condition” under OFLA/FMLA. Qualifying exigency leave (QE leave) Under the new regulations. For example. leave to employees who care for family members injured in the line of duty (also known as “military caregiver leave”) and 2. A female employee may take up to 36 weeks of OFLA leave in a 12-month period: • 12 weeks of pregnancy or childbirth disability leave and • 12 weeks of parental leave and • 12 weeks of sick-child leave. employees may be eligible for up to 12 weeks of FMLA leave for a “qualifying exigency” arising from a spouse. FMLA and workers’ compensation Employers may not count a work-related injury against OFLA or FMLA leave. or a State call if (and only if) the State call is ordered by the President in support of a “contingency operation” under specific 109 . Further. a male employee who takes 12 weeks of parental leave may also take up to 12 weeks of sick-child leave. leave for family members of service-members called to active duty (also known as “qualified exigency” leave). FMLA and military leave In 2008 and 2009. or parent being on active duty or called to active duty. child.

The new regulations establish seven “specific and exclusive” reasons for which an employee can take qualifying exigency leave. Other activities which arise from active duty may be eligible if the employee and the employer agree – including agreement on the scheduling and duration of the leave. Employees seeking QE leave must give reasonable and practicable notice where foreseeable. The eligible family members for QE leave of “spouse. which are described in more detail below: • • • • • • • short-notice deployment military events and activities school and childcare activities financial and legal arrangements counseling rest and recuperation post-deployment activities. 688.S. or for “in loco parentis” situations.Time off and leaves of absence provisions of 10 U. adopted. child or parent” are more broadly defined than for regular FMLA (and. is different than for Military Caregiver Leave). or to retired members of the regular Armed Forces or Reserve. and provide an anticipated duration of the absence. First. an employer may require a certification that the covered military member is a member of the National Guard or Reserve who is on active duty or called to active duty in support of a contingency operation. cite one of the 7 listed reasons for QE leave. foster or step-child or legal ward. A copy of the military member’s active duty 110 . notably. The notice must inform the employer of the active duty status or call. a child for the purposes of QE leave is a biological. New Form WH-384 – Certification of Qualifying Exigency for Military Family Leave An employer may require two different types of certification with respect to military exigency leave. An employee is not eligible for Qualifying Exigency leave relating to a servicemember who is a member of the Regular Armed Forces. These calls to active duty are only made to members of the National Guard or Reserve.C. While “spouse” and “parent” are self-explanatory.

and to attend meetings with staff at a 111 • • . the American Red Cross. The lengthy definition and explanations limit QE leave to the following situations: • Short-notice deployment – when a covered military member is notified of an impending call or order to active duty in support of a contingency operation seven or less calendar days prior to the date of deployment. also called “Certification of Qualifying Exigency for Military Family Leave” (see page 135).]” This category also includes situations where childcare is required “on an urgent. military-sponsored events that are related to the active duty or call. or to attend “family support or assistance programs and informational briefings sponsored or promoted” by the military. . The Department of Labor has developed a prototype form for QE certification. An employer can also verify the use of QE leave with third parties associated with the leave. . the amount of leave needed. immediate need basis (but not on a routine.” to enroll or transfer to a new school or day care facility a child of a covered servicemember. as it will often contain the information necessary for an employer to confirm the employee’s eligibility to take leave. the WH-384. Employers should use the form whenever possible or practical to do so. necessitates a change in the existing childcare arrangement[.dol. Military events and related activities – to attend official. Department of Labor web site: www. QE leave categories The new regulations specify in great detail the seven categories of QE Leave. Once an employee furnishes the certification. A copy of this new form is available for downloading by going to the U. Both certifications must be provided within 15 days absent unusual circumstances. regular. the employer can require a statement from the employee (including available written support documentation) about the nature and details of the specific reason for the QE leave. the employer may not require the same certification again for subsequent absences related to the same active duty of that particular military member.pdf. or a financial planner for a meeting for which QE leave is used.” Childcare and school activities – “to arrange for alternative childcare when the active duty or call . and the employee’s relationship to the military member. or everyday basis).S. or military service organizations “that are related to the active duty or call.gov/esa/whd/forms/WH-384. such as the teacher for a parent/teacher conference for which QE leave is used.Time off and leaves of absence orders will suffice. In addition.

enrolling in the Defense Enrollment Eligibility Reporting System (DEERS).” In all cases.” Additional activities – “To address other events which arise out of the covered military member’s active duty or call to active duty status provided that the employer and employee agree that such • • • • 112 . “and any other official ceremony or program sponsored by the military for a period of 90 days following the termination of the covered military member’s active duty status.Time off and leaves of absence school or daycare facility. . obtaining military identification cards. parent-teacher conferences. rest and recuperation during the period of deployment. transferring bank account signature authority.” Counseling – QE Leave is available when the covered employee attends counseling for him/herself.” “Rest and recuperation” – When the covered employee needs to spend time with a covered military member who is on short-term. arranging. or meetings with school counselors. “such as meetings with school officials regarding disciplinary measures. such as preparing and executing financial and healthcare powers of attorney. “provided that the need for counseling arises from the active duty or call to active duty status of a covered military member. or preparing or updating a will or living trust.” This category includes situations where the covered employee must act as the covered military member’s representative “for purposes of obtaining. for the covered military member or child of the covered military member. reintegration briefings and events. . temporary.” Post-deployment activities – When the covered employee attends arrival ceremonies. or appealing military service benefits while the covered military member is on active duty or call to active duty status. but no more than five days “for each instance of rest and recuperation.” • Financial and legal arrangements – “To make or update financial or legal arrangements to address the covered military member’s absence while on active duty .” This definition also provides a covered employee with time to “address issues that arise from the death of a covered military member while on active duty status. attendance by the covered employee at these activities must be “necessary due to circumstances arising from the active duty or call to active duty status of a covered military member. such as meeting and recovering the body of the covered military member and making funeral arrangements. and for a period of 90 days following the termination of the covered military member’s active duty status.

entitled “Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave”. The rules suggest that a former member of the military with an injury or illness that did not manifest itself until after discharge from the military is not a “covered servicemember. 113 . employers must calculate an employee’s eligibility for military caregiver leave by looking at a single 12-month period measured forward from the date an employee’s leave to care for the covered servicemember begins. A complication or an aggravation of the same injury which gave rise to the previous Military Caregiver Leave is not a “subsequent injury or illness. intermittently.dol. Department of Labor web site: www.S. parent or next of kin of a “covered servicemember. and agree to both the timing and duration of such leave. or a nonnetwork authorized private health care provider. In general.” During any single 12-month period. to be used for certification of MC leave situations. per-injury basis (which may be taken continuously. is available for downloading by going to the U. daughter. a Department of Defense TRICARE network. Regardless of which 12-month calculation period/rule for establishing the leave year that an employer follows. National Guard or Reserve. or on a reduced schedule basis). son. Then. once a single 12-month period expires.” Military caregiver leave An employee may take up to 26 weeks of Military Caregiver leave during a single 12-month period on a per-covered servicemember. WH-385.Time off and leaves of absence leave shall qualify as an exigency. Military Caregiver Leave is available to an eligible employee who is the spouse.pdf.” In addition. however. the employee becomes eligible for another 26 weeks of military caregiver leave during a subsequent single 12-month period to care for a different covered servicemember or to care for the same covered servicemember if he/she incurs a subsequent serious injury or illness.gov/esa/whd/forms/WH-385.” A “covered servicemember” for MC leave is a current member of the Regular Armed Forces. the covered servicemember must be receiving medical treatment or oversight by a Department of Defense health care provider. A copy of WH-385. the employee’s total leave entitlement is limited to a combined total of 26 weeks for all qualifying reasons under FMLA and military leave. a Veterans Affairs health care provider. New Form WH-385 – Certification for Military Caregiver Leave The Department of Labor has developed a prototype form. an employer may require information from the health care provider and from the employee and/or covered servicemember to support military caregiver leave. including those on the temporary disability retired list (the TDRL).

the following sample policy states that health insurance will continue during the course of the leave. however.Time off and leaves of absence Section I of the WH-385 relates primarily to the servicemember’s military status and the care to be provided. consult with your company’s legal counsel to determine which provisions apply to your company. Employers who fall under OFLA only. 114 . group health plan benefits must be maintained on the same basis as coverage would have been provided if the employee had been continually employed during the leave period. Again. and this is because during a FMLA-qualified leave. need not provide continuing benefits during family medical leave unless the employer has a policy or practice to continue benefits. Section II is a medical certification of the servicemember’s serious injury or illness to be completed by a Department of Defense or Veteran’s Affairs health care provider. or a DOD TRICARE network or non-work authorized private health care provider. absent unusual circumstances. and discuss with legal counsel other provisions included in this policy that may not apply. SAMPLE OFLA/FMLA POLICY The following sample policy could be used by an employer who is subject to both OFLA and FMLA. For example. Oregon employers with fewer than 50 employees should remove references to FMLA (and leaves provided under FMLA). Both certifications must be provided within 15 days.

Time off and leaves of absence SAMPLE FAMILY AND MEDICAL LEAVE POLICY ________ recognizes that employees need support in balancing work. impairment or physical or mental condition that involves: 1. Definitions Family member • For purposes of FMLA. _________’s policies are in compliance with federal and Oregon leave laws and will administer this policy in accordance with all legal requirements. full calendar days and any subsequent treatment or period of incapacity relating to the same condition that also involves: • in-person treatment by a health care provider two or more times within 30 days of the first day of incapacity. step. inpatient care. • Child – For purposes of OFLA parental and sick child leave. or in loco parentis). injury. or in loco parentis). foster. with the first treatment occurring within 7 days of the first day of incapacity. “family member” is defined as a spouse. Please also refer to the “Employee Rights and Responsibilities” notice posted in __________. and parent or child of same-gender domestic partner. or child (biological. which is incorporated here by reference. an incapacity of more than three consecutive. or 115 . “family member” also includes a parent-in-law. same-gender domestic partner. parent (biological. then the state or federal law takes precedence over the conflicting provision of this policy. adopted. adopted. Employees seeking further information should contact ________. grandchild. “child” includes a biological. foster. In the event that any part of this policy is in conflict with current state or federal law. the child of a same-gender domestic partner or a child with whom the employee is in a relationship of in loco parentis. personal and family responsibilities. adoptive. including any period of incapacity connected with inpatient care or any subsequent treatment connected with such inpatient care. continuing treatment for: a. For purposes of OFLA. Serious health condition – ”Serious health condition” is defined under FMLA as an illness. foster or stepchild. step. grandparent. All other nonconflicting provisions of this policy will remain in full force and effect. or 2.

physical therapy for severe arthritis. periodontal disease. any period of incapacity due to pregnancy or prenatal care. 2. This type 116 . etc.e. headaches other than migraine. 3.Time off and leaves of absence • in-person treatment by a health care provider on at least one occasion occurring within 7 days of the first day of incapacity. b.). etc... upset stomach. dialysis for kidney disease. Employee’s Serious Health Condition Leave: To recover from or seek treatment for an employee’s serious health condition. diabetes. which results in a regimen of continuing treatment under the supervision of a health care provider.). minor ulcers. or e. epilepsy. routine dental or orthodontia problems. Family Member’s Serious Health Condition Leave: To care for a family member with a serious health condition. asthma. including pregnancy-related conditions and prenatal care. c. are examples of conditions that are not generally defined as serious health conditions. Alzheimer’s. Reasons for Taking Leave Family Medical Leave may be taken under any of the following circumstances: 1.. chemotherapy or radiation for cancer. and cosmetic treatments (without complications). etc. any period of incapacity or treatment for a chronic serious health condition (i. d. earaches. Parental leave must be completed within 12 months of the birth of a newborn or placement of an adopted or foster child. Parental Leave: For the birth of a child or for the placement of a child under 18 years of age for adoption or foster care. Sick Child Leave: To care for a child who suffers from an illness or injury that does not qualify as a serious health condition but that requires home care. The common cold. flu. permanent or long-term incapacity for which treatment may not be effective but is under the continuing supervision of a health care provider (i. terminal stages of a disease. 4.e.). severe stroke.e. multiple treatments by a health care provider for and recovery from restorative surgery after an accident or other injury or a condition that if not treated would result in incapacitation of more than three calendar days (i.

Call to Active Duty Leave: Eligible employees with a spouse. If a part-time employee works a varying schedule. son. an employee must have been employed for at least 180 days and worked an average of at least 25 hours per week. including a member of the National Guard or Reserves. recuperation. the leave entitlement is based on the average weekly hours over the twelve weeks worked prior to the beginning of the leave period. an employee must have been employed for at least 180 days (no per-week hourly minimum is required). attending certain counseling sessions. Sick child leave is not available if another family member is able and willing to care for the child. and if they are employed at a worksite where 50 or more employees are employed by the employer within 75 miles of that worksite.250 hours during the 12 months preceding the date leave is to begin.” “Qualifying exigencies” may include attending certain military events. or is on the temporary disability retired list. who has a serious injury or illness incurred in the line of duty on active duty that may render the servicemember medically unfit to perform his or her duties for which the servicemember is undergoing medical treatment. daughter or parent on active duty or call to active duty status in the National Guard or Reserves in support of a contingency operation may use their 12-week leave entitlement to address certain “qualifying exigencies. This type of leave is available under FMLA only. or is in outpatient status. and attending post-deployment reintegration briefings.Time off and leaves of absence of leave does not provide for routine medical and dental appointments or issues surrounding the availability of childcare when the child is not ill or injured. FMLA – Employees are eligible for federal Family Leave if they have worked for a covered employer for at least one year (which may be based on separate stints of employment). This type of leave is available only to employees who are eligible under OFLA. Servicemember Family Leave: Eligible employees may take up to 26 weeks of leave to care for a “covered servicemember” during a single 12-month period. arranging for alternative childcare. 117 . A “covered servicemember” is a current member of the Armed Forces. To qualify for parental leave under Oregon law. 5. Part-time Employees – Part-time employees who meet the hourly eligibility requirements for family leave are entitled to a pro-rated equivalent of 12 workweeks of leave during the year. Eligible Employees OFLA – To qualify for Oregon Family Leave for a serious health condition or sick child leave. 6. This type of leave is available under FMLA only. addressing certain financial and legal arrangements. for 1. or therapy.

the remaining leave entitlement would be any balance of the twelve weeks which has not been used during the immediately preceding twelve months.Time off and leaves of absence Leave under state and federal law will run concurrently when permitted. or call to active duty leave. An employee may be temporarily reassigned to a position that better accommodates an intermittent or reduced schedule. leave due to a qualifying exigency may be taken on an intermittent or reduced leave schedule basis. injury or condition related to pregnancy or childbirth that disables the employee. eligible employees are entitled to Family Medical Leave within the following limits: • twelve weeks of Family Medical Leave (parental leave. Employees must make reasonable efforts to schedule planned medical treatments 118 . Additionally. • • When leave is taken for Servicemember Family Leave. Intermittent Leave Intermittent or reduced schedule leave may be taken when medically necessary due to the serious health condition of a covered family member or the employee or the serious injury or illness of a covered servicemember. serious health condition leave. twelve weeks of leave for an illness. an eligible employee is entitled to a combined total of 26 workweeks of leave for purposes of parental leave. an eligible employee may take up to 26 weeks of leave during a single twelve-month period to care for the servicemember. Each time an employee takes Family Medical Leave. One-Year Calculation Period The “twelvemonth period” during which leave is available (also referred to as the “one-year leave calculation period”) will be determined by a rolling twelve-month period measured backward from the date an employee uses any Family Medical Leave. Length of Leave In any one-year calculation period. Please contact ____________ for more information on eligibility. During the single 12-month period in which servicemember family leave is taken. sick child leave. serious health condition leave. employees covered by OFLA will not be reassigned without their express consent and agreement. or call to active duty leave). and employees who take the entire twelve weeks of parental leave are entitled to an additional twelve weeks of leave to care for a sick child.

notice need only be given one time. the 119 . or the planned treatment for a serious injury or illness of a covered servicemember. regardless of how far in advance such leave is foreseeable. including consulting ___________ prior to the scheduling of treatment in order to work out a treatment schedule which best suits the needs of both the company and the employee. Whether leave is to be continuous or is to be taken intermittently or on a reduced schedule basis. employees must provide written notice within three days of returning to work. or a medical emergency. Sufficient information may include that the employee is unable to perform job functions. For Call to Active Duty Leave. the employee must notify Human Resources within three business days. planned medical treatment for a serious health condition of the employee or of a family member. or whether the need for leave is foreseeable. the family member is unable to perform daily activities. or as soon as possible. If circumstances change during the leave and the leave period differs from the original request. notice must be given as soon as practicable. or the start date of the employee’s Family Medical Leave may be delayed. Employee Responsibilities – Notice Employees must provide at least 30 days advance notice before Family Medical Leave is to begin if the reason for leave is foreseeable based on an expected birth. Certification Generally speaking. such as because of a lack of knowledge of approximately when leave will be required to begin. Intermittent leave for parental leave is not available. a change in circumstances. placement for adoption or foster care.Time off and leaves of absence so as to minimize disruption of _________ operations. Regardless of the reason for leave. notice must be provided as soon as practicable. If 30 days notice is not practicable. but the employee shall advise Human Resources as soon as practicable if dates of scheduled leave change or are extended. Employees who fail to comply with Company’s leave procedures may be denied leave. employees must provide sufficient information for Company to determine if the leave may qualify for FMLA or OFLA protection and the anticipated timing and duration of the leave. Further. employees will be expected to comply with Company’s normal call-in procedures. or were initially unknown.

one three-day occurrence or three separate instances) of sick child leave within a oneyear period.. Employees using PTO during a portion of approved Family Medical Leave in which a holiday occurs will qualify to receive holiday pay.Time off and leaves of absence need for hospitalization or continuing treatment by a health care provider. Holiday Pay While on Leave [Optional] Employees receiving short. 120 .or long-term disability will not qualify for holiday pay. In some cases (except for leave to care for a sick child). Employees who are on unpaid leave during a holiday will not qualify to receive holiday pay. Employees requesting serious health condition leave for themselves or to care for a covered family member will be required to provide certification from the health care provider of the employee or the covered family member to support the request. Fitness-for-Duty Certification If Family Medical Leave is for the employee’s own serious health condition. medical certification (fitness-for-duty certification) from their health care provider stating that the employee is able to resume work. Employees shall inform their supervisor or Human Resources if they wish to use PTO or other paid leave during a qualifying leave of absence. Employees also may be required to submit subsequent medical verification. Employees must furnish Company’s requested medical certification information within 15 calendar days after such information is requested by the Company. Company may require a second or third opinion. the employee must furnish. the leave will be unpaid. If the employee’s PTO time is exhausted. Employees requesting sick child leave under OFLA may be required to submit a medical certificate if the employee has requested to use more than three days (i. Substitution of Paid Leave for Unpaid Leave Employees may use any available paid time off while on approved Family Medical Leave. Additionally: 1. Employees also must inform the employer if the requested leave is for a reason for which FMLA leave was previously taken or certified. or circumstances supporting the need for either Call to Active Duty or Servicemember Family Leave. 2.e. prior to returning to work. at Company’s expense.

reinstatement shall not be considered if the leave period exceeds the maximum allowed. With the exception of employees on leave as the result of an on-the-job injury or illness or otherwise required by law. the employee may be reassigned to an available equivalent position. The use of Family Medical Leave cannot result in the loss of any employment benefit that accrued prior to the start of an employee’s leave. Please see ____ for more information regarding health insurance coverage. the employee may qualify for workers’ compensation time-loss benefits. If an employee is on approved OFLA Leave. Reinstatement is not guaranteed if the position has been eliminated under circumstances where the law does not require reinstatement. 121 .Time off and leaves of absence On-the-job Injury or Illness Periods of employee disability resulting from a compensable on-the-job injury or illness will qualify as Federal Family Medical Leave (FMLA) if the injury or illness is a “serious health condition” as defined by applicable law. Periods of employee disability resulting from a disabling compensable workers’ compensation injury will not be counted as OFLA leave unless the injury or illness is a “serious health condition” of the employee as defined by Oregon law and the employee has refused a bona fide offer of light-duty or modified employment. If the position has been eliminated. Employees are expected to promptly return to work when the circumstances requiring Family Medical Leave have been resolved. Company will continue the employee’s health coverage under any “group health plan” on the same terms as if the employee had continued to work. Company will continue the employee’s health coverage under any “group health plan” through the end of the month in which the leave began. even if leave was originally approved for a longer period. If the employee’s serious health condition is the result of an on-the-job injury or illness. Employees wishing to maintain health insurance during a period of approved OFLA leave will be responsible for bearing the cost of coverage. Job Protection Employees returning to work from Family Medical Leave will be reinstated to their former position. Benefits While on Leave If an employee is on approved Family Medical Leave under FMLA.

or who use Family Medical Leave for reasons other than the reason for which leave had been granted. Employees who work for other employers during their leave. 122 . may be subject to discipline up to and including termination.Time off and leaves of absence Employees are on leave because they are unable to work.

Time off and leaves of absence EMPLOYEE RIGHTS AND RESPONSIBILITIES UNDER THE FMLA 123 .

Time off and leaves of absence CERTIFICATION OF HEALTH-CARE PROVIDER (EMPLOYEE) 124 .

Time off and leaves of absence 125 .

Time off and leaves of absence 126 .

Time off and leaves of absence 127 .

Time off and leaves of absence CERTIFICATION OF HEALTH-CARE PROVIDER (FAMILY MEMBER) 128 .

Time off and leaves of absence 129 .

Time off and leaves of absence 130 .

Time off and leaves of absence 131 .

Time off and leaves of absence NOTICE OF ELIGIBILITY AND RIGHTS & RESPONSIBILITIES 132 .

Time off and leaves of absence 133 .

Time off and leaves of absence DESIGNATION NOTICE 134 .

Time off and leaves of absence CERTIFICATION OF QUALIFYING EXIGENCY 135 .

Time off and leaves of absence 136 .

Time off and leaves of absence 137 .

Time off and leaves of absence CERTIFICATION FOR SERIOUS INJURY OR ILLNESS OF COVERED SERVICEMEMBER 138 .

Time off and leaves of absence 139 .

Time off and leaves of absence 140 .

Time off and leaves of absence 141 .

specific job duties the employee may perform on a limited basis. including but not limited to. and specific job duties the employee may not perform at all): ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ The employee’s restrictions will continue until (indicate the date each restriction listed in the preceding answer will end): _______________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ I will next examine the employee on: ________________________________________________ Physician’s Signature/Date 142 . hours of work. the employee may return to work without restriction on: ________________  In my opinion. the employee may return to work with the restrictions described below on: __________________________________________________________________________ The employee has the following restrictions (indicate all restrictions on the employee’s work activities.Time off and leaves of absence PHYSICIAN’S RELEASE TO RETURN TO WORK Employee’s name:___________________________________ Date of release:_______________ Physician’s name and field of specialization:__________________________________________ I last examined or treated the employee on: ___________________________________________ I expect that condition to continue until: _____________________________________________  In my opinion.

an employee returning from medical leave must submit a doctor’s statement indicating that the employee has been released to return to work. If circumstances require an extension of the leave for any reason. the Company’s need to fill vacancies. the Company cannot guarantee reinstatement of the employee upon completion of an approved leave of absence. SAMPLE POLICY (if employer not covered by FMLA/OFLA) If an employee expects to be absent from work for more than three consecutive days (weekends included) as a result of illness. the employee must provide the Company with a physician’s statement attesting to the employee’s continued medical condition and inability to work. If an employee is unable to return to work after 26 weeks. employers in Oregon had broad discretion to define their medical leave of absence policies. The employee also may be required to submit to an examination by a physician selected by the Company before the leave of absence will be approved. subject to budgetary restrictions. Whatever policy an employer chooses to use. medical leaves of absence under this policy are unpaid. he or she must submit a written request for medical leave to the Human Resources Department at least 30 days before the anticipated commencement of the leave. and/or long-term disability benefits under the Company’s policies. The written leave request normally should follow this notification by no more than three days. the Company will make every effort to return the employee to a comparable job. However. however. In the case of an emergency or when 30-days’ notice cannot otherwise be provided. Unless otherwise required by applicable law. his or her employment will be terminated. short-term disability benefits. an employee on medical leave may be eligible for paid sick days. As a general matter. Those employers not covered by the FMLA/OFLA still have that discretion. it must be consistently applied. the employee’s request for medical leave must be supported by a physician’s certification of the medical need for leave. 143 . In addition. The maximum duration of a medical leave of absence is 26 weeks.Time off and leaves of absence Employers not covered by FMLA/OFLA Until the enactment of the FMLA/OFLA. In all situations. This certification must be furnished within 15 days of the employee’s leave request. and the Company’s ability to find qualified temporary replacements. injury. the employee or a member of the employee’s immediate family must notify the employee’s supervisor or manager as soon as possible. Nonetheless. or other disability (including pregnancy).

Time off and leaves of absence REQUEST FORM FOR NON-FMLA/OFLA LEAVE Employee’s name:______________________________ Date of request: _____________________ My department and job title are: ______________________________________________________ My supervisor is: __________________________________________________________________ My seniority date is:________________________________________________________________ I request a leave of absence for the following reason: _____________________________________       Personal illness or injury Illness or injury of a family member Military duty Jury duty Subpoenaed as witness Other _______________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ I would like the leave to begin on:_____________________________________________________ I expect to return to work on:_________________________________________________________ Address and phone number while on leave: _____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Employee’s Signature Date 144 .

This leave of absence period includes ___________ days of paid vacation and _________ days of personal leave.Time off and leaves of absence REQUEST FOR LEAVE OF ABSENCE (NON-FMLA/OFLA) This form must be completed by the personnel director AND the employee. DATE: TO: FROM: {Date} PERSONNEL DEPARTMENT {Employee Name} GENERAL INFORMATION 1. 145 . Type of leave of absence requested: (Medical or non-medical) _______________________ __________________________________________________________________________ __________________________________________________________________________ 2. Date of leave of absence: FROM: _____________________ Day leave begins TO: ___________________ Day leave ends 4. Reason for leave of absence:___________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 3.

my employment will be terminated.Time off and leaves of absence TERMS AND CONDITIONS RELATING TO YOUR LEAVE OF ABSENCE: Returning to Work I understand that if my leave was for medical reasons. I must present a doctor’s statement (stating that I am unable to work or identifying any limitations to my work activity) when I return to work. Employee’s Signature/Date 146 . I also understand that the Company will make every reasonable effort to place me in the same or a comparable position when I return to work. I further understand that if I refuse. without reasonable cause. any of the positions offered to me upon my return.

An employee must give the employer reasonable advance notice of the intention to take leave unless unfeasible and the employer may require certification of the need for leave. Documents pertaining to an employee’s leave should be kept in a separate file from the employee’s personnel file and access should be restricted. as well as parents or guardians of minor children who are victims. Unless required by contract. an employer must provide domestic violence leave to an eligible employee. sexual assault or stalking or is a parent or guardian of a minor child or dependent who is a victim and • leave is for an authorized purpose. domestic violence leave may overlap with other types of unpaid leave. obtaining counseling or services from a victim services provider. All information and documentation pertaining to the leave. leave provided as a reasonable accommodation under disability laws. 147 . a new Oregon law went into effect that permits employees who are victims of domestic violence. collective bargaining agreement or employer policy. sexual assault or stalking to take unpaid leave from work for a reasonable period of time to seek assistance. Moreover. including the fact the employee requested or obtained leave. The law applies to employers with 6 or more employees in Oregon for each working day during 20 or more calendar workweeks in the year in which an eligible employee takes leave.Time off and leaves of absence Domestic violence leave In 2007. Except where it would impose undue hardship. Depending on the circumstances. an employer is prohibited from discriminating or retaliating against an employee who requests and or takes leave. an employer must permit the employee to use any accrued vacation or other paid leave. An employee is eligible to take leave if he or she: • • has worked an average of more than 25 hours per week for at least 180 days immediately before the date the employee takes leave is a victim of domestic violence. Employers should review and revise leave and other affected policies to ensure immediate compliance. An “authorized purpose” includes seeking legal or law enforcement assistance or remedies – seeking medical treatment or recovering from injuries. or relocating or taking steps to secure a safe home for the employee or minor child. including family and medical leave. an employer is not required to grant paid leave – however. and leave for victims of crime. must be kept strictly confidential and cannot be released without the employee’s express authorization. The law applies to victims.

Notice of need to take leave should be provided by submitting a request for leave in writing to your supervisor as far in advance as possible. Pregnancy Discrimination Act (PDA) Employers of 15 or more employees should be aware of the Pregnancy Discrimination Act (PDA). you should provide as much advance notice as is practicable of your intention to take leave. Moreover. When taking leave in an unanticipated or emergency situation. you must give oral or written notice as soon as is practicable.Time off and leaves of absence DOMESTIC VIOLENCE LEAVE POLICY (leave to address specific crimes) Any Oregon employee who has worked an average of at least 25 hours per week for 180 days is eligible for reasonable unpaid leave to address domestic violence. member of the clergy. or related medical conditions is a form of prohibited sex discrimination. Leave is generally unpaid. or victim services provider. indicating the time needed and when it is needed and the reason for the leave. to seek counseling from a licensed mental health professional. or documentation from a law enforcement officer. protective order or other evidence of a court proceeding. In essence. The PDA amended Title VII to provide that discrimination on the basis of pregnancy. It constitutes a disability leave due to the medical aspects of pregnancy and childbirth. 1. Pregnancy leave is unique because it may encompass two different types of leave. If more leave than originally authorized needs to be taken. employers should be cautious in adopting leave policies that provide no leave or insufficient leave for pregnancy-related disability to avoid drawing a discrimination charge on the theory that such a policy has an adverse impact on female employees. Female employees who are pregnant must therefore be allowed to take disability leaves of absence for pregnancy that are commensurate with leaves available to other employees for other medical conditions. 148 . When seeking this type of leave. sexual assault. such as a police report. or to relocate or secure an existing home. but you may use any accrued vacation or similar paid time off while on this type of leave. Company will then generally require certification of the need for the leave. this notice may be given by any other person on your behalf. to seek medical treatment for or recover from injuries. childbirth. When leave is unanticipated. or stalking of the employee or his or her minor dependants. attorney. unless giving the advance notice is not feasible. Reasons for taking leave include the need to seek legal or law enforcement assistance or remedies. employers cannot treat pregnancy leave less favorably than they treat other types of disability leave. healthcare professional. you should give Company notice as soon as is practicable prior to the end of the authorized leave. to obtain services from a victim services provider.

if applicable. Additionally. its policy should state whether the employee will be entitled to pay during this period and the conditions for taking such leave. then the employer should treat pregnancy leave solely as a type of disability leave and not allow the mother additional time off solely to care for the child. that leave also must be made available to male employees on an equal basis. If an employer allows its female employees to take this latter type of parenting leave. Overlap of Americans with Disabilities Act (ADA) and Oregon’s disability law and workers’ compensation Employers of 15 or more employees (or six or more under Oregon’s disability law) also should be aware of the potential application of the ADA and Oregon’s disability law in cases involving medical leaves of absence. except to the extent required by FMLA/OFLA. the employer should draft the policy carefully so as to avoid any apparent promise of reinstatement upon completion of an employee’s personal leave. It also may be a type of parenting leave to the extent that it provides the employee with time to care for her newborn child. Such an employee would be entitled to a reasonable accommodation of his or her disability if the employee could perform essential job functions with such an accommodation. including a leave protected by the FMLA/OFLA. if an employer not covered by FMLA/OFLA does not wish to allow its male employees leave to care for a newborn child. If an employer chooses to voluntarily provide such leave. Therefore.Time off and leaves of absence 2. Personal leaves of absence Employers are not obligated by either federal or state law to provide personal leaves of absence to their employees. Under the ADA and Oregon’s disability law. Additionally. employees who sustain on-the-job injuries and who qualify for workers’ compensation benefits may be eligible for leave periods greater than what FMLA or OFLA requires. Employers are advised to consult with an attorney regarding these overlapping laws. might be considered a qualified individual with a disability upon his or her return to work. an employee who takes a medical leave. 149 . Employers therefore should be careful not to terminate an employee who desires to return to work but whose leave period has expired without first determining whether the employee is protected by the ADA or by Oregon’s disability law.

the law does not require employers to provide any specific amount of such leave. Although such payments are not mandated by law (except as discussed below). or sibling. employers should be aware. SAMPLE POLICY Bereavement leave will be granted to full-time employees in the event of absence necessitated by the death of a family member. Bereavement leave There is no obligation under federal or state law to provide unpaid or paid bereavement leave to employees.Time off and leaves of absence SAMPLE POLICY A full-time employee who has completed at least one year of service with the Company may request an unpaid personal leave of absence for a period of up to 30 days. In the event of the death of an employee’s spouse. father. If bereavement leave is offered. that this is a benefit commonly offered by employers. Personal days or vacation days may be used if additional time off is needed. federal law creates certain job protections for employees who take temporary leaves of absence for active or reserve military duty. A personal leave must be requested in writing at least two weeks in advance. in which case oral notification should be followed by written application for the leave. All unused. or son. Some employers also require proof of the death or the relationship to the employee to prevent abuse of the benefit. parent. from the standpoint of recruiting and retaining the most highly qualified employees. In the event of the death of an employee’s grandparent.or daughter-in-law. but will make every effort to reinstate employees to their former positions if business requirements permit. provided the leave does not seriously disrupt the Company’s operations. 150 . However. the employee will be granted three days off work with pay. unless necessitated by an emergency. child. Personal leave may be granted for any justifiable reason at the Company’s discretion. Military leave The sample policy contains a provision for partial wage payments to employees on a short-term military leave of absence. Requests for bereavement leave should be made to the employee’s immediate supervisor before the leave is to begin. A bereavement leave policy should specify eligibility requirements and conditions for such leave.or mother-in-law. the employee will be granted one day off work with pay. The Company cannot guarantee reinstatement to employees returning from personal leave (unless such leave is covered by the Family and Medical Leave Act). accrued vacation and personal days must be used before a personal leave will be granted. including the relationship of the deceased to the employee.

the employer may be able to avoid the legal requirement to reinstate an employee upon return from military leave. to an alternative position of like seniority.Time off and leaves of absence Uniformed Services Employment and Re-employment Rights Act (USERRA) The Uniformed Services Employment and Re-employment Rights Act of 1994 (USERRA) prohibits employers from terminating any employee – unless the employee is employed for a brief. in some circumstances. In addition. and pay for which the employee is qualified. the employee must be reinstated to the position he or she held when the military leave began. to the extent such coverage is otherwise provided. If the length of service is 181 days or more. Finally. Reinstated employees also are entitled to full seniority benefits. then the individual must apply for reinstatement within 14 days of completion of service. Upon return from military leave. Employees who desire reinstatement under USERRA must apply for reinstatement within a limited period following termination of their military service. 151 . an employee is entitled to reinstatement in a position that the employee would have obtained if he or she had been continuously employed or. in some circumstances. the employee generally must report for reinstatement on the first regularly scheduled working day following his or her completion of the service. the employee may not be discharged for one year subsequent to the employee’s return except for just cause. coverage must be offered to the employee – at a cost to the employee of not more than 102 percent of actual premium costs – for a period of up to 18 months. and pay. non-recurrent period and has no reasonable expectation that employment will continue – who indefinitely takes a leave of absence of up to five years (or more in limited circumstances) for active or reserve military service. If the military leave is 30 days or less. status. Employees taking military leave also are entitled to elect to continue health care coverage. status. for a period of up to 31 days. in a position of like seniority. annual. If the period of service is between 31 and 180 days. employees taking military leave under the USERRA may use any accrued vacation. After 31 days. Employers are advised to consult with legal counsel regarding USERRA rights and responsibilities. then the employee may not be discharged without just cause for a period of six months after reinstatement. then the employee has up to 90 days to apply for reinstatement under USERRA. or similar leave in lieu of unpaid leave. Under very limited circumstances in which the employer can show that reinstatement would be impossible or unreasonable. if an employee is absent for more than 180 days for military duty. or in which reinstatement would pose an undue hardship on the employer. If unqualified for such a position. or. If the military leave is more than 30 but less than 181 days.

As in the sample policy. Jury duty Although neither federal nor state law requires employers to pay employees for jury duty. however. and may elect to continue health-care benefits to the extent permitted by law. Military reservist employees and those volunteering for or called to active military duty are entitled to re-employment with the Company upon their return from duty in full compliance with all applicable federal and state laws. SAMPLE POLICY ABC Company will grant employees time off for mandatory jury duty and/or jury duty orientation. 152 . during their leave of absence. A copy of the court notice must be submitted to the employee’s manager to verify the need for such leave. any requirements for receiving jury duty pay from the employer should be outlined in the policy. including discipline or discharge. It is the employee’s responsibility to keep his or her supervisor or manager informed about the amount of time required for jury duty and to provide documentation regarding the amount of jury duty pay received in order to receive the Company-provided compensation supplement.Time off and leaves of absence SAMPLE POLICY ABC Company provides compensation for two weeks during annual reserve and national guard military training for regular full-time employees who have completed the orientation period. Regular part-time and temporary employees do not qualify for military leave compensation. In addition. Time spent on military leave will not be counted as vacation time used. federal law prohibits employers from taking any adverse action. employees who request a military leave of absence may elect to use any accrued vacation pay in lieu of unpaid leave. against an employee who is absent from work because of jury service. As a measure of goodwill towards employees. besides the military leave benefits discussed above. The amount of the military leave compensation paid is the difference between military pay and regular pay based on a 40-hour workweek. The employee will receive the difference between jury duty pay and his or her normal salary or wage for each day of jury duty up to a maximum of five days per year in addition to any other paid leave. many employers elect to supplement jury duty pay so that employees continue to receive their regular compensation during this time. The employee is expected to report for work when doing so does not conflict with court obligations.

The “stimulus bill” signed by President Obama in February 2009. full-time employees. Under ARRA. COBRA While the Consolidated Omnibus Budget Reconciliation Act (COBRA) does not require that employers offer health insurance coverage. 2009. and then refer employees to the relevant insurance documents for further information. Failure to comply with COBRA’s terms can result in significant penalties and expense to covered employers. contains $21 billion for expanded COBRA continuation rights. employers who do provide such coverage and who employ more than 20 employees are governed by COBRA. Briefly.Chapter 8 Employee benefits Health insurance Employers are not required by law to provide their employees with health insurance. Part-time employees are not eligible for health-insurance coverage. full-time employees. COBRA requires covered employers to provide continuing coverage to qualified departing employees and/or their beneficiaries in certain circumstances. As other employee benefits are offered by the Company. These documents govern all issues relating to employee health insurance. Those employees who wish to have their dependents included in the insurance plan are required to pay a portion of the monthly premium for that coverage on a payroll deduction basis. employees will be advised and provided with copies of relevant plan documents. The employee handbook should simply provide general descriptions of the available health benefits in the policy. Employers who choose to offer such benefits should distribute complete insurance information to employees regarding these benefits rather than including such detailed information in an employee handbook. with new provisions effective as of March 1. SAMPLE POLICY ABC Company offers medical insurance for all of its regular. The group insurance policy and the summary plan description issued to employees set out the terms and conditions of the health insurance plan. Employers must also notify covered employees and their spouses of their rights under COBRA within the first 90 days of coverage under any health plan or within 30 days after a qualifying event occurs. Copies are available from the Human Resources office. The Company pays the cost of individual coverage for its regular. also known as the American Recovery and Reinvestment Act of 2009 (ARRA). covered employers must offer eligible former employees who have previously declined COBRA coverage 153 .

specifically.doc and available in Spanish via the Department of Labor’s web site. and still have it. Employers are advised to consult with legal counsel regarding the new law.dol. but does not include the COBRA coverage election information.gov/ebsa/modelelectionnotice. 2009. 2008. have already elected COBRA coverage. who experienced a qualifying event at any time from September 1. not just covered employees. General Notice (Full version): Plans subject to COBRA must send the General Notice to all qualified beneficiaries. all eligible former employees who were/are voluntarily terminated between September 1. Model General Notice of COBRA Continuation Coverage Rights (presented at time of hire): also available at www. and requirements for seeking reimbursement of the COBRA coverage subsidized by the employer. if any.Employee benefits a new 60-day period to elect COBRA and receive a reduced health premium. regardless of the type of qualifying event. It may be sent in lieu of the full version to individuals who experienced a qualifying event during on or after September 1. and who either have not yet been provided an election notice or who were provided an election notice on or after February 17. 2009. Employees are not eligible if their involuntary termination was for “gross misconduct” as defined under the COBRA regulations. Model Notice in Connection with Extended Election Periods: This should be provided to qualified beneficiaries who: ■ • • • • • have received a COBRA election notice 154 . and available in Spanish via the Department of Labor’s web site. 2009 that did not include the additional information required by ARRA. 2008.dol. and December 31. This full version includes information on the premium reduction as well as information required in a COBRA election notice. but should receive notice of the premium reduction. to COBRA continuation coverage. Model COBRA Continuation Coverage (presented at time of qualifying event): also available at www.gov/ebsa/modelgeneralnotice.doc. 2008 through December 31. pay only 35 percent of their COBRA premiums (the remaining 65 percent is reimbursed to the coverage provider or employer through a tax credit). The following sample COBRA forms are included in this chapter: • COBRA Information: An internal recordkeeping form. General Notice (Abbreviated version): The abbreviated version of the General Notice includes the same information as the full version regarding the availability of the premium reduction and other rights under ARRA. Employers are encouraged to discuss with health insurance administrators or third-party COBRA providers regarding what information should be kept regarding departing employees and their entitlement. Eligible former employees who have previously elected COBRA should start receiving the subsidy and do not need to make a new election.

these notices may be provided by that administrator.gov/ebsa/COBRAmodelnotice.html (see pages 157-201). or who elected COBRA but subsequently discontinued it. 155 . These forms can be downloaded from www.) Employers should consult with their third-party administrator of COBRA benefits and/or legal counsel to determine what specifics should be included in the various notices employees are required to receive. The “General Notices” and “Model Notice In Connection with Extended Election Periods” may be used to replace or supplement the “Model General Notice of COBRA Continuation Coverage Rights” and/or the “Model COBRA Continuation Coverage” notice. employers are strongly encouraged to seek legal guidance on this law’s notice requirements. For those employers utilizing an external health care administrator.Employee benefits ■ are not currently enrolled in COBRA and ■ who had a qualifying event during the period beginning 9/1/08 through 2/16/09. The notice informs them about their extended COBRA election period and the availability of the subsidy. and when those notices should be provided. (Note: Given the complexity of COBRA laws and regulations.dol. This includes persons who never elected COBRA.

V Voluntary Quit X Disabled O Other DEPENDENTS A Over dependent or student age D Divorced I Dependent.Employee benefits COBRA INFORMATION EMPLOYER:________________________________ QUALIFYING PERSON: (Please check one)  Employee  Dependent (Complete Employee/Dependent Information) NAME:___________________________________ PHONE: __________________________________ BIRTH DT: _______________________________ ADDRESS:___________________________ EMPLOYEE NUMBER:________________ EE HIRE DATE: ______________________ DATE OF QUALIFYING EVENT: (Termination/Divorce/Other) __________________________ COVERAGE: SINGLE  FAMILY CLASS CODE: _________________ Is employee and/or dependent covered under another group insurance plan? Employee:  Yes  No Dependent:  Yes  No ******************************************************************************* SPOUSE/DEPENDENT NAME: ____________________ RELATIONSHIP: _______________ DEPENDENT S. please give address if different from employee’s: ___________________________________________ ___________________________________ ******************************************************************************* COBRA QUALIFYING EVENT:/:VALID CODES FOR QUALIFYING ARE: EX-EMPLOYEE B Company Bankruptcy F Fired (Eligible) G Fired (Gross misconduct) H Hours Reduced L Lay Off M Eligible for Medicare R Retired T Takeover by New Admin. S. no coverage P Death of employee ADDITIONAL INFORMATION: ____________________________________________________ EMPLOYEE SIGNATURE:_________________________________________________________ Date Received:______________________________________ Date Entered: __________________ 156 . NUMBER: _____________________ DATE OF BIRTH: ______________ If dependent.

as appropriate and check appropriate box or boxes. COBRA continuation coverage will cost: [enter amount each qualified beneficiary will be required to pay for each option per month of coverage and any other permitted coverage periods. If you do not elect COBRA continuation coverage. which will continue group health care coverage under the Plan for up to ___ months [enter 18 or 36.Employee benefits MODEL COBRA CONTINUATION COVERAGE (FOR USE BY SINGLE-EMPLOYER GROUP HEALTH PLANS) [Enter date of notice] Dear: [Identify the qualified beneficiary(ies).] You do not have to send any payment with the Election Form. Please read the information contained in this notice very carefully. names may be added]:     Employee or former employee Spouse or former spouse Dependent child(ren) covered under the Plan on the day before the event that caused the loss of coverage Child who is losing coverage under the Plan because he or she is no longer a dependent under the Plan If elected. Important additional information about payment for COBRA continuation coverage is included in the pages following the Election Form. COBRA continuation coverage will begin on [enter date] and can last until [enter date]. by name or status] This notice contains important information about your right to continue your health care coverage in the [enter name of group health plan] (the Plan). if appropriate: You may elect any of the following options for COBRA continuation coverage: [list available coverage options]. [Add. 157 . your coverage under the Plan will end on [enter date] due to [check appropriate box]:  End of employment  Death of employee  Entitlement to Medicare  Reduction in hours of employment  Divorce or legal separation  Loss of dependent child status Each person (“qualified beneficiary”) in the category(ies) checked below is entitled to elect COBRA continuation coverage. To elect COBRA continuation coverage. follow the instructions on the next page to complete the enclosed Election Form and submit it to us.

_________________________________________________________________________ [Add if appropriate: Coverage option elected: _______________________________] c. If you do not submit a completed Election Form by the due date shown above. Read the important information about your rights included in the pages after the Election Form. with telephone number and address]. Send completed Election Form to: [Enter Name and Address] This Election Form must be completed and returned by mail [or describe other means of submission and due date].Employee benefits If you have any questions about this notice or your rights to COBRA continuation coverage. you will lose your right to elect COBRA continuation coverage. Under federal law. if you change your mind after first rejecting COBRA continuation coverage. However. you should contact [enter name of party responsible for COBRA administration for the Plan. complete this Election Form and return it to us. you must have 60 days after the date of this notice to decide whether you want to elect COBRA continuation coverage under the Plan. you may change your mind as long as you furnish a completed Election Form before the due date. your COBRA continuation coverage will begin on the date you furnish the completed Election Form. I (We) elect COBRA continuation coverage in the [enter name of plan] (the Plan) as indicated below: Name Date of Birth Relationship to Employee SSN (or other identifier) a. it must be post-marked no later than [enter date]. _________________________________________________________________________ [Add if appropriate: Coverage option elected: _______________________________] b. If you reject COBRA continuation coverage before the due date. COBRA Continuation Coverage Election Form Instructions: To elect COBRA continuation coverage. If mailed. _________________________________________________________________________ [Add if appropriate: Coverage option elected: _______________________________] _____________________________________ Signature ______________________________________ Print Name ______________________________________ ______________________________________ ______________________________________ Print Address ______________________________ Telephone number _____________________________ Date _____________________________ Relationship to individual(s) listed above 158 .

divorce or legal separation. coverage may be continued for up to a total of 36 months. 159 . This notice shows the maximum period of continuation coverage available to the qualified beneficiaries. and the employee became entitled to Medicare benefits less than 18 months before the qualifying event. coverage generally may be continued only for up to a total of 18 months. Each qualified beneficiary who elects continuation coverage will have the same rights under the Plan as other participants or beneficiaries covered under the Plan. including [add if applicable: open enrollment and] special enrollment rights. or both) after electing continuation coverage. How long will continuation coverage last? In the case of a loss of coverage due to end of employment or reduction in hours of employment. a qualified beneficiary becomes entitled to Medicare benefits (under Part A. Continuation coverage may also be terminated for any reason the Plan would terminate coverage of a participant or beneficiary not receiving continuation coverage (such as fraud). and the dependent children of the covered employee. “qualified beneficiaries” can include the employee (or retired employee) covered under the group health plan. Part B. Continuation coverage will be terminated before the end of the maximum period if: • • • • any required premium is not paid in full on time. after electing continuation coverage. or the employer ceases to provide any group health plan for its employees. When the qualifying event is the end of employment or reduction of the employee’s hours of employment. the employee’s becoming entitled to Medicare benefits or a dependent child ceasing to be a dependent under the terms of the plan. the covered employee’s spouse. In the case of losses of coverage due to an employee’s death. COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. Continuation coverage is the same coverage that the Plan gives to other participants or beneficiaries under the Plan who are not receiving continuation coverage. Depending on the type of qualifying event. a qualified beneficiary becomes covered.Employee benefits Important Information About Your COBRA Continuation Coverage Rights What is continuation coverage? Federal law requires that most group health plans (including this Plan) give employees and their families the opportunity to continue their health care coverage when there is a “qualifying event” that would result in a loss of coverage under an employer’s plan. under another group health plan that does not impose any pre-existing condition exclusion for a pre-existing condition of the qualified beneficiary.

Disability An 11-month extension of coverage may be available if any of the qualified beneficiaries is determined by the Social Security Administration (SSA) to be disabled.Employee benefits [If the maximum period shown on page 1 of this notice is less than 36 months. Continuation coverage may be elected for only one. you must complete the Election Form and furnish it according to the directions on the form. Each qualified beneficiary has a separate right to elect continuation coverage. A parent may elect to continue coverage on behalf of any dependent children. the covered employee’s becoming entitled to Medicare benefits (under Part A. Failure to provide notice of a disability or second qualifying event may affect the right to extend the period of continuation coverage. The maximum amount of continuation coverage available when a second qualifying event occurs is 36 months. or for all dependent children who are qualified beneficiaries. The disability has to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. Such second qualifying events may include the death of a covered employee. several. [Describe Plan provisions for requiring notice of disability determination. For example. add the following three paragraphs:] How can you extend the length of COBRA continuation coverage? If you elect continuation coverage. Part B. including time frames and procedures.] Each qualified beneficiary who has elected continuation coverage will be entitled to the 11-month disability extension if one of them qualifies. Second Qualifying Event An 18-month extension of coverage will be available to spouses and dependent children who elect continuation coverage if a second qualifying event occurs during the first 18 months of continuation coverage. or both). These events can be a second qualifying event only if they would have caused the qualified beneficiary to lose coverage under the Plan if the first qualifying event had not occurred. How can you elect COBRA continuation coverage? To elect continuation coverage. divorce or separation from the covered employee. You must notify the Plan within 60 days after a second qualifying event occurs if you want to extend your continuation coverage. the employee’s spouse may elect continuation coverage even if the employee does not. If the qualified beneficiary is determined by SSA to no longer be disabled. an extension of the maximum period of coverage may be available if a qualified beneficiary is disabled or a second qualifying event occurs. 160 . You must notify [enter name of party responsible for COBRA administration] of a disability or a second qualifying event in order to extend the period of continuation coverage. you must notify the Plan of that fact within 30 days after SSA’s determination. The employee or the employee’s spouse can elect continuation coverage on behalf of all of the qualified beneficiaries. or a dependent child’s ceasing to be eligible for coverage as a dependent under the Plan.

doleta. in the case of an extension of continuation coverage due to a disability. you can lose the right to avoid having pre-existing condition exclusions applied to you by other group health plans if you have more than a 63-day gap in health coverage. each qualified beneficiary may be required to pay the entire cost of continuation coverage. You are responsible for making sure that the amount of your first payment is correct. you will lose all continuation coverage rights under the Plan. you will lose the guaranteed right to purchase individual health insurance policies that do not impose such pre-existing condition exclusions if you do not get continuation coverage for the maximum time available to you. If you have questions about these new tax provisions. More information about the Trade Act is also available at www. How much does COBRA continuation coverage cost? Generally. You may contact [enter appropriate contact information. Under the new tax provisions. e. Second.cfm.Employee benefits In considering whether to elect continuation coverage. 161 . When and how must payment for COBRA continuation coverage be made? First payment for continuation coverage If you elect continuation coverage. you must make your first payment for continuation coverage not later than 45 days after the date of your election. if mailed. you may call the Health Coverage Tax Credit Customer Contact Center toll-free at 1-866-628-4282. [If employees might be eligible for trade adjustment assistance.. including continuation coverage.) If you do not make your first payment for continuation coverage in full not later than 45 days after the date of your election. You have the right to request special enrollment in another group health plan for which you are otherwise eligible (such as a plan sponsored by your spouse’s employer) within 30 days after your group health coverage ends because of the qualifying event listed above. However. the following information may be added: The Trade Act of 2002 created a new tax credit for certain individuals who become eligible for trade adjustment assistance and for certain retired employees who are receiving pension payments from the Pension Benefit Guaranty Corporation (PBGC) (eligible individuals). (This is the date the Election Notice is post-marked.g. You will also have the same special enrollment right at the end of continuation coverage if you get continuation coverage for the maximum time available to you.gov/tradeact/2002act_index. and election of continuation coverage may help you not have such a gap. The required payment for each continuation coverage period for each option is described in this notice. you should take into account that a failure to continue your group health coverage will affect your future rights under federal law. Finally. you do not have to send any payment with the Election Form. 150 percent) of the cost to the group health plan (including both employer and employee contributions) for coverage of a similarly situated plan participant or beneficiary who is not receiving continuation coverage. First. The amount a qualified beneficiary may be required to pay may not exceed 102 percent (or. the Plan Administrator or other party responsible for COBRA administration under the Plan] to confirm the correct amount of your first payment. TTD/TTY callers may call toll-free at 1-866-626-4282. eligible individuals can either take a tax credit or get advance payment of 65% of premiums paid for qualified health insurance. you should take into account that you have special enrollment rights under federal law.

Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit the EBSA website at www. If you have any questions concerning the information in this notice. but before the end of the grace period for the coverage period. The periodic payments can be made on a monthly basis. enter with appropriate dates: You may instead make payments for continuation coverage for the following coverage periods. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website. including COBRA. you will be given a grace period of 30 days after the first day of the coverage period [or enter longer period permitted by Plan] to make each periodic payment. For more information about your rights under ERISA.S. you will be required to make periodic payments for each subsequent coverage period. Under the Plan. your coverage under the Plan will be suspended as of the first day of the coverage period and then retroactively reinstated (going back to the first day of the coverage period) when the periodic payment is received. you will lose all rights to continuation coverage under the Plan. you should contact [enter name of party responsible for COBRA administration for the Plan. The Plan [select one: will or will not] send periodic notices of payments due for these coverage periods. each of these periodic payments for continuation coverage is due on the [enter due day for each monthly payment] for that coverage period. your rights to coverage. enter and modify as necessary: However. The amount due for each coverage period for each qualified beneficiary is shown in this notice.dol. with telephone number and address]. contact the U.gov/ebsa. If you make a periodic payment on or before the first day of the coverage period to which it applies. Your first payment and all periodic payments for continuation coverage should be sent to: [enter appropriate payment address] For more information This notice does not fully describe continuation coverage or other rights under the Plan. if you pay a periodic payment later than the first day of the coverage period to which it applies. due on the following dates:]. [If Plan suspends coverage during grace period for nonpayment. More information about continuation coverage and your rights under the Plan is available in your summary plan description or from the Plan Administrator. Your continuation coverage will be provided for each coverage period as long as payment for that coverage period is made before the end of the grace period for that payment. [If Plan offers other payment schedules.] If you fail to make a periodic payment before the end of the grace period for that coverage period. and other laws affecting group health plans. This means that any claim you submit for benefits while your coverage is suspended may be denied and may have to be resubmitted once your coverage is reinstated. Grace periods for periodic payments Although periodic payments are due on the dates shown above.Employee benefits Periodic payments for continuation coverage After you make your first payment for continuation coverage. your coverage under the Plan will continue for that coverage period without any break.) 162 . the Health Insurance Portability and Accountability Act (HIPAA). or if you want a copy of your summary plan description.

You should also keep a copy.Employee benefits Keep Your Plan Informed of Address Changes In order to protect your and your family’s rights. of any notices you send to the Plan Administrator. you should keep the Plan Administrator informed of any changes in your address and the addresses of family members. for your records. 163 .

164 . The right to COBRA continuation coverage was created by a federal law. It can also become available to other members of your family who are covered under the Plan when they would otherwise lose their group health coverage. you should review the Plan’s Summary Plan Description or contact the Plan Administrator. which is a temporary extension of coverage under the Plan. your spouse. or You become divorced or legally separated from your spouse. If you are an employee. qualified beneficiaries who elect COBRA continuation coverage [choose and enter appropriate information: must pay or are not required to pay] for COBRA continuation coverage. and what you need to do to protect the right to receive it. If you are the spouse of an employee. the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).” You. For additional information about your rights and obligations under the Plan and under federal law. you will become a qualified beneficiary if you lose your coverage under the Plan because any of the following qualifying events happens: • • • • • Your spouse dies. and your dependent children could become qualified beneficiaries if coverage under the Plan is lost because of the qualifying event. Your spouse’s hours of employment are reduced. Your spouse becomes entitled to Medicare benefits (under Part A. What is COBRA Continuation Coverage? COBRA continuation coverage is a continuation of Plan coverage when coverage would otherwise end because of a life event known as a “qualifying event. This notice contains important information about your right to COBRA continuation coverage. or both). After a qualifying event. Under the Plan. or Your employment ends for any reason other than your gross misconduct. Your spouse’s employment ends for any reason other than his or her gross misconduct.” Specific qualifying events are listed later in this notice. COBRA continuation coverage must be offered to each person who is a “qualified beneficiary. Part B. when it may become available to you and your family. you will become a qualified beneficiary if you lose your coverage under the Plan because either one of the following qualifying events happens: • • Your hours of employment are reduced.Employee benefits MODEL GENERAL NOTICE OF COBRA CONTINUATION COVERAGE RIGHTS (FOR USE BY SINGLE-EMPLOYER GROUP HEALTH PLANS) ** Continuation Coverage Rights Under COBRA** Introduction You are receiving this notice because you have recently become covered under a group health plan (the Plan). This notice generally explains COBRA continuation coverage. COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage.

165 . COBRA continuation coverage will be offered to each of the qualified beneficiaries. When is COBRA Coverage Available? The Plan will offer COBRA continuation coverage to qualified beneficiaries only after the Plan Administrator has been notified that a qualifying event has occurred. When the qualifying event is the end of employment or reduction of hours of employment. You Must Give Notice of Some Qualifying Events For the other qualifying events (divorce or legal separation of the employee and spouse or a dependent child’s losing eligibility for coverage as a dependent child). Part B.Employee benefits Your dependent children will become qualified beneficiaries if they lose coverage under the Plan because any of the following qualifying events happens: • • • • • • The parent-employee dies. death of the employee. you must notify the Plan Administrator within 60 days [or enter longer period permitted under the terms of the Plan] after the qualifying event occurs. the employer must notify the Plan Administrator of the qualifying event. add the following paragraph:] Sometimes. Covered employees may elect COBRA continuation coverage on behalf of their spouses. or The child stops being eligible for coverage under the plan as a “dependent child. or both). including a description of any required information or documentation. The retired employee’s spouse. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. and dependent children will also become qualified beneficiaries if bankruptcy results in the loss of their coverage under the Plan. and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan. [add if Plan provides retiree health coverage: commencement of a proceeding in bankruptcy with respect to the employer. Part B. The parent-employee’s employment ends for any reason other than his or her gross misconduct. The parents become divorced or legally separated. If a proceeding in bankruptcy is filed with respect to [enter name of employer sponsoring the plan]. You must provide this notice to: [Enter name of appropriate party]. filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying event. [Add description of any additional Plan procedures for this notice.] or the employee’s becoming entitled to Medicare benefits (under Part A. or both). surviving spouse. the retired employee will become a qualified beneficiary with respect to the bankruptcy. The parent-employee’s hours of employment are reduced. The parent-employee becomes entitled to Medicare benefits (Part A.] How is COBRA Coverage Provided? Once the Plan Administrator receives notice that a qualifying event has occurred.” [If the Plan provides retiree health coverage. and parents may elect COBRA continuation coverage on behalf of their children.

including a description of any required information or documentation. or if the dependent child stops being eligible under the Plan as a dependent child. you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage. There are two ways in which this 18-month period of COBRA continuation coverage can be extended. For example. Part B. and the time period for giving notice. for a maximum of 36 months. becomes entitled to Medicare benefits (under Part A.Employee benefits COBRA continuation coverage is a temporary continuation of coverage. or both). your divorce or legal separation. [Add description of any additional Plan procedures for this notice. but only if the event would have caused the spouse or dependent child to lose coverage under the Plan had the first qualifying event not occurred. if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates. 166 . Disability extension of 18-month period of continuation coverage If you or anyone in your family covered under the Plan is determined by the Social Security Administration to be disabled and you notify the Plan Administrator in a timely fashion. the name of the appropriate party to whom notice must be sent. or both). This extension may be available to the spouse and any dependent children receiving continuation coverage if the employee or former employee dies. Part B. COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare entitlement. When the qualifying event is the death of the employee. the employee’s becoming entitled to Medicare benefits (under Part A. which is equal to 28 months after the date of the qualifying event (36 months minus 8 months). The disability would have to have started at some time before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. when the qualifying event is the end of employment or reduction of the employee’s hours of employment. COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. and the employee became entitled to Medicare benefits less than 18 months before the qualifying event. for a total maximum of 29 months. Otherwise. COBRA continuation coverage generally lasts for only up to a total of 18 months. or gets divorced or legally separated. the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage.] Second qualifying event extension of 18-month period of continuation coverage If your family experiences another qualifying event while receiving 18 months of COBRA continuation coverage. COBRA continuation coverage lasts for up to a total of 36 months. if notice of the second qualifying event is properly given to the Plan. or a dependent child’s losing eligibility as a dependent child. When the qualifying event is the end of employment or reduction of the employee’s hours of employment.

gov/ebsa.) Keep Your Plan Informed of Address Changes In order to protect your family’s rights. the Health Insurance Portability and Accountability Act (HIPAA). you should keep the Plan Administrator informed of any changes in the addresses of family members. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit the EBSA website at www. contact the nearest Regional or District Office of the U.S. including COBRA. For more information about your rights under ERISA.Employee benefits If You Have Questions Questions concerning your Plan or your COBRA continuation coverage rights should be addressed to the contact or contacts identified below. for your records. and other laws affecting group health plans.dol. You should also keep a copy. Plan Contact Information [Enter name of group health plan and name (or position). of any notices you send to the Plan Administrator. address and phone number of party or parties from whom information about the plan and COBRA continuation coverage can be obtained on request 167 . (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.

To elect COBRA continuation coverage. by name or status] This notice contains important information about your right to continue your health care coverage in the [enter name of group health plan] (the Plan). follow the instructions on the following pages to complete the enclosed Election Form and submit it to us. and obligations and the “Application for Treatment as an Assistance Eligible Individual. restrictions. you should read this notice and the attached documents carefully. 2008 and ends with December 31. reference the “Summary of the COBRA Premium Reduction Provisions under ARRA” with details regarding eligibility.Employee benefits MODEL COBRA CONTINUATION COVERAGE ELECTION NOTICE (For use by group health plans for qualified beneficiaries who have not yet received an election notice and with qualifying events occurring during the period that begins with September 1. your coverage under the Plan will end on [enter date] due to [check appropriate box(es)]:  End of employment  Involuntary  Voluntary  Divorce or legal separation  Death of employee  Entitlement to Medicare  Reduction in hours of employment  Loss of dependent child status 168 .) [Enter date of notice] Dear: [Identify the qualified beneficiary(ies). 2008 and ends with December 31.” If you believe you meet the criteria for the premium reduction. You are receiving this election notice because you experienced a loss of coverage that occurred during the period that begins with September 1. In particular. 2009. 2009 and you may be eligible for the temporary premium reduction for up to nine months. complete the “Application for Treatment as an Assistance Eligible Individual” and return it with your completed Election Form. Please read the information contained in this notice very carefully. To help determine whether you can get the ARRA premium reduction. If you do not elect COBRA continuation coverage. The American Recovery and Reinvestment Act of 2009 (ARRA) reduces the COBRA premium in some cases.

] COBRA continuation coverage will cost: [enter amount each qualified beneficiary will be required to pay for each option per month of coverage and any other permitted coverage periods]. or an on-site medical clinic. a flexible spending arrangement (FSA). You do not have to send any payment with the Election Form. vision coverage. counseling coverage. 169 . insert: “To change the coverage option(s) for your COBRA continuation coverage to something different than what you had on the last day of employment. including a health reimbursement arrangement that qualifies as an FSA. Important additional information about payment for COBRA continuation coverage is included in the pages following the Election Form. names may be added]:  Employee or former employee  Spouse or former spouse  Dependent child(ren) covered under the Plan on the day before the event that caused the loss of coverage  Child who is losing coverage under the Plan because he or she is no longer a dependent under the Plan If elected. which will continue group health care coverage under the Plan for up to ___ months [enter 18 or 36. If you have any questions about this notice or your rights to COBRA continuation coverage. and cannot be limited to only dental coverage. COBRA continuation coverage will begin on [enter date] and can last until [enter date].Employee benefits Each person (“qualified beneficiary”) in the category(ies) checked below is entitled to elect COBRA continuation coverage. you should contact [enter name of party responsible for COBRA administration for the Plan. if appropriate: You may elect any of the following coverage options in which you are already enrolled for COBRA continuation coverage: [list available coverage options].] [If the plan permits Assistance Eligible Individuals to elect to enroll in coverage that is different than coverage in which the individual was enrolled at the time the qualifying event occurred. be offered to active employees. Available coverage options are: [insert list of available coverage options]. complete the “Form for Switching COBRA Continuation Coverage Benefit Options” and return it to us. If you qualify as an “Assistance Eligible Individual” this cost will be [include the amount that the Assistance Eligible Individual is required to pay for each option] for up to nine months. [Add. with telephone number and address].” The different coverage must cost the same or less than the coverage the individual had at the time of the qualifying event. as appropriate and check appropriate box or boxes.

_________________________________________________________________________ [Add if appropriate: Coverage option(s): _______________________________ c. Read the important information about your rights included in the pages after the Election Form I (We) elect COBRA continuation coverage in the [enter name of plan] (the Plan) as indicated below: Name Date of Birth Relationship to Employee SSN (or other identifier) a. your COBRA continuation coverage will begin on the date you furnish the completed Election Form. you have 60 days after the date of this notice to decide whether you want to elect COBRA continuation coverage under the Plan. if you change your mind after first rejecting COBRA continuation coverage. If mailed. it must be post-marked no later than [enter date]. Under federal law. you may change your mind as long as you furnish a completed Election Form before the due date. _________________________________________________________________________ [Add if appropriate: Coverage option(s): _______________________________ _____________________________________ Signature ______________________________________ Print Name ______________________________________ ______________________________________ ______________________________________ Print Address _____________________________ Date _____________________________ Relationship to individual(s) listed above ______________________________ Telephone number 170 . However.Employee benefits COBRA Continuation Coverage Election Form Instructions: To elect COBRA continuation coverage. Send completed Election Form to: [Enter Name and Address] This Election Form must be completed and returned by mail [or describe other means of submission and due date]. _________________________________________________________________________ [Add if appropriate: Coverage option(s): _______________________________ b. you will lose your right to elect COBRA continuation coverage. complete this Election Form and return it to us. If you do not submit a completed Election Form by the due date shown above. If you reject COBRA continuation coverage before the due date.

] Instructions: To change the benefit option(s) for your COBRA continuation coverage to something different than what you had on the last day of employment. _________________________________________________________________________ Old Coverage Option: ____________________________ New Coverage Option: __________________________ c. *THIS IS NOT YOUR ELECTION NOTICE* YOU MUST SEPARATELY COMPLETE AND RETURN THE ELECTION NOTICE TO SECURE YOUR COBRA CONTINUATION COVERAGE. Send completed form to: [Enter Name and Address] This form must be completed and returned by mail [or describe other means of submission and due date]. you have 90 days after the date of this notice to decide whether you want to switch benefit options. I (We) would like to change the COBRA continuation coverage option(s) in the [enter name of plan] (the Plan) as indicated below: Name Date of Birth Relationship to Employee SSN (or other identifier) a. it must be post-marked no later than [enter date]. If mailed. _________________________________________________________________________ Old Coverage Option: ____________________________ New Coverage Option: __________________________ b. _________________________________________________________________________ Old Coverage Option: ____________________________ New Coverage Option: __________________________ _____________________________________ Signature ______________________________________ Print Name ______________________________________ ______________________________________ ______________________________________ Print Address ______________________________ Telephone number 171 _____________________________ Date _____________________________ Relationship to individual(s) listed above . Under federal law. complete this form and return it to us.Employee benefits Form for Switching COBRA Continuation Coverage Benefit Options [Only use this model form if the plan permits Assistance Eligible Individuals to elect to enroll in coverage that is different than coverage in which the individual was enrolled at the time the qualifying event occurred.

COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. the covered employee’s spouse. Continuation coverage will be terminated before the end of the maximum period if: • • • • any required premium is not paid in full on time. including [add if applicable: open enrollment and] special enrollment rights. [If the maximum period shown on page 1 of this notice is less than 36 months. coverage generally may be continued only for up to a total of 18 months. Continuation coverage is the same coverage that the Plan gives to other participants or beneficiaries under the Plan who are not receiving continuation coverage. and the employee became entitled to Medicare benefits less than 18 months before the qualifying event. or the employer ceases to provide any group health plan for its employees. divorce or legal separation.Employee benefits Important Information About Your COBRA Continuation Coverage Rights What is continuation coverage? Federal law requires that most group health plans (including this Plan) give employees and their families the opportunity to continue their health care coverage when there is a “qualifying event” that would result in a loss of coverage under an employer’s plan. This notice shows the maximum period of continuation coverage available to the qualified beneficiaries. after electing continuation coverage. coverage may be continued for up to a total of 36 months. “qualified beneficiaries” can include the employee (or retired employee) covered under the group health plan. a qualified beneficiary first becomes covered. Each qualified beneficiary who elects continuation coverage will have the same rights under the Plan as other participants or beneficiaries covered under the Plan. add the following three paragraphs:] 172 . and the dependent children of the covered employee. a qualified beneficiary first becomes entitled to Medicare benefits (under Part A. the employee’s becoming entitled to Medicare benefits or a dependent child ceasing to be a dependent under the terms of the plan. or both) after electing continuation coverage. Continuation coverage may also be terminated for any reason the Plan would terminate coverage of a participant or beneficiary not receiving continuation coverage (such as fraud). In the case of losses of coverage due to an employee’s death. Part B. Depending on the type of qualifying event. When the qualifying event is the end of employment or reduction of the employee’s hours of employment. under another group health plan that does not impose any preexisting condition exclusion for a preexisting condition of the qualified beneficiary. How long will continuation coverage last? In the case of a loss of coverage due to end of employment or reduction in hours of employment.

A parent may elect to continue coverage on behalf of any dependent children. Disability An 11-month extension of coverage may be available if any of the qualified beneficiaries is determined under the Social Security Act (SSA) to be disabled. several. If the qualified beneficiary is determined to no longer be disabled under the SSA. Each qualified beneficiary has a separate right to elect continuation coverage. Failure to provide notice of a disability or second qualifying event may affect the right to extend the period of continuation coverage. First. including time frames and procedures. you must notify the Plan of that fact within 30 days after that determination. and election of continuation 173 . divorce or legal separation from the covered employee. the employee’s spouse may elect continuation coverage even if the employee does not. or both). The maximum amount of continuation coverage available when a second qualifying event occurs is 36 months. These events can be a second qualifying event only if they would have caused the qualified beneficiary to lose coverage under the Plan if the first qualifying event had not occurred. The employee or the employee’s spouse can elect continuation coverage on behalf of all of the qualified beneficiaries.] Each qualified beneficiary who has elected continuation coverage will be entitled to the 11-month disability extension if one of them qualifies.Employee benefits How can you extend the length of COBRA continuation coverage? If you elect continuation coverage. How can you elect COBRA continuation coverage? To elect continuation coverage. Second Qualifying Event An 18-month extension of coverage will be available to spouses and dependent children who elect continuation coverage if a second qualifying event occurs during the first 18 months of continuation coverage. Continuation coverage may be elected for only one. the covered employee’s becoming entitled to Medicare benefits (under Part A. [Describe Plan provisions for requiring notice of disability determination. You must notify the Plan within 60 days after a second qualifying event occurs if you want to extend your continuation coverage. You must notify [enter name of party responsible for COBRA administration] of a disability or a second qualifying event in order to extend the period of continuation coverage. an extension of the maximum period of coverage may be available if a qualified beneficiary is disabled or a second qualifying event occurs. The disability has to have started at some time on or before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. For example. In considering whether to elect continuation coverage. you should take into account that a failure to continue your group health coverage will affect your future rights under federal law. you can lose the right to avoid having preexisting condition exclusions applied to you by other group health plans if you have a 63-day gap in health coverage. Part B. or for all dependent children who are qualified beneficiaries. you must complete the Election Form and furnish it according to the directions on the form. or a dependent child’s ceasing to be eligible for coverage as a dependent under the Plan. Such second qualifying events may include the death of a covered employee.

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coverage may help prevent such a gap. Second, you will lose the guaranteed right to purchase individual health coverage that does not impose a preexisting condition exclusion if you do not elect continuation coverage for the maximum time available to you. Finally, you should take into account that you have special enrollment rights under federal law. You have the right to request special enrollment in another group health plan for which you are otherwise eligible (such as a plan sponsored by your spouse’s employer) within 30 days after your group health coverage ends because of the qualifying event listed above. You will also have the same special enrollment right at the end of continuation coverage if you get continuation coverage for the maximum time available to you. How much does COBRA continuation coverage cost? Generally, each qualified beneficiary may be required to pay the entire cost of continuation coverage. The amount a qualified beneficiary may be required to pay may not exceed 102 percent (or, in the case of an extension of continuation coverage due to a disability, 150 percent) of the cost to the group health plan (including both employer and employee contributions) for coverage of a similarly situated plan participant or beneficiary who is not receiving continuation coverage. The required payment for each continuation coverage period for each option is described in this notice. The American Recovery and Reinvestment Act of 2009 (ARRA) reduces the COBRA premium in some cases. The premium reduction is available to certain individuals who experience a qualifying event that is an involuntary termination of employment during the period beginning with September 1, 2008 and ending with December 31, 2009. If you qualify for the premium reduction, you need only pay 35 percent of the COBRA premium otherwise due to the plan. This premium reduction is available for up to nine months. If your COBRA continuation coverage lasts for more than nine months, you will have to pay the full amount to continue your COBRA continuation coverage. See the attached “Summary of the COBRA Premium Reduction Provisions under ARRA” for more details, restrictions, and obligations as well as the form necessary to establish eligibility. [If employees might be eligible for trade adjustment assistance, the following information must be added: The Trade Act of 2002 created a tax credit for certain individuals who become eligible for trade adjustment assistance and for certain retired employees who are receiving pension payments from the Pension Benefit Guaranty Corporation (PBGC). Under the tax provisions, eligible individuals can either take a tax credit or get advance payment of 65% of premiums paid for qualified health insurance, including continuation coverage. ARRA made several amendments to these provisions, including an increase in the amount of the credit to 80% of premiums for coverage before January 1, 2011 and temporary extensions of the maximum period of COBRA continuation coverage for PBGC recipients (covered employees who have a nonforfeitable right to a benefit any portion of which is to be paid by the PBGC) and TAAeligible individuals. If you have questions about these provisions, you may call the Health Coverage Tax Credit Customer Contact Center toll-free at 1-866-628-4282. TTD/TTY callers may call toll-free at 1866-626-4282. More information about the Trade Act is also available at www.doleta.gov/tradeact.]

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When and how must payment for COBRA continuation coverage be made? First payment for continuation coverage If you elect continuation coverage, you do not have to send any payment with the Election Form. However, you must make your first payment for continuation coverage not later than 45 days after the date of your election. (This is the date the Election Notice is post-marked, if mailed.) If you do not make your first payment for continuation coverage in full not later than 45 days after the date of your election, you will lose all continuation coverage rights under the Plan. You are responsible for making sure that the amount of your first payment is correct. You may contact [enter appropriate contact information, e.g., the Plan Administrator or other party responsible for COBRA administration under the Plan] to confirm the correct amount of your first payment or to discuss payment issues related to the ARRA premium reduction. Periodic payments for continuation coverage After you make your first payment for continuation coverage, you will be required to make periodic payments for each subsequent coverage period. The amount due for each coverage period for each qualified beneficiary is shown in this notice. The periodic payments can be made on a monthly basis. Under the Plan, each of these periodic payments for continuation coverage is due on the [enter due day for each monthly payment] for that coverage period. [If Plan offers other payment schedules, enter with appropriate dates: You may instead make payments for continuation coverage for the following coverage periods, due on the following dates:]. If you make a periodic payment on or before the first day of the coverage period to which it applies, your coverage under the Plan will continue for that coverage period without any break. The Plan [select one: will or will not] send periodic notices of payments due for these coverage periods. Grace periods for periodic payments Although periodic payments are due on the dates shown above, you will be given a grace period of 30 days after the first day of the coverage period [or enter longer period permitted by Plan] to make each periodic payment. Your continuation coverage will be provided for each coverage period as long as payment for that coverage period is made before the end of the grace period for that payment. [If Plan suspends coverage during grace period for nonpayment, enter and modify as necessary: However, if you pay a periodic payment later than the first day of the coverage period to which it applies, but before the end of the grace period for the coverage period, your coverage under the Plan will be suspended as of the first day of the coverage period and then retroactively reinstated (going back to the first day of the coverage period) when the periodic payment is received. This means that any claim you submit for benefits while your coverage is suspended may be denied and may have to be resubmitted once your coverage is reinstated.] If you fail to make a periodic payment before the end of the grace period for that coverage period, you will lose all rights to continuation coverage under the Plan. Your first payment and all periodic payments for continuation coverage should be sent to: [enter appropriate payment address]

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For more information This notice does not fully describe continuation coverage or other rights under the Plan. More information about continuation coverage and your rights under the Plan is available in your summary plan description or from the Plan Administrator. If you have any questions concerning the information in this notice, your rights to coverage, or if you want a copy of your summary plan description, you should contact [enter name of party responsible for COBRA administration for the Plan, with telephone number and address]. Private sector employees seeking more information about rights under ERISA, including COBRA, the Health Insurance Portability and Accountability Act (HIPAA), and other laws affecting group health plans, can contact the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) at 1-866-444-3272 or visit the EBSA website at www.dol.gov/ebsa. State and local government employees should contact HHS-CMS at www.cms.hhs.gov/COBRAContinuationofCov/ or NewCobraRights@cms.hhs.gov. Keep Your Plan Informed of Address Changes In order to protect your and your family’s rights, you should keep the Plan Administrator informed of any changes in your address and the addresses of family members. You should also keep a copy, for your records, of any notices you send to the Plan Administrator.

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be offered to active employees. and cannot be limited to only dental coverage. counseling coverage. a flexible spending arrangement (FSA). complete the “Application for Treatment as an Assistance Eligible Individual” and return it to us at [insert mailing address]. [If the plan permits Assistance Eligible Individuals to elect to enroll in coverage that is different than coverage in which the individual was enrolled at the time the qualifying event occurred. complete the “Form for Switching COBRA Continuation Coverage Benefit Options” and return it to us.) [Enter date of notice] Dear: [Identify the qualified beneficiary(ies). including a health reimbursement arrangement that qualifies as an FSA. 2008 to advise them of the availability of the premium reduction. The American Recovery and Reinvestment Act of 2009 (ARRA) reduces the COBRA premium in some cases.Employee benefits MODEL COBRA CONTINUATION COVERAGE SUPPLEMENTAL NOTICE (For use by group health plans for qualified beneficiaries currently enrolled in COBRA coverage with qualifying events that occurred on or after September 1. To help determine whether you can get the ARRA premium reduction. and obligations and the “Application for Treatment as an Assistance Eligible Individual. or an on-site medical clinic. 2008 and chose to elect COBRA continuation coverage. Please read the information contained in this notice very carefully. reference the “Summary of the COBRA Premium Reduction Provisions under ARRA” with details regarding eligibility.” If you believe you meet the criteria for the premium reduction. If your loss of health coverage was due to an involuntary termination of employment you may be eligible for the temporary premium reduction for up to nine months. vision coverage. Available coverage options are: [insert list of available coverage options]. In particular. ] 181 . You are receiving this notice because you experienced a loss of coverage at some time on or after September 1. you should read this notice and the attached documents carefully. restrictions.” The different coverage must cost the same or less than the coverage the individual had at the time of the qualifying event. insert: “To change the coverage option(s) for your COBRA continuation coverage to something different than what you had on the last day of employment. by name or status] This notice contains important information about additional rights you may have related to your COBRA continuation coverage in the [enter name of group health plan] (the Plan).

2009. If you have questions about these provisions. including an increase in the amount of the credit to 80% of premiums for coverage before January 1. Under the tax provisions.] When and how must payment for COBRA continuation coverage be made? Other than the amount. 2008 and ending with December 31. the following information must be added: The Trade Act of 2002 created a tax credit for certain individuals who become eligible for trade adjustment assistance and for certain retired employees who are receiving pension payments from the Pension Benefit Guaranty Corporation (PBGC). This premium reduction is available for up to nine months. nothing else about the payment has changed. eligible individuals can either take a tax credit or get advance payment of 65% of premiums paid for qualified health insurance. you will have to pay the full amount to continue your COBRA continuation coverage. The premium reduction is available to certain individuals who experience a qualifying event that is an involuntary termination of employment during the period beginning with September 1. in the case of an extension of continuation coverage due to a disability. and obligations as well as the form necessary to establish eligibility. 182 . you need only pay 35 percent of the COBRA premium otherwise due to the plan.Employee benefits Important Information about Your COBRA Continuation Coverage Rights How much does COBRA continuation coverage cost? Generally..doleta. All periodic payments for continuation coverage should be sent to: [enter appropriate payment address] You may contact [enter appropriate contact information. 150 percent) of the cost to the group health plan (including both employer and employee contributions) for coverage of a similarly situated plan participant or beneficiary who is not receiving continuation coverage. ARRA made several amendments to these provisions. including continuation coverage. the Plan Administrator or other party responsible for COBRA administration under the Plan] to confirm the correct amount of your first payment or to discuss payment issues related to the ARRA premium reduction.gov/tradeact. The amount a qualified beneficiary may be required to pay may not exceed 102 percent (or. The required payment for each continuation coverage period for each option is described in this notice. restrictions. TTD/TTY callers may call toll-free at 1866-626-4282. [If employees might be eligible for trade adjustment assistance. each qualified beneficiary may be required to pay the entire cost of continuation coverage. See the attached “Summary of the COBRA Premium Reduction Provisions under ARRA” for more details. More information about the Trade Act is also available at www. e. If your COBRA continuation coverage lasts for more than nine months.g. 2011 and temporary extensions of the maximum period of COBRA continuation coverage for PBGC recipients (covered employees who have a nonforfeitable right to a benefit any portion of which is to be paid by the PBGC) and TAAeligible individuals. you may call the Health Coverage Tax Credit Customer Contact Center toll-free at 1-866-628-4282. The American Recovery and Reinvestment Act of 2009 (ARRA) reduces the COBRA premium in some cases. If you qualify for the premium reduction.

gov. or if you want a copy of your summary plan description. you should contact [enter name of party responsible for COBRA administration for the Plan. the summary plan description. More information about continuation coverage and your rights under the Plan is available in your original COBRA election notice. If you have any questions concerning the information in this notice. Keep Your Plan Informed of Address Changes In order to protect your and your family’s rights. with telephone number and address].hhs. Private sector employees seeking more information about rights under ERISA.gov/ebsa. your rights to coverage. and other laws affecting group health plans. 183 . of any notices you send to the Plan Administrator. including COBRA. can contact the U.S. the Health Insurance Portability and Accountability Act (HIPAA). you should keep the Plan Administrator informed of any changes in your address and the addresses of family members.cms. You should also keep a copy.dol.gov/COBRAContinuationofCov/ or NewCobraRights@cms. for your records.Employee benefits For more information This notice does not fully describe continuation coverage or other rights under the Plan. State and local government employees should contact HHS-CMS at www. or from the Plan Administrator.hhs. Department of Labor’s Employee Benefits Security Administration (EBSA) at 1-866-444-3272 or visit the EBSA website at www.

_________________________________________________________________________ Old Coverage Option:____________________________ New Coverage Option: __________________________ _____________________________________ Signature ______________________________________ Print Name ______________________________________ ______________________________________ ______________________________________ Print Address ______________________________ Telephone number _____________________________ Date _____________________________ Relationship to individual(s) listed above 184 . _________________________________________________________________________ Old Coverage Option:____________________________ New Coverage Option: __________________________ c. If mailed. it must be post-marked no later than [enter date]. Under federal law.Employee benefits Form for Switching COBRA Continuation Coverage Benefit Options [Only use this model form if the plan permits Assistance Eligible Individuals to elect to enroll in coverage that is different than coverage in which the individual was enrolled at the time the qualifying event occurred. complete this Form and return it to us.] Instructions: To change the benefit option(s) for your COBRA continuation coverage to something different than what you have. you have 90 days after the date of this notice to decide whether you want to switch benefit options. I (We) would like to change the COBRA continuation coverage option(s) in the [enter name of plan] (the Plan) as indicated below: Name Date of Birth Relationship to Employee SSN (or other identifier) a. Send completed Form to: [Enter Name and Address] This Form must be completed and returned by mail [or describe other means of submission and due date]. _________________________________________________________________________ Old Coverage Option:____________________________ New Coverage Option: __________________________ b.

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MODEL COBRA CONTINUATION COVERAGE ADDITIONAL ELECTION NOTICE (For use by group health plans for qualified beneficiaries who are or would be an Assistance Eligible Individual but are not enrolled in COBRA coverage (including those who never elected AND those who elected but subsequently discontinued coverage) with qualifying events that occurred during the period from September 1, 2008 through February 16, 2009.) [Enter date of notice] Dear: [Identify the qualified beneficiary(ies), by name or status] This notice contains important information about additional rights to continue your health care coverage in the [enter name of group health plan] (the Plan). Please read the information contained in this notice very carefully. The American Recovery and Reinvestment Act of 2009 (ARRA) reduces the COBRA premium in some cases. You are receiving this notice because you experienced a loss of coverage at some time from September 1, 2008 through February 16, 2009 and either chose not to elect COBRA continuation coverage at that time OR elected COBRA but subsequently discontinued that coverage. If your loss of health coverage was due to an involuntary termination of employment you may be eligible for a second COBRA election opportunity and the temporary premium reduction for up to nine months. To help determine whether you can get the ARRA premium reduction, you should read this notice and the attached documents carefully. In particular, reference the “Summary of the COBRA Premium Reduction Provisions under ARRA” with details regarding eligibility, restrictions, and obligations and the “Application for Treatment as an Assistance Eligible Individual.” If you believe you meet the criteria for the premium reduction, complete the “Application for Treatment as an Assistance Eligible Individual” and return it with your completed Election Form. To elect COBRA continuation coverage, follow the instructions on the following pages to complete the enclosed Election Form and submit it to us. Each person (“qualified beneficiary”) in the category(ies) checked below is entitled to elect COBRA continuation coverage, which generally will continue group health care coverage under the Plan for up to 18 months after an involuntary termination of employment. [Check appropriate box or boxes; names may be added]:

 Employee or former employee  Spouse or former spouse  Dependent child(ren) covered under the Plan on the day before the involuntary termination of employment (and any new dependents born, adopted, or placed for adoption between the date coverage was lost and February 17, 2009).
If elected, COBRA continuation coverage will begin retroactively on [enter the date of the first day of the first coverage period beginning on or after February 17, 2009] and can last until [enter the date that is 18 months after the qualifying event]. [Add, if appropriate: You may elect any of the following options for COBRA continuation coverage: [list available coverage options]. 189

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[If the plan permits Assistance Eligible Individuals to elect to enroll in coverage that is different than coverage in which the individual was enrolled at the time the qualifying event occurred, insert: “To change the coverage option(s) for your COBRA continuation coverage to something different than what you had on the last day of employment, complete the “Form for Switching COBRA Continuation Coverage Benefit Options” and return it to us. Available coverage options are: [insert list of available coverage options].” The different coverage must cost the same or less than the coverage the individual had at the time of the qualifying event; be offered to active employees; and cannot be limited to only dental coverage, vision coverage, counseling coverage, a flexible spending arrangement (FSA), including a health reimbursement arrangement that qualifies as an FSA, or an on-site medical clinic. ] COBRA continuation coverage will cost: [enter amount each qualified beneficiary will be required to pay for each option per month of coverage and any other permitted coverage periods.] If you qualify as an “Assistance Eligible Individual” this cost can be reduced to [include the amount that is 35 percent of the amount above for each option] for up to nine months. You do not have to send any payment with the Election Form. Important additional information about payment for COBRA continuation coverage is included in the pages following the Election Form. If you have any questions about this notice or your rights to COBRA continuation coverage, you should contact [enter name of party responsible for COBRA administration for the Plan, with telephone number and address].

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Employee benefits

COBRA Continuation Coverage Election Form Instructions: Under the American Recovery and Reinvestment Act you are only entitled to elect
COBRA continuation coverage at this time if you lost group health plan coverage due to an involuntary termination of employment during the period that begins with September 1, 2008 and ends with December 31, 2009. To elect COBRA continuation coverage, complete this Election Form and return it to us. Under federal law, you have 60 days after the date of this notice to decide whether you want to elect COBRA continuation coverage under the Plan. Send completed Election Form to: [Enter Name and Address] This Election Form must be completed and returned by mail [or describe other means of submission and due date]. If mailed, it must be post-marked no later than [enter date]. If you do not submit a completed Election Form by the due date shown above, you will lose your right to elect COBRA continuation coverage. If you reject COBRA continuation coverage before the due date, you may change your mind as long as you furnish a completed Election Form before the due date. However, if you change your mind after first rejecting COBRA continuation coverage, your COBRA continuation coverage will begin on the date you furnish the completed Election Form.

I (We) elect COBRA continuation coverage in the [enter name of plan] (the Plan) as indicated below: Name Date of Birth Relationship to Employee SSN (or other identifier)

a. _________________________________________________________________________ [Add if appropriate: Coverage option(s): _______________________________] b. _________________________________________________________________________ [Add if appropriate: Coverage option(s): _______________________________] c. _________________________________________________________________________ [Add if appropriate: Coverage option(s): _______________________________] _____________________________________ Signature ______________________________________ Print Name ______________________________________ ______________________________________ ______________________________________ Print Address ______________________________ Telephone number _____________________________ Date _____________________________ Relationship to individual(s) listed above

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Employee benefits

Form for Switching COBRA Continuation Coverage Benefit Options
[Only use this model form if the plan permits Assistance Eligible Individuals to elect to enroll in coverage that is different than coverage in which the individual was enrolled at the time the qualifying event occurred.] Instructions: To change the benefit option(s) for your COBRA continuation coverage to something different than what you had on the last day of employment, complete this Form and return it to us. Under federal law, you have 90 days after the date of this notice to decide whether you want to switch benefit options. Send completed Form to: [Enter Name and Address] This Form must be completed and returned by mail [or describe other means of submission and due date]. If mailed, it must be post-marked no later than [enter date]. *THIS IS NOT YOUR ELECTION NOTICE* YOU MUST SEPARATELY COMPLETE AND RETURN THE ELECTION NOTICE TO SECURE YOUR COBRA CONTINUATION COVERAGE. I (We) would like to change the COBRA continuation coverage option(s) in the [enter name of plan] (the Plan) as indicated below: Name Date of Birth Relationship to Employee SSN (or other identifier)

a. _________________________________________________________________________ Old Coverage Option: ____________________________ New Coverage Option: __________________________ b. _________________________________________________________________________ Old Coverage Option: ____________________________ New Coverage Option: __________________________ c. _________________________________________________________________________ Old Coverage Option: ____________________________ New Coverage Option: __________________________ _____________________________________ Signature ______________________________________ Print Name ______________________________________ ______________________________________ ______________________________________ Print Address ______________________________ Telephone number _____________________________ Date _____________________________ Relationship to individual(s) listed above

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Failure to provide notice of a disability or second qualifying event may affect the right to extend the period of continuation coverage. a qualified beneficiary becomes covered. a qualified beneficiary becomes entitled to Medicare benefits (under Part A. How can you extend the length of COBRA continuation coverage? If you elect continuation coverage. 193 . 2009 due to an involuntary termination of employment that occurred during that period. 2009] and can generally continue for up to 18 months from the date of your involuntary termination of employment. an extension of the maximum period of coverage may be available if a qualified beneficiary is disabled or a second qualifying event occurs. “How much does COBRA continuation coverage cost?” How long will continuation coverage last? Your coverage will begin retroactively on [insert date that is the beginning of the first period of coverage on or after February 17.Employee benefits Important Information About Your COBRA Continuation Coverage Rights Am I eligible to elect COBRA continuation Coverage at this time? Only individuals who lost group health coverage from September 1. and who did not elect COBRA continuation coverage during their first election period OR who elected but subsequently discontinued COBRA coverage (for reasons other than becoming eligible for another group health plan or Medicare). under another group health plan that does not impose any pre-existing condition exclusion for a pre-existing condition of the qualified beneficiary. You must notify [enter name of party responsible for COBRA administration] of a disability or a second qualifying event in order to extend the period of continuation coverage. after electing continuation coverage. Information about the amount of the premium reduction and how it affects your premium payments can be found below under the question. or the employer ceases to provide any group health plan for its employees. The duration of the premium reduction is determined separately and may not last for the entire length of your COBRA coverage. Part B. you are not entitled to this second election period. If you lost group health coverage for any other reason between these dates and did not elect COBRA continuation coverage when it was first offered. Continuation coverage may also be terminated for any reason the Plan would terminate coverage of a participant or beneficiary not receiving continuation coverage (such as fraud). 2008 through February 16. Am I eligible for the premium reduction? If you lost group health coverage from September 1. 2008 through February 16. or both) after electing continuation coverage. you are entitled to receive the premium reduction. 2009 due to an involuntary termination of employment that occurred during that period and are not eligible for Medicare or other group health plan coverage. are entitled to elect coverage at this time. See the question below entitled “How much does COBRA continuation coverage cost?” Continuation coverage will be terminated before the end of the 18 month period if: • • • • any required premium is not paid in full on time.

divorce or separation from the covered employee. you must notify the Plan of that fact within 30 days after that determination. Continuation coverage may be elected for only one. 194 . or a dependent child’s ceasing to be eligible for coverage as a dependent under the Plan. The employee or the employee’s spouse can elect continuation coverage on behalf of all of the qualified beneficiaries. or both). A parent may elect to continue coverage on behalf of any dependent children. For example. Each qualified beneficiary has a separate right to elect continuation coverage. including time frames and procedures. The maximum amount of continuation coverage available when a second qualifying event occurs is 36 months. In considering whether to elect continuation coverage. or for all dependent children who are qualified beneficiaries. you will lose the guaranteed right to purchase individual health coverage that does not impose a preexisting condition exclusion if you do not elect continuation coverage for the maximum time available to you.Employee benefits Disability An 11-month extension of coverage may be available if any of the qualified beneficiaries is determined under the Social Security Act (SSA) to be disabled.] Each qualified beneficiary who has elected continuation coverage will be entitled to the 11-month disability extension if one of them qualifies. and election of continuation coverage may help prevent such a gap. If you do elect continuation coverage under this additional election period. you should take into account that a failure to continue your group health coverage will affect your future rights under Federal law. Second. the covered employee’s becoming entitled to Medicare benefits (under Part A. You must notify the Plan within 60 days after a second qualifying event occurs if you want to extend your continuation coverage. How can you elect COBRA continuation coverage? To elect continuation coverage. several. The disability has to have started at some time on or before the 60th day of COBRA continuation coverage and must last at least until the end of the 18-month period of continuation coverage. [Describe Plan provisions for requiring notice of disability determination. you can lose the right to avoid having preexisting condition exclusions applied to you by other group health plans if you have a 63-day gap in health coverage. you must complete the Election Form and furnish it according to the directions on the form. If the qualified beneficiary is determined to no longer be disabled under the SSA. the employee’s spouse may elect continuation coverage even if the employee does not. Such second qualifying events may include the death of a covered employee. First. These events can be a second qualifying event only if they would have caused the qualified beneficiary to lose coverage under the Plan if the first qualifying event had not occurred. the period from qualifying event to the date coverage begins under your election will not count as a break in coverage in determining whether you had a 63-day break in coverage. Second Qualifying Event An 18-month extension of coverage will be available to spouses and dependent children who elect continuation coverage if a second qualifying event occurs during the first 18 months of continuation coverage. Part B.

[If employees might be eligible for trade adjustment assistance.doleta. The amount a qualified beneficiary may be required to pay may not exceed 102 percent (or. if mailed. The premium reduction is available to certain individuals who experience a qualifying event that is an involuntary termination of employment during the period beginning with September 1.) If you do not make your first payment for continuation coverage in full not later than 45 days after the date of your election. If your COBRA continuation coverage lasts for more than nine months. 2011 and temporary extensions of the maximum period of COBRA continuation coverage for PBGC recipients (covered employees who have a nonforfeitable right to a benefit any portion of which is to be paid by the PBGC) and TAAeligible individuals. If you have questions about these provisions. you will lose all continuation coverage rights under the Plan. Under the tax provisions. More information about the Trade Act is also available at www. The American Recovery and Reinvestment Act of 2009 (ARRA) reduces the COBRA premium in some cases. including continuation coverage. restrictions. See the attached “Summary of the COBRA Premium Reduction Provisions under ARRA” for more details. you do not have to send any payment with the Election Form. This premium reduction is available for up to nine months.gov/tradeact. If you qualify for the premium reduction. eligible individuals can either take a tax credit or get advance payment of 65% of premiums paid for qualified health insurance.] When and how must payment for COBRA continuation coverage be made? First payment for continuation coverage If you elect continuation coverage. ARRA made several amendments to these provisions. you may call the Health Coverage Tax Credit Customer Contact Center toll-free at 1-866-628-4282. you must make your first payment for continuation coverage not later than 45 days after the date of your election. (This is the date the Election Notice is post-marked. each qualified beneficiary may be required to pay the entire cost of continuation coverage. TTD/TTY callers may call toll-free at 1866-626-4282. the following information must be added: The Trade Act of 2002 created a tax credit for certain individuals who become eligible for trade adjustment assistance and for certain retired employees who are receiving pension payments from the Pension Benefit Guaranty Corporation (PBGC). and obligations as well as the form necessary to establish eligibility. You may contact 195 . 150 percent) of the cost to the group health plan (including both employer and employee contributions) for coverage of a similarly situated plan participant or beneficiary who is not receiving continuation coverage. However. including an increase in the amount of the credit to 80% of premiums for coverage before January 1. You are responsible for making sure that the amount of your first payment is correct. 2009. The required payment for each continuation coverage period for each option is described in this notice. you will have to pay the full amount to continue your COBRA continuation coverage.Employee benefits How much does COBRA continuation coverage cost? Generally. in the case of an extension of continuation coverage due to a disability. 2008 and ending with December 31. you need only pay 35 percent of the COBRA premium otherwise due to the plan.

e. your rights to coverage. The Plan [select one: will or will not] send periodic notices of payments due for these coverage periods. and other laws affecting group health plans. with telephone number and address]. enter and modify as necessary: However. you will be given a grace period of 30 days after the first day of the coverage period [or enter longer period permitted by Plan] to make each periodic payment. your coverage under the Plan will be suspended as of the first day of the coverage period and then retroactively reinstated (going back to the first day of the coverage period) when the periodic payment is received.g. Your first payment and all periodic payments for continuation coverage should be sent to: [enter appropriate payment address] For more information This notice does not fully describe continuation coverage or other rights under the Plan. Your continuation coverage will be provided for each coverage period as long as payment for that coverage period is made before the end of the grace period for that payment. The periodic payments can be made on a monthly basis. Periodic payments for continuation coverage After you make your first payment for continuation coverage. the Plan Administrator or other party responsible for COBRA administration under the Plan] to confirm the correct amount of your first payment.Employee benefits [enter appropriate contact information. If you make a periodic payment on or before the first day of the coverage period to which it applies. This means that any claim you submit for benefits while your coverage is suspended may be denied and may have to be resubmitted once your coverage is reinstated. [If Plan suspends coverage during grace period for nonpayment. Private sector employees seeking more information about rights under ERISA. if you pay a periodic payment later than the first day of the coverage period to which it applies. enter with appropriate dates: You may instead make payments for continuation coverage for the following coverage periods. or if you want a copy of your summary plan description. [If Plan offers other payment schedules.] If you fail to make a periodic payment before the end of the grace period for that coverage period. Under the Plan. The amount due for each coverage period for each qualified beneficiary is shown in this notice. you should contact [enter name of party responsible for COBRA administration for the Plan. Department of Labor’s Employee Benefits Security Administration (EBSA) at 1-866-444-3272 or visit the EBSA website at 196 . your coverage under the Plan will continue for that coverage period without any break. Grace periods for periodic payments Although periodic payments are due on the dates shown above. More information about continuation coverage and your rights under the Plan is available in your summary plan description or from the Plan Administrator. you will be required to make periodic payments for each subsequent coverage period. you will lose all rights to continuation coverage under the Plan. but before the end of the grace period for the coverage period.. the Health Insurance Portability and Accountability Act (HIPAA). including COBRA. each of these periodic payments for continuation coverage is due on the [enter due day for each monthly payment] for that coverage period. If you have any questions concerning the information in this notice. due on the following dates:]. can contact the U.S.

gov/ebsa.hhs.dol. you should keep the Plan Administrator informed of any changes in your address and the addresses of family members. You should also keep a copy. for your records.Employee benefits www.hhs. State and local government employees should contact HHS-CMS at www.cms. 197 .gov/COBRAContinuationofCov/ or NewCobraRights@cms. of any notices you send to the Plan Administrator. Keep Your Plan Informed of Address Changes In order to protect your and your family’s rights.gov.

Employee benefits 198 .

Employee benefits 199 .

Employee benefits 200 .

Employee benefits 201 .

This coverage applies to any disability that prevents the employee from working for more than 90 days. to a maximum of 90 days. reference should be made to the plan documents for the details of coverage. Employers who choose to provide such benefits to their employees should include requirements for eligibility to receive benefits and the amount of such benefits in its policies. the Company pays 60 percent of the employee’s regular compensation for each week the employee is disabled. The Company pays the cost of coverage for this benefit. Part-time employees are not eligible for short-term disability coverage. full-time employees who have worked for the Company for at least one year. As in the case of health insurance. The Company pays the full cost of this benefit. Those documents govern all issues relating to the long-term disability insurance.Employee benefits Short. 202 . To maintain eligibility for benefits. ABC Company provides short-term disability benefits to regular. The group insurance policy and the summary plan description issued to employees set out the terms and conditions of the long-term disability plan. A complete description of the Company’s short-term disability plan is provided in the group insurance policy and summary plan description issued to employees. the employee must be in compliance with the Company’s Medical Leaves of Absence Policy. SAMPLE POLICY Long-term Disability Plan ABC Company provides long-term disability insurance for all of its regular. Part-time employees are not eligible for long-term disability coverage.and long-term disability plans Employers are not legally obligated to provide any short-term or long-term disability benefits (with the exception of state-mandated workers’ compensation insurance coverage). after a waiting period of five working days. Under this plan. full-time employees. SAMPLE POLICY Short-term Disability Plan In the event an employee is away from work because of illness or disability (including pregnancy) and exhausts available sick days.

Any tuition reimbursement program should be in writing and contain the requirements for receiving reimbursement. deductions from an employee’s pay may occur if the employee authorizes the deduction in writing. which results in increased productivity for the employer.Employee benefits 401(K) plan Employers have no legal obligation to provide their employees with either retirement benefits or a profit-sharing plan. Employers who do provide the benefit should make reference to the plan’s availability and that it is governed by the plan documents. 203 . The plan administrator should be able to provide the employer with any forms electing participation in the 401k plan or otherwise connected to the plan. also obtain the employee’s express written consent to deduct 401k contributions from the paycheck for deposit into the 401k account. Employers should. Under the plan. because education programs encourage employees to obtain additional skills and knowledge in their respective fields of specialization. up to two percent of that employee’s compensation. however. The Company may make matching contributions in an amount equal to one-third of each employee’s salary deferral. employers should enter into a written agreement with the employee to recoup those costs in the event the employee discontinues his or her studies for any reason. Most plans reimburse the employee at the conclusion of the course if it is successfully completed and related to the employee’s job. Employers should not attempt to include all the provisions of the 401k plan in a handbook. SAMPLE POLICY ABC Company sponsors a 401(k) profit-sharing plan for all eligible employees. If tuition costs are advanced. Continuing education Employers are not obligated to reimburse employees for continuing education. and the payments are recorded in employer’s books or records. however. Employees should be given – and referred to – the plan documents for complete information regarding the benefit. Employees must be compensated for time spent attending mandatory on-the-job training programs or seminars. Under Oregon law. The Company also may make additional profit-sharing contributions to the plan in its discretion. employees may elect to make contributions to the plan through salary deferral. Most employers offering a 401k plan utilize an external plan administrator for the plan. A sample policy is provided below. Some employers choose to do so. The terms of the plan and eligibility requirements are set out in the written plan document and summary plan description issued to employees. the deduction is for the employee benefit.

fees. fees. To qualify for reimbursement. 204 . and books for courses taken that are directly related to improvement of relevant job skills with the Company. The Company will reimburse you fully for tuition. Proof of passing grade or certificate of satisfactory course completion and receipts for tuition. Courses must be taken at times other than during scheduled working hours. Reimbursement may be subject to taxes. and books must be turned in to the Human Resources Department in order to receive your reimbursement. All reimbursements are subject to the approval of your supervisor or manager and the Human Resources Manager. you may qualify for tuition reimbursement.Employee benefits SAMPLE POLICY As a full-time employee of ABC Company. This policy also covers all courses taken to fulfill the requirements of a degree program approved by your manager. you must receive a passing grade and you must be an employee in good standing at the time of reimbursement. All tuition reimbursements must be requested in writing and approved prior to beginning the course.

boli.state. In the sample policy that follows. etc. All Oregon employers. depending on how long an employee works in a given shift. If applicable. or the wage and hour laws described in this chapter. depending on the type of workers employed (exempt versus non-exempt. Oregon employers are strongly advised to consult with legal counsel regarding which laws and which policies apply and/or are not required. may not apply.shtml. Meal periods and rest breaks In addition to a policy that identifies an employer’s workweek. 653 and elsewhere). non-exempt employee whose work period is eight hours long must receive at least one unpaid. For example.).and Oregon-required postings can be printed and downloaded for free at: www. It is strongly advised that all employers consult with legal counsel about the wage and hour policies and laws that apply specifically to them. complicated. Copies of the FLSA. employers should also have a policy advising employees of any meal periods.Chapter 9 Hours of work and overtime The wage and hour laws applicable to Oregon employers are vast. for example.or. agriculture workers. some or all of the policies provided in this section. 10-minute rest breaks at other times during the course of his shift. once established. Again. and everchanging. minors. manufacturing workers. Further. The defined workweek will help determine when an employee has worked more than 40 hours a week for overtime purposes. employees subject to a collective bargaining agreement. different shifts also may be described. rest breaks or other breaks to which they are entitled by law. the employer should not change the defined workweek except for a legitimate business reason.us/ BOLI/CRD/C_Postings. however. Oregon law requires employers to provide nonexempt employees with rest breaks and meal periods at specific times. Hours of work It is essential that every employer adopt a policy defining its workweek and normal office and production hours. the number of each meal period and/or rest breaks an 205 . Employers are free to define the workweek as starting on any day and time. the typical adult. are required to have two postings at their places of employment regarding the minimum wage and other applicable laws under the federal Fair Labor Standards Act (FLSA) or its Oregon equivalent (found in Oregon Revised Statutes Chapters 652. 30-minute meal period during the middle of the shift and two paid.

pdf (a Spanish version can be found at: www. to rest. 2009. the employer must give notice to each employee affected by the undue hardship provision on a form prescribed by BOLI and maintain a record of that notice. the regulations identifies circumstances in which employers are not required to provide the full 30-minute meal period and/or relieve an employee completely from duty. When an employer can demonstrate that providing an employee a meal period would impose an undue hardship on the operation of the business and does not provide the full 30-minute meal period.gov/BOLI/WHD/docs/WH-161.oregon. Specifically. uninterrupted rest breaks of at least 15 minutes for each four-hour segment worked. and to use the restroom and must be paid for this time. In addition. Minors must receive at least a 30-minute meal period no later than five hours and one minute after beginning work. minors must receive paid. unpaid meal period where the employee is relieved of all duties would impose an undue hardship on the operation of the employer’s business. Note that this policy does not address the break laws applicable to minors.Hours of work and overtime employee may take per shift worked is included. and would need to be modified to specify the meal and break periods unique to minors.oregon. financial resources. undue hardship means: “significant difficulty or expense when considered in relation to the size. employees must still be provided with adequate time to consume a meal. Oregon employers became obligated to follow new state administrative rules regarding meal periods and rest breaks. this is in addition to all rest periods required by rule for the number of hours worked on any given shift.gov/BOLI/WHD/docs/WH-161S. As used in the revised meal period rule. Under the new rule. acts of nature or other exceptional and unanticipated circumstances that only rarely and temporarily preclude the provision of a meal period or • industry practice or custom has established a paid meal period of less than 30 minutes (but no less than 20 minutes) during which the employee is relieved of all duties or • providing a 30-minute. nature or structure of the employer’s business.pdf ). A copy of the notice is included at the end of this chapter and can be downloaded from: www. In addition.” 206 . Effective January 12. an employer who does not provide an employee with a 30-minute meal period in which the employee is relieved of all duties must be able to demonstrate that: • failure to provide a meal period was caused by unforeseeable equipment failures.

to 11:00 p. Nonexempt employees are required to take at least a 30-minute unpaid meal period when the work period is six hours or greater. to 7:00 a.m. An employee who fails to abide by these policies and laws may be subjected to discipline. Number of rest breaks required 0 1 1 2 3 Number of meal periods required 0 0 1 1 1 Length of work period 2 hours or less 2 hrs. The law requires an uninterrupted period in which the employee is relieved of all duties. uninterrupted 10-minute rest break for every four-hour segment or major portion thereof in the work period. – 13 hrs.Hours of work and overtime SAMPLE POLICY Workweek The workweek is Monday at 12:00 a. These breaks are mandatory and are not optional. Evening (second) shift is from 3:00 p. the employee must inform his or her supervisor before the end of the shift so that the Company may pay the employee for that work. she should contact the Human Resources Department immediately. If. 59 min. Meals and rest breaks may not be “skipped” in lieu of leaving early. 6 hrs.. 1 min.. an employee is required to remain on duty or to perform any tasks during the meal period. If an employee has questions about the rest or meal breaks available to him or her. The rest break should be given in the middle of each segment.m. through Sunday at 11:59 p. up to and including termination. 6 hrs. the employer must take a rest break for that segment.m.. because of the nature or circumstances of the work.m. – 10 hrs. 1 min. – 5 hrs. 1 min.. An employee’s lunch hour and rest break(s) may not be taken together as one break.m. whenever possible. Break and Meal Periods Nonexempt employees are required to take a paid. Night (third) shift is from 11:00 p. Sample rest and meal break schedules are listed below. Day (first) shift is from 7:00 a. to 3:00 p.. No meal period is required if the work period is less than six hours. 207 .m. Whenever a segment exceeds two hours.m.m. 59 min. 10 hrs.

208 .pdf).oregon.pdf (English) and www. employers are required to provide their employees with meal periods of at least 30 minutes of uninterrupted time in which the employee is relieved of all duties for work periods of at least six hours. 2009. effective March 16.oregon. The required notices are available at www.oregon.pdf (Spanish) or upon request from any BOLI office. and use the restroom. and employees must be paid for this time.gov/BOLI/WHD/docs/WH-161. employers must provide a copy of a notice to each employee affected by the undue hardship provision in the language used by the employer to communicate with the employee on a form prescribed by BOLI. In addition. Employers claiming an undue hardship exception must still provide employees with adequate time to consume a meal. rest. One exception provides that employers that can show that providing a meal period would impose an “undue hardship” on the operation of the employer’s business are not required to provide 30-minute uninterrupted meal periods.gov/BOLI/LEGAL/docs/Meal_and_Rest_ Periods_Final_Rule_January2009.gov/BOLI/WHD/docs/WH-161S. Employers are required to retain and keep available to the commissioner a copy of the notice for the duration of the employee’s employment and for no less than six months after the termination date of the employee.Hours of work and overtime “UNDUE HARDSHIP” NOTICE TO EMPLOYEES REGARDING MEAL AND REST PERIODS Pursuant to OAR 839-020-0050 (www. There are some exceptions to this requirement.

Hours of work and overtime NOTICE TO EMPLOYEES REGARDING MEAL AND REST PERIODS 209 .

This could include: • • • • 210 the employee’s work area a room connected to a public restroom (such as a lounge) a child care facility an empty or unused office .gov/BOLI/LEGAL/docs/ mealwaiver. paid. Employers are not required to pay the employee for the full 30-minute rest period. other than a public restroom or toilet stall.Hours of work and overtime Restaurant and beverage service industries Beginning January 1st 2008. See the form at the end of this chapter. An employer subject to the breast milk break law. Employees expressing breast milk Oregon employers who employ 25 or more employees in the State of Oregon must provide reasonable rest periods to accommodate an employee who needs to express milk for her child 18 months of age or younger. employees who earn and report tips to employers can now waive their right to a 30-minute meal break. as well as be paid for this time. 10-minute break periods for work shifts of 4 hours or more. where the employee may express milk concealed from view and without intrusion by other employees or the public.pdf New hires may not seek a waiver until they have worked seven calendar days. however. in close proximity to the employee’s work station. or download the form from: www. however.077. This translates into no less than 30 minutes during each four-hour work period. must make a reasonable effort to provide the employee with a private location within close proximity to the employee’s work area to express milk.oregon. BOLI states that a “private location” is “a place. a 30-minute break is mandatory and can not be waived. and they are not required to provide employees with an additional ten-minute paid rest break in addition to the 30-minute period – employers. If the employee works 8 hours or more. Further. up to and including termination. is effective only when the employer and employee sign a BOLI-approved waiver each time the a waiver is sought. Employees are unable to waive their mandatory. and that employees who waive their meal periods and do not sign waiver forms will be subjected to discipline. The waiver. ORS 653. Employers who employ individuals who earn and report tips should consider modifying the sample policy above to state that waivers of the meal period will be granted if the employee signs the waiver form. employees who work over six hours in a shift and waive their right to a 30-minute break must still be provided the opportunity to consume food while continuing to work. must pay the employee for the usual 10-minute break period (leaving the other 20 minutes unpaid).

SAMPLE POLICY Nursing mothers may take a thirty-minute rest period to express milk during each four-hour work period. Company will make reasonable efforts to provide the employee with a private location within close proximity to the employee’s work area to express milk.). These rest periods shall. etc. Finally. 211 . beverages. if feasible. if one is offered to other employees for the storage of food. Company will try to provide employees who take breaks to express milk with additional hours to make up for the breaks to the extent they are unpaid. Please provide two weeks’ notice to your supervisor if you intend to express milk during work hours so arrangements can be made to accommodate your needs. be taken at the same time as rest periods that are otherwise provided to the employee. employers must allow the employee to bring a cooler or other insulated container to store the expressed milk (or use a publicly available refrigerator to do so.Hours of work and overtime • • conference room storage space.

Hours of work and overtime REQUEST AND AGREEMENT TO WAIVE MEAL PERIODS 212 .

A well-written and legally sound overtime policy may assist the employer in complying with this statute. An employer may not delay payment of an employee’s wages. The provision for double time pay for holiday work in the sample policy is optional. This rule should be enforced consistently and impartially. if an employee works unauthorized overtime. Overtime Employers must comply with the requirements of Oregon law and the FLSA concerning overtime premium pay for non-exempt employees. Non-exempt employees are entitled to receive a premium rate of one and one-half times the employee’s regular rate of pay for hours actually worked in excess of 40 per predefined workweek. even if the employee fails to submit timesheets as required. Salaried exempt employees also may be required to record their time on either a time card or time sheet. It is therefore recommended that employers include a requirement that overtime hours be authorized in advance. Filling out another employee’s time card. employers must keep accurate records of all hours worked by their non-exempt employees. who will attempt to promptly correct legitimate errors. although it will 213 . While the sample policy also can be used with time clocks. An employee who fails to record his or her time may be subjected to discipline as well. Under current law. A timekeeping provision such as the sample policy can help facilitate compliance with these requirements. Any errors on your time card should be reported immediately to your supervisor. The FLSA merely requires that such time be recorded and kept accurately by the employer. the Fair Labor Standards Act (FLSA). there is no legal requirement that such clocks be used – as opposed to other means – to record non-exempt work time. allowing another employee to fill out your time card. SAMPLE POLICY All non-exempt employees must accurately record time worked on a time card for payroll purposes. including before and after the lunch break. Employees are required to record their own time at the beginning and end of each work period.Hours of work and overtime Timekeeping requirements Under Oregon wage and hour law and its federal counterpart. Salaried exempt employees are not entitled to overtime pay under the FLSA. employers are obligated to pay overtime premiums if they knew or had reason to believe that employees were working overtime hours. Employees also must record their time whenever they leave the building for any reason other than Company business. Then. or altering any time card will be grounds for discipline up to and including termination. even if the hours worked were not specifically authorized by the employer.

Supervisor Authorization No overtime may be worked by (non-exempt) employees unless specifically authorized by supervision or management. Any violations of this policy shall subject the offending employee to discipline under the Company’s progressive discipline policy. the non-exempt employee performing that job at the conclusion of his or her straight-time hours will normally be expected to continue to perform the job on an overtime basis. or a holiday. There is no requirement under the law to pay employees “double time” under any situation. Sunday. Paid hours not actually worked (for example. When overtime is required by the Company on a Sunday or on a holiday. 214 . Assignment of Overtime Work When overtime work is required by the Company on a particular job on a shift commencing on a day other than Saturday. SAMPLE POLICY Time-and-a-half The Company pays one and one-half times a non-exempt employee’s hourly rate for all hours worked over 40 in any workweek. vacation. holidays. When overtime work is assigned by the Company on a Saturday. Non-exempt employees are those who work in positions for which an overtime premium must be paid under the Fair Labor Standards Act. Sunday. it generally will be assigned in order of seniority to the employees who regularly perform the particular work involved. Double Time The Company pays two times a non-exempt employee’s hourly rate for all hours worked on any Company-designated holiday. the employee will be subject to discipline under the employer’s policy. or holiday. The following sample policy includes a double time provision for illustrative purposes only. etc.Hours of work and overtime not excuse the employer from paying the employee for that time. the Company will endeavor to give the employees required to work notice of their assignment during their last shift worked prior to such Sunday or Holiday. Limitation on Overtime Pay Overtime pay (premium rates) shall not be paid twice for the same hours (pyramiding).) will not be counted toward the 40 per workweek required to receive overtime pay.

215 .Hours of work and overtime Direct deposit Oregon law does not clearly specify whether an employer may require all employees to use direct deposit. the employer remains obligated to provide employees with an itemized wage statement at each payday the strict deadlines for paying an employee’s final wages upon termination are not altered because of the use of direct deposit. or to make direct deposit a condition of employment for job applicants (assuming the employer had given prior notice to the prospective employees that direct deposit would be required as a condition of employment). BOLI. In other words. interprets this language to mean that an employer is prohibited from changing the method of transmitting wages to an employee without the employee’s consent. “an employer and an employee may agree to authorize an employer” to pay wages due to the employee by direct deposit. and a salary change recommendation form. Employers who use direct deposit should be mindful of the following: • • • the law requires that any direct deposit of wages be “without discount. both of which may fall under Oregon’s “personnel records” statute. The law states that a final paycheck may be paid by direct deposit “provided the employee and the employer have agreed to such deposit. an employer. may not require the direct deposit of paychecks for employees who previously received those wages in some other form unless the employee gives voluntary consent in order to use direct deposits (or electronic transfers) for pay purposes. however. Neither the law nor BOLI explicitly prohibit employers from requiring all new hires to use direct deposit. This chapter also includes a sample employee payroll change notice.” meaning that the employer may not charge or deduct any fee for the electronic transaction even if employers and employees use direct deposit.” Employers should consult with their payroll providers to determine what type of information is needed from an employee to ensure that direct deposit is successful. according to BOLI. The attached sample payroll direct deposit form is for illustrative purposes only. Under Oregon law.

216 .Hours of work and overtime PAYROLL DIRECT DEPOSIT FORM DATE: (Employee’s Name) I hereby authorize the payroll direct deposit actions described below. (Employee’s Signature) ACCOUNT TYPE & NUMBER ACTION TO BE TAKEN NEW TOTAL DEDUCTION EACH PAY PERIOD $ CHECKING ____ ____ ____ ____ ____ ____ ____ (Account Number)  Begin Direct Deposit  Change Direct Deposit  Cancel Direct Deposit ____ ____ ____ ____ ____ ____ ____ (Bank Routing Number) (Bank Name) SAVINGS ____ ____ ____ ____ ____ ____ ____ (Account Number) (Bank Location/City)  Begin Direct Deposit  Change Direct Deposit $  Cancel Direct Deposit ____ ____ ____ ____ ____ ____ ____ (Bank Routing Number) (Bank Name) (Bank Location/City) PLEASE ATTACH A COPY OF DEPOSIT SLIP(S) AND RETURN TO PAYROLL DEPARTMENT.

Hours of work and overtime EMPLOYEE PAYROLL CHANGE NOTICE Name: Department: Effective Date: Change of:  Name  Address  Marital Status  Wage Rate  Department  Position  Emergency Contact  Full-Time/Part-Time Status FROM Payroll No.:  Leave of Absence  Workers’ Compensation  Educational  Jury Duty  Medical and/or Family Leave Purpose:  Completion of Training  Benefit Coverage  Authorized Deduction  Separation from Employment  Telephone Number  Military TO Date: Date: Submitted by: (Supervisor) Received by: (Personnel/Payroll) 217 .: Employee No.

Hours of work and overtime SALARY CHANGE RECOMMENDATION FORM EMPLOYEE NAME _______________________________________________________________ EMPLOYEE # DEPARTMENT HIRE DATE ______________________________ PERFORMANCE RATING___________________________ PRESENT SALARY_________________JOB GRADE__________TITLE __________________ RECOMMENDED SALARY________________JOB GRADE_______TITLE _______________ AMOUNT/PERCENT/DATE OF INCREASE AMOUNT/PERCENT/DATE OF PREVIOUS INCREASE / / / _______________ / _________ REASON FOR INCREASE:  MERIT  PROMOTION  EQUITY  OTHER STATUS:  EXEMPT  NONEXEMPT EFFECTIVE DATE OF INCREASE __________________________________________________ COMMENTS: ____________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ SUPERVISOR SIGNATURE_______________________________ MANAGER SIGNATURE _________________________________ EXECUTIVE SIGNATURE________________________________ PERSONNEL SIGNATURE _______________________________ DATE NEXT ELIGIBLE FOR INCREASE:___________________ DATE _______________ DATE _______________ DATE _______________ DATE _______________ 218 .

with an explanation of the conditions and requirements for receiving such advances. in the employer’s written policies. If an employer chooses to have a policy allowing such advances. Oregon employers are best served by not allowing employees to take payroll advances. it may wish to include the policy. 219 .Hours of work and overtime Payroll advances As a general matter. SAMPLE POLICY No payroll advances are permitted by the Company against paychecks or unaccrued vacation.

Hours of work and overtime 220 .

The employer should attempt to consistently follow the procedures outlined in its performance review policy. Performance reviews should be tied directly to the goals of the department or division for which the employee works and reflect goals previously communicated to the individual employee. A court may not believe that an employee’s poor performance led to a termination decision when the performance reviews do not reflect that poor performance. but rather to acknowledge that they have received and reviewed the contents of the evaluation form. or any other disparate treatment theory. It is simply a good management practice. and progress towards that goal should be evaluated in the review. and most employers conduct periodic performance reviews of their employees. A performance review should not be the only feedback that an employee receives. An inaccurate review is worse than no review in many circumstances. identifies any performance problems. whether defending against claims based upon discrimination. Employees should be required to date and sign the evaluation form not to indicate agreement with its contents. and rate the employee as an “average” performer. Finally. and on what bases. and encourages employees to improve their performance. Each evaluation form should also contain space for the employee to respond to it. accurate and thoughtful documentation regarding an individual employee’s performance is invaluable in litigation. all performance reviews should be reviewed by Human Resources for consistency and any legal issues prior to being communicated to the employee. promotion and layoff There is no law requiring employers to provide performance reviews. but also any unsatisfactory work performance or disciplinary problems. An effective review tells an employee whether they are meeting or exceeding performance goals. if the employee does not respond to the evaluation form in writing. Employers should adopt a policy advising employees how often they will be reviewed.Chapter 10 Performance reviews. however – it is simply one tool that an employer has to manage its employees. what managers or executive officers should sign off on the reviews). 221 . a court or jury may consider this decision an acquiescence or agreement to the contents of the review. For example. Finally. that level should be communicated to the employee at the beginning of the evaluation period. Performance reviews must accurately document not only an employee’s strengths and skills. if an employee is expected to meet a certain production level. Each employer should decide on whether additional approvals of the performance evaluations are appropriate (for example. wrongful termination.

SAMPLE POLICY All ABC Company employees will receive periodic performance reviews. and objectives or goals for future work performance. 222 . on or about the anniversary date of your employment with the Company Your performance evaluation will include factors such as the quality and quantity of your work. while others are simply ask if the employee meets or exceeds expectations. your attendance record. your work attitude. and your attitude toward others. performance evaluations will be conducted annually. areas of needed improvement.Performance reviews. After the review. your initiative. your knowledge of the job. you will be provided an opportunity to respond to the review. Your review will be conducted by your supervisor who will discuss it with you. Review the different options. promotion and layoff A number of different types of performance reviews are included. Your first performance evaluation will be after completion of your orientation period. below. The performance evaluation should help you to become aware of your progress. Positive performance evaluations do not guarantee increases in compensation or promotions. and choose which performance review format is most appropriate for your work environment. Some of the reviews utilize a point system. and will be asked to sign the written evaluation simply to acknowledge that it has been presented to you and discussed with you by your supervisor and that you are aware of its contents. After that review.

Explanation required.Demonstrated knowledge and understanding of all phases of the job. Quantity of Work . Technical Competency . Explanation of Rating ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ 0 1 2 3 4 5 NR 0 1 2 3 4 5 NR B. (For each performance factor. Meets Expectancy (Acceptable Standards) 2 = Minimally Satisfactory – Performance meets minimum acceptable standards.Volume of work performed in relation to job requirements. Improvement is needed to meet acceptable standards. circle the appropriate rating. NR = Not Rated – Performance not observed or not applicable. 1 = Marginal – Performance is slightly below acceptable standards. Explanation of Rating: ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ 223 . Above Expectancy (Above Standard) 4 = Above Average – Performance is frequently above acceptable standards.) I. GENERAL PERFORMANCE FACTORS RATING FACTOR A. 3 = Fully Satisfactory – Performance consistently meets acceptable standards. promotion and layoff PERFORMANCE APPRAISAL Review Date: _______________________________ Date In Job: ______________________________ Name:_____________________________________ Division: ________________________________ Department: ________________________________ Job Title: ________________________________ Officer Title: _______________________________ EXPLANATION OF RATINGS Below Expectancy (Substandard) 0 = Unsatisfactory – Performance is consistently below acceptable standards.Performance reviews. Immediate and substantial improvement required. Improvement necessary for consistent acceptable performance. 5 = Exceptional – Performance is outstanding and consistently exceeds acceptable standards.

Accuracy and thoroughness of work performed. Policy Compliance and Communication . to subordinates. B.Adherence to and communication of policies.Effective training and motivation of subordinates.Ability to analyze assignments and establish priorities for achievement of objectives.Performance reviews. Explanation of Rating: ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ II. C. Quality of Work . Communication . Problem-Solving Ability . promotion and layoff 0 1 2 3 4 5 NR C.Effectiveness of written and oral communication skills with coworkers and/or customers in the performance of duties.. Cooperation . Work Planning . Explanation of Rating: ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ 0 1 2 3 4 5 NR E. benefits. etc. SUPERVISORY PERFORMANCE 0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5 0 1 2 3 4 5 A. Explanation of Rating: ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ 0 1 2 3 4 5 NR F. procedures. Productivity Effectiveness .Performance in directing assigned work group in achieving work objectives. D.Relationship with co-workers in performing assignments and ability to accept assignments willingly. Development of Subordinates .Performance of supervisor in resolving work related and employee-related problems. 224 . Explanation of Rating: ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ 0 1 2 3 4 5 NR D.

promotion and layoff III. describe the employee’s contributions to achieving the department/division profit plan objectives in the following areas: (1) (2) (3) Business development/income generation Reduction of expenses Other 0 1 2 3 4 5 F. ATTENDANCE/TARDINESS Days Absent Days Tardy  Acceptable  Needs Improvement  Unacceptable ***NOTE – DO NOT CONSIDER THE EMPLOYEE’S ABSENCES THAT WERE EXCUSED OR COVERED BY THE FAMILY AND MEDICAL LEAVE ACT OR ANY OTHER FEDERAL OR STATE LAW.*** Comments: (any “Needs Improvement” or “Unacceptable” rating requires comments) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ IV.Performance reviews. SUMMARY COMMENTS A. Overall Assessment of employee’s performance 225 . Employee’s significant weak points: C. Employee’s significant strong points: B. Development of future potential: If applicable. E. Necessary improvements: D.

Performance reviews. SIGNATURES _____________________________________ _____________________________________ _____________________________________ Date: ______________ Date: ______________ Date: ______________ Date: ______________ Signature of Employee: Signature of Supervisor: Signature of Manager: Signature of Human Resources: _____________________________________ NOTE: ALL APPLICABLE PERFORMANCE IMPROVEMENT PLANS SHOULD BE ATTACHED IF OVERALL RATING IS LESS THAN EXPECTED LEVEL. ***THE COMPANY IS AN AT-WILL EMPLOYER. MEANING THAT EITHER THE COMPANY OR EMPLOYEE CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.*** 226 . THE RATINGS REFLECTED BY THIS FORM DO NOT ALTER THE PARTIES’ AT-WILL RELATIONSHIP. promotion and layoff V. EMPLOYEE COMMENTS Employee Comments: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ VI.

and behaviors demonstrating commitment to and an awareness of the regulated aspects of the job (safety. Consider the major responsibilities or objectives for the period being reviewed.) COMMENT: 227 . Complete the comment sections to support your evaluation JOB UNDERSTANDING: How well does the employee demonstrate an understanding of the total duties and tasks required for satisfactory performance and demonstrate technical competence in the job? Consider evidence of short/long term planning. ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ SECTION 2 Outstanding 5 Excellent 4 Effective 3 Needs Improvement Unsatisfactory 1 2 FACTORS AFFECTING PERFORMANCE AND POTENTIAL: Evaluate the effectiveness of the employee’s behaviors in the areas listed below for the period covered by this report.Performance reviews. promotion and layoff PERFORMANCE APPRAISAL SUMMARY Name ___________________________ Title __________________ Grade _____ Date ________ Location _________________________ Division ____________________ Date Employed in Present Position _________________ Appraising Supervisor/Manager____________________ Department ___________ Date of Last Review ____________________ Reviewed By __________________________ SECTION 1 KEY JOB RESPONSIBILITIES: Using the job position description as a guide list below the major elements or key responsibilities of the position. environmental concerns. delegating. affirmative action. cost/profit consciousness. coaching. etc.

Be sure to include any special project responsibility. Consider ability to observe and remain alert to changing conditions that affect the work. dates.Performance reviews. dates. promotion and layoff Outstanding 5 Excellent 4 Effective 3 Needs Improvement Unsatisfactory 1 2 ANALYTICAL SKILLS: How well does the employee perform the analytical aspects of the job? Consider effectiveness in problem identification analysis of possible solutions. working with appropriate resources. PARTICULAR STRENGTHS: AREAS NEEDING ATTENTION: CAREER/DEVELOPMENT PLAN Indicate career/development plans discussed with employee. Be sure to include any program/seminar titles. COMMENT: INTERPERSONAL SKILLS/COMMUNICATION: How well does the employee communicate both orally and in written form? How well does he/she listen and express thoughts and ideas clearly? Consider the abilities to work well with groups with superiors. creativity and balanced judgment. etc. peers or subordinates to be persuasive. program/seminar titles. PARTICULAR STRENGTHS: AREAS NEEDING ATTENTION: 228 . COMMENT: DEVELOPMENT PLAN Please indicate career/development plans discussed with employee. etc. and taking initiative and demonstrating innovation.

Performance reviews. 5 Outstanding 4 Exceeds Standards 3 Meets Standards 2 Needs Improvement 1 Unsatisfactory COMMENTS SUMMARIZING PERFORMANCE BASED ON DISCUSSIONS AND SUPPORTING PERFORMANCE EVALUATION EMPLOYEE COMMENTS:____________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Date Date Signature of Appraising Supervisor/Manager Signature of Employee 229 . please indicate by checking the appropriate box your overall appraisal of this individual’s contribution. promotion and layoff OVERALL EVALUATION OF PERFORMANCE: Considering both the performance against objectives and the evaluations given on the section of Factors Affecting Performance. and note supporting comments.

3. Check rating box to indicate the employee’s performance. Performance is of high quality and is achieved on a consistent basis. 2. Meets performance standards of the job. Indicate N/A if not applicable. U – Unsatisfactory – Results are generally unacceptable and require immediate improvement. Improvement is necessary. V – Very Good – Results clearly exceed most position requirements. Quality – The extent to which an employee’s work is accurate. Definitions of Performance Ratings O – Outstanding – Performance is exceptional in all areas and is recognizable as being far superior to others. General Factors 1. Productivity – The extent to which an employee produces a significant volume of work efficiently in a specified period of time. promotion and layoff PERFORMANCE APPRAISAL PLEASE PRINT Employee Name Department Reason for Review Performance Annual Merit Date employee began present position / Scheduled appraisal date / /______ Promotion Title Employee # Peer Appraisal Unsatisfactory Other / /______ End of Introductory Period / Date of last appraisal Instructions: Carefully evaluate employee’s work performance in relation to the essential functions of the job. Points will be totaled and averaged for an overall performance score. No merit increase should be granted to individuals with this rating. Supportive Details or Comments Points Points 230 .Performance reviews. thorough and neat. N/A – Not Applicable or too soon to rate. Job Knowledge – The extent to which an employee possesses the practical/technical knowledge required on the job. G – Good – Competent and dependable level of performance. Rating O V G I U O V G I U O V G I U 100-90 89-80 79-70 69-60 Below 60 1 100-90 89-80 79-70 69-60 Below 60 100-90 89-80 79-70 69-60 Below 60 Points I – Improvement Needed – Performance deficient in certain areas. Assign points for each rating within the scale and write that number in the corresponding points box.

Initiative – The extent to which an employee seeks out new assignments and assumes additional duties when necessary. promotion and layoff 4.Performance reviews. supervisors. and/or outside contacts. and communicate with coworkers. Adherence to Policy – The extent to which an employee follows safety and conduct rules. Attendance – The extent to which an employee is punctual. Interpersonal Relationships – The extent to which an employee is willing and demonstrates the ability to cooperate. Judgment – The extent to which an employee demonstrates proper judgment and decisionmaking skills when necessary. Reliability – The extent to which an employee can be relied upon regarding task completion and follow-up. other regulations and adheres to company policies. 11. subordinates. 8. 10. 6. Creativity – The extent to which an employee proposes ideas. O V G I U O V G I U O V G I U O V G I U O V G I U O V G I U O V G I U 100-90 89-80 79-70 69-60 Below 60 100-90 89-80 79-70 69-60 Below 60 100-90 89-80 79-70 69-60 Below 60 100-90 89-80 79-70 69-60 Below 60 100-90 89-80 79-70 69-60 Below 60 100-90 89-80 79-70 69-60 Below 60 100-90 89-80 79-70 69-60 Below 60 Points Points Points Points Points Points Points O V G I U 100-90 89-80 79-70 69-60 Below 60 Points 231 . 7. 9. observes prescribed work break/meal periods and has an acceptable overall attendance record. work. Independence – The extent to which an employee performs work with little or no supervision. finds new and better ways of doing things. 5.

Accomplishments or new abilities demonstrated since last review: _____________________________ ________________________________________________________________________________ ________________________________________________________________________________ 2.Performance reviews. Specific areas of needed improvement: __________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 3. Recommendations for professional development (seminars. promotion and layoff Rate employee’s overall performance in comparison to position duties and responsibilities. 1. schooling. No Follow-up Date ___/___/___ Date ___/___/___ ***THE COMPANY IS AN AT-WILL EMPLOYER. Outstanding Very Good Good Improvement Needed Unsatisfactory 100 . THE RATINGS REFLECTED BY THIS FORM DO NOT ALTER THE PARTIES’ ATWILL RELATIONSHIP.60 Below 60 Total Points ÷ Number of Factors Rated = Overall Rating Complete all of the following sections.): ______________ ________________________________________________________________________________ ________________________________________________________________________________ 4. training. etc.90 89 . MEANING THAT EITHER THE COMPANY OR EMPLOYEE CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.70 69 .80 79 .*** 232 . Absences: Number of incidents _______________ Number of days ____________________________ Additional Employee Comments ___________________________________________________________ _______________________________________________________________________________________ Discussed with individual on ___/___/___ Follow-up requested/desired Evaluator’s Signature Yes Employee’s Signature* *I acknowledge that this Performance Appraisal was discussed with me.

Volume. and neatness. INITIATIVE. EXPECTATION CATEGORY BELOW QUALITY OF WORK. DEPENDABILITY. thoroughness. Ability to convey information in an efficient. and courteous manner via telephone. You should support ratings with appropriate performance-based comments. Staff member plans ahead. 233 . follow assignments through to completion. stay on job. carry out instructions. Extent to which you can depend on staff member to report on time. Extent of information and understanding possessed by staff member in own particular field. Ability to learn new duties and adjust to new situations. promotion and layoff PERFORMANCE EVALUATION EVALUATOR: NAME: POSITION: DATE OF EMPLOYMENT: OFFICE: REVIEW DATE PREPARED: Annual Before beginning this evaluation. ABOVE AT QUALITY OF WORK. coherent. Work meets quality requirements of accuracy. etc. WRITTEN AND ORAL COMMUNICATION. Does the staff member work effectively in the absence of detailed instruction? Does the staff member contribute new ideas? ADAPTABILITY. Extent to which staff member is a “self starter” in attaining work objectives. you should carefully review the criteria to be considered for each rating category given below and the instructions on the reverse side of the form.Performance reviews. speed of output KNOWLEDGE OF POSITION. written work.

promotion and layoff EXPECTATION CATEGORY BELOW INTERPERSONAL RELATIONSHIPS. ABOVE AT ATTITUDE. Staff member is a team player. 234 .Performance reviews. and coworkers. administration. breaks. tardiness. Please note that “at expectation” completely describes satisfactory performance. This performance evaluation should be discussed with each employee. Exhibits a positive attitude towards firm. Shows initiative. Interacts well with coworkers.) DO NOT CONSIDER ABSENCES COVERED BY THE FAMILY & MEDICAL LEAVE ACT OR OTHER APPLICABLE FEDERAL OR STATE LAW. Your ratings and comments should be kept as objective as possible. Conscientious about attendance and punctuality (sick leave. tactfulness. Cooperation is given fully. OTHER COMMENTS: SIGNATURES EMPLOYEE EVALUATOR HUMAN RESOURCES __________________________________ __________________________________ _________________________________ DATE ____________________ DATE ____________________ DATE ____________________ INSTRUCTIONS FOR COMPLETING THE PERFORMANCE EVALUATION This performance evaluation is to serve as a record of performance and accomplishments during the past 12 months. ATTENDANCE. etc. does not waste time when he/she could assist others. Cooperation with others. This evaluation will also be used in selecting qualified individuals for further assignments and in administering an equitable compensation program. Its purpose is to summarize the information necessary to report the individual’s current performance and to assist you and others in effectively developing and counseling the staff member. ability to get along with co-workers and superiors.

*** 235 . supervision or guidance is required in daily work. promotion and layoff RATINGS The following descriptions will help you in using the rating scale. ***THE COMPANY IS AN AT-WILL EMPLOYER. If this category is used. may be made in the space provided. either exceptional performance or recommendations for improvements. This evaluation will be that normally used to describe performance of high quality that meets the standards of the firm. Recommendations for improvements should be directed to specific areas in which the staff member may improve performance. Write “No Basis” in the section if the evaluator is unable to appraise the performance of the individual due to the nature of the individual’s assignment. if any. The basis for performance ratings should be indicated in the comments section.Performance reviews. Indicates performance that requires improvement. Very little. Above Expectation At Expectation Below Expectation No Basis Indicates exceptional performance that consistently exceeds the quality and quantity requirements of the position. there should be specific comments regarding how performance is to be improved. MEANING THAT EITHER THE COMPANY OR EMPLOYEE CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASONS. Indicates performance that consistently meets the requirements of the position. Works very well with a minimum of supervision. THE RATINGS REFLECTED BY THIS FORM DO NOT ALTER THE PARTIES’ AT-WILL RELATIONSHIP. OTHER COMMENTS BY EVALUATOR Additional comments or observations not previously made with respect to the rating.

Any decision to increase or change an individual employee’s compensation rests within the sole discretion of the Company. There is no requirement that a formal policy explaining this practice be adopted. Promotions and transfers Employers often prefer to promote or transfer employees “from within. SAMPLE POLICY Your compensation will be reviewed on a regular basis by your manager and the Company. but if it is. the policy should be consistently followed while preserving the employer’s option to publicly advertise positions and/or pursue an outside candidate for open positions. and provide an incentive to employees to improve work performance. such as an Equal Pay Act action. The Company also prefers to promote from within. The amount and frequency of any compensation increase you may receive will be based upon your job performance. provide opportunities for advancement. the amount of your present salary or wage in relation to the minimum and maximum of the compensation range assigned to your job. promotion and layoff Compensation reviews Some employers choose to adopt a compensation review policy to advise employees of the probable timing of compensation increases and the factors that the employer will consider in making wage increase determinations. A compensation review policy should be flexible. and make clear to employees that any changes in compensation are within the sole discretion of the employer. SAMPLE POLICY It is the policy of the ABC Company to fill all positions with the best qualified people. If adopted. the profitability of the Company. 236 . Such reviews generally are conducted on at least an annual basis and typically follow your annual performance appraisal. either directly promote or transfer a qualified employee of the Company or open the position for application by internal and external candidates.Performance reviews. management may.” This practice can increase employee morale. and any other factor which the Company considers appropriate. There is no requirement that such a policy be adopted. at its discretion. As positions become available. however. the employer must be diligent about following the policy or risk affecting employee morale and the employer’s ability to defend against a later discrimination claim. the length of time since your last increase.

non-biased performance evaluations. then. the Company should review the selection criteria. Frequently. Employers may be subjected to substantial penalties if WARN’s notice requirements are not followed. job vacancies will be advertised with outside sources during the same week they are posted on the bulletin boards.Performance reviews. or recall is the risk of a claim of unlawful discrimination. A layoff policy may be appropriate for an employer that experiences significant seasonal or cyclical changes in the size of its workforce. To the extent possible. the evaluation of how the skills. business-related criteria. selected employees. At most. seniority. and the ultimate decision. Employers should follow a similar process in connection with any recall. open positions will be posted on the official Company bulletin boards for at least five work days. and all other factors being equal. In determining which employees will be affected by the layoff (or conversely. For employers with a constant workforce size. abilities and performance of individual employees fit into those needs. the skills and abilities of the individual employees. An employer with 100 or more employees facing the possibility of a significant layoff or plant closing should contact an attorney to ensure compliance with the federal Worker Adjustment and Retraining Notification Act (WARN). reduction in force. Documentation of the decision-making process by the employer is also critical in rebutting a claim of discrimination related to a layoff or recall. including whether seniority will be a factor. promotion and layoff At the Company’s discretion. a layoff policy is not for every employer. a layoff policy should advise employees of the general criteria that will be considered. Accordingly. Layoff and recall Layoff policies should not be adopted lightly. To apply for a position. Inherent in any layoff. and impact of the decisions to determine whether a discriminatory disparate impact will result to any protected category or whether any other issues arise that could increase litigation risks. recalled). The required qualifications for each open job will be indicated on the listing. an employer should consider only legitimate. the employer should document the business needs it is considering. such as the business needs of the Company. The specific details of the selection process should not be included in a layoff policy. WARN requires certain prior notice obligations to covered employers if an employment site (one or more facilities or operating units within an employment site) will be shut down. a layoff policy may not be appropriate and could be problematic. This is done to speed up the screening process and to aid in ensuring that vacancies are filled by the most qualified persons. 237 . Prior to adopting a layoff policy. Prior to the final decision being made. an employer should consult legal counsel and seriously consider whether such a policy is necessary. and maintain the Company’s discretion in the decision making process. and the shutdown will result in an employment loss for 50 or more employees during any 30-day period. objective. you should submit a formal application for the position to Human Resources referencing the position and requesting an interview.

employees subject to layoff will be informed of the nature of the layoff and the foreseeable duration of the layoff. employers should consider consulting with legal counsel prior to any layoff. among other things. though not provided.Performance reviews. productivity. 238 . whether short-term or indefinite. the terms of which will be governed by the actual group insurance contract in effect at the time the employee returns to work. SAMPLE POLICY Under some circumstances. In determining which employees will be subject to layoff. If possible. Information concerning employee rights under COBRA is available from the Human Resources Department. the skill. Insurance coverage. past performance. When workload increases to the extent that additional employees are needed. operational requirements. benefits and time of service will be fully reinstated on the date of return to work. promotion and layoff Because of the legal requirements of WARN and the potential for litigation associated with any layoff. This rule does not apply to the group insurance plan. and attendance of those involved. The Company reserves the right to hire new employees during a layoff period when required skills for the work at hand are not available without training among the laid-off employees. the Company will consider. the Company may recall individuals according to these same selection criteria. If an employee on layoff has fulfilled the orientation period requirements at the time of layoff. and the employee is recalled by the Company and returns to work within 90 calendar days of the date of layoff. All Company benefits will terminate at the time of layoff. will remain available under the provisions of COBRA. ABC Company may need to restructure its operations or reduce its workforce.

materials.Chapter 11 Confidentiality and conflicts of interest Confidentiality of company information Depending on the work environment and the employee’s access to confidential information. it will nonetheless serve to remind employees of the company’s expectation that certain information will not be disclosed to others outside the business or used by employees to their own advantage. Examples include. proprietary information. (c) is received 239 . the following: data. While a written confidentiality policy does not have the same legal force as a confidentiality agreement. agreements. business plans. “Confidential Information” may or may not be patentable. and financial information. a confidentiality policy is still beneficial. “Confidential Information” means nonpublic information relating to ABC Company or its business. customer or supplier lists. and/or business relationships involving ABC Company and others. for any reason. Employees with access to trade secret. either directly or indirectly. either during their employment with ABC Company or at any time following termination of that employment. but are not limited to. research results. and/or other intellectual property of the Company should be required to sign a NonDisclosure Agreement. product formulas. employees shall not. Even if employees are required to sign an NDA or other agreement. Your legal counsel can advise you of whether such an agreement is warranted in your workplace. or use nay Confidential Information of ABC Company. SAMPLE POLICY (Option 1) Except as is necessary for the proper performance of their duties for ABC Company. “Confidential Information” does not include information that: (a) is publicly available other than as a result of improper disclosure by ABC Company employees. disclose to any person or entity outside of ABC Company. “Confidential Information” includes the existence and terms of any negotiations. marketing plans. a statement in one form or another may be essential to safeguarding the employer’s proprietary information. (b) an employee can convincingly show was known to him or her before its receipt from the Company.

or relating to Confidential Information. These methods include. This agreement will be provided to each employee to sign upon the employee’s initial employment. Brands. Ownership of Intellectual Property ABC Company employees may create or develop intellectual property in the course of their employment with the Company. or relating to Confidential Information. logos. and other trademarks or service marks. referring to. 240 . All ABC Company employees are required to use all reasonable and necessary means to ensure that electronic transmissions containing or relating to Confidential Information are not compromised. or (d) is approved in writing by ABC Company’s President for release or is otherwise excluded from the definition of Confidential Information with the employee. Some examples of intellectual property are: • • • • Inventions. notes. but are not limited to. data encryption.Confidentiality and conflicts of interest on a nonconfidential basis from a third party. files. all ABC Company employees will be required to sign an agreement concerning the protection of Confidential Information upon their date of hire. Software Intellectual Property that employees create in the course of their employment belongs to ABC Company. containing. Upon separation with ABC Company. records. employees must promptly return any and all documents. whether in hard copy or on computer disk. take all precautions necessary to protect from loss or disclosure any and all documents or other information containing. The agreement that each employee signs protecting Confidential Information also assigns ownership of this intellectual property to ABC Company. referring. lists. at all times. anti-virus software. or other tangible items. In addition. whether patentable or unpatentable. ABC Company employees shall. Materials that are subject to copyright. and any other electronic programs that would facilitate protection of Confidential Information. Care is especially important in the are of electronic communications. the use of firewalls.

2007. R&D data. manufacturers’ sales representatives and other outside parties about our expanding role in new markets. You must protect all confidential information of the Company by safeguarding it when in use. organization.. The Act does not apply to the use of social security numbers for internal verification or administrative purposes. sales. a person’s social security number may not be printed on those materials. filing it properly when not in use. customer lists and requirements.” please refer the caller to your supervisor or to a member of the Management Team. present technology. future plans. Confidentiality of employee information Effective October 1. the Act does not apply to records that are required by law to be made publicly available. In addition. or individual that maintains or possesses an Oregon resident’s personal information that is used in the 241 .Confidentiality and conflicts of interest SAMPLE POLICY (Option 2) Confidentiality During the course of your employment with the Company. receive phone calls and inquiries from the press. Notification of a security breach This provision of the Act applies to any business. pricing. you may be exposed to confidential information regarding the company or its business (e. to our ability to achieve financial success and provide employment stability. personnel issues. or any other matter. Note: If there are specific types of “confidential information” that apply to your industry or business. Maintaining the confidentiality of the Company’s nonpublic information is extremely important to our competitive position in the industry and ultimately.g. If you should be questioned about any aspect of the company that is not generally known to the public concerning the company’s products. business systems. future plans.). sales figures. Protecting Social Security Numbers The Act prohibits the public display or disclosure of more than the last four digits of a social security number. You may even from time to time. if a card or other materials are required to access the business’s products or services. programs. products. all Oregon employers became required by law to safeguard an employee’s confidential information pursuant to the Oregon Consumer Identity Theft Protection Act (“the Act”). For example. and discussing or otherwise disclosing it only with or to those who have a legitimate need to know related to the Company’s business. and if you have not been specifically identified as a “corporate spokesperson. etc. list them in the policy.

Instead. businesses should adopt and maintain document-retention schedules so that confidential information is regularly destroyed when no longer needed. Businesses should restrict access to electronic confidential information to a small number of designated people. The business must include the police report number. Employers should consult with their legal counsel to determine what form of notice. If a business determines. confidentiality.000 individuals. and integrity of employees’ personal information. it would be a good idea to obtain information in writing from hardware and software suppliers regarding the safeguards used to protect confidential information. and the information should be password-protected. businesses or organizations that maintain or possess an individual’s personal information must develop. Businesses that contract with an IT company should ensure that the IT company spells out its sufficient safeguards in the contract with the business. the business must notify. Safeguarding personal information Effective January 1. Similarly. consult with legal counsel about a best practices approach for safeguarding personal information and complying with the Act. implement. passport numbers. best complies with the Act’s requirements. The Act includes guidelines for compliance. and the contents of that notice. technical. and credit card numbers. if available. distribution. that the affected individuals are not likely to be harmed by the security breach. and content of the notification given by the business to the individuals. and access to the locked cabinets should be limited to a few employees. consistent with the needs and investigation of law enforcement. driver’s license numbers. and maintain reasonable safeguards to protect the security. financial account numbers. • • 242 . the business need not notify the individuals. after appropriate investigation or consultation with law enforcement. Under the Act. If a security breach affects more than 1. all consumer reporting agencies regarding the timing. without unreasonable delay. In addition.Confidentiality and conflicts of interest course of business. and physical safeguards. There is no established set of practices that each business must follow to comply with the Act. if a business’s computer files containing personal information have been subject to a security breach. Any employee with a key who leaves the company should return the key. Such a determination must be documented in writing. and the documentation must be maintained for five years. and suggests options for an information security program that includes administrative. The notification must be done in the most expeditious time possible. 2008. Personal information includes social security numbers. the business must notify the affected individuals. the legislature has recognized that adequate safeguards will vary from business to business depending on the size and technical nature of the business. Some examples of ways to safeguard confidential information include the following: • Paper documents containing confidential information should be stored in locked cabinets.

243 . Businesses should establish a written procedure for identifying and responding to security breaches. competitor or other company. An owner of a small business (defined as a manufacturing business having 200 or fewer employees and all other forms of business having 50 or fewer employees) may adopt measures appropriate to its size and activities and the sensitivity of the information collected. maintaining an ownership interest in a customer. No matter the origin of the conflict. or an employee whose second job interferes with his or her job performance.Confidentiality and conflicts of interest • Many security breaches occur when laptops are stolen. or the Health Insurance Portability and Accountability Act of 1996 is also in compliance with the Act. and can only address conflicts that arise during the employment relationship. Only conduct by current employees can be addressed. if detrimental conflicts of interest are likely to arise. • • Any business that is subject to and complies with Title V of the Gramm-Leach-Bliley Act of 1999. Businesses might consider providing a locked box for the disposal of paper documents containing confidential information. A business might consider prohibiting employees from storing confidential information on business laptops and instead require that such information be stored on the server. Competitive activity by a former employee is not precluded by such a policy. A conflict could arise from an employee performing services for a competitor. Conflicts of interest Conflicts of interest are a growing concern to all employers. an employer should consider adopting a conflict of interest policy. Such a policy cannot impose an otherwise unenforceable covenant not to compete. Documents in the locked box could then be shredded on a regular basis by a designated employee or shredding service.

or competitor of the Company. or competitor of the Company other than recognized financial institutions. banks. daughter. occasional meals. supplier of materials or services. director. or anything of value from any current or prospective customer. son. or competitor. please contact Company management. or consultant for a customer. supplier of materials or services. supplier of materials or services. Failure to report any questionable item and/or obtain prior written approval may have serious consequences up to and including termination and legal action. client. or wife) any financial interest in the business of any customer. entertainment. other than minor Christmas or holiday gifts. mother. 3. supplier of materials or services. officer. unless the amount held is in excess of 10 percent of the outstanding stock of that corporation or the stock held has a value representing more than 10 percent of the individual’s personal net worth. This does not include a financial interest in widely held corporations that are quoted and sold on the open market. or supplier of materials or services. or competitor of the Company. 5. It is important to avoid not only any situation that is an obvious conflict of interest such as those listed above. 2. etc. client. client. sister. client. If you have any questions concerning this subject. Doing any work or providing any other assistance to a current or prospective client. brother. The following examples have been deemed to involve a conflict of interest that violates Company policy: 1. Borrowing money from or lending money to any current or prospective customer. Accepting gifts. Holding by an employee or an immediate family member of an employee (including father. husband. credit unions. Serving as an employee. and entertainment of a nominal nature. the Company requires that all employees be guided by the highest standard of conduct in their business contacts and relationships. for example. To protect and enhance our reputation. 4. 244 . but also any situation that might give the appearance of being a conflict of interest. The reputation of the Company is a direct reflection of the business conduct of all who work for it. or competitor of the Company.Confidentiality and conflicts of interest SAMPLE POLICY It is the objective of ABC Company to maintain an organization guided and governed by the highest standards of conduct and ethics.

health insurance forms. and requiring that if social security numbers are used. many employers rely upon social security numbers as a de facto “employee identification number” used throughout the employment relationship. a few states have already adopted legislation prohibiting such use of social security numbers. at most. Accordingly.Confidentiality and conflicts of interest Social security numbers Employees are often asked for their social security numbers in the employment context. and personnel action forms. including social security numbers and health information. When discarding old personnel files or other information that may contain private employee information. 245 . employers should take measures to ensure that the documents are actually destroyed (burned or shredded) and not simply discarded. employees and employers are becoming concerned about this practice as disclosure and dissemination of an employee’s social security number could contribute to identity theft. of course). only the last four digits can be printed on any document mailed or transmitted to the employee (with the exception of tax reporting documents. Employers should consider either adopting a policy that provides employees with an alternative employee identification number or not requesting or using an employee’s social security number except as required by law. More and more. Indeed. including pay stubs.

Confidentiality and conflicts of interest 246 .

cause to be filed. EEO policies). subcontractor. testify. or agent” of such company may not “demote.Chapter 12 Complaint-reporting procedures In addition to the complaint reporting procedure available to employees with complaints about harassment (discussed in Chapter 6. or otherwise assist in an investigation regarding any conduct which the employee reasonably believes constitutes a violation [of federal securities law or SEC rules and regulations]. or terminate misconduct) or • to file. suspend. cause information to be provided. and provides that a publicly traded company or any “officer. an employee handbook should also contain a complaint reporting procedure to address other work-related complaints. or otherwise assist in a proceeding filed or about to be filed (with any knowledge of the employer) relating to an alleged violation of 247 . Employers subject to the Sarbanes-Oxley Act of 2002 may also have a legal reason to include a complaint reporting procedure in their employee handbooks. or in any other manner discriminate against an employee in the terms or conditions of employment” because of any lawful act done by the employee: • to provide information. employee. contractor. when the information or assistance is provided to or the investigation is conducted by: ■ a Federal regulatory or law enforcement agency or ■ any Member of Congress or any committee of Congress or ■ a person with supervisory authority over the employee (or such other person working for the employer who has the authority to investigate. participate in. sample complaint reporting procedures are included in this chapter. threaten. Such a procedure can be as simple as an “open door policy” or as detailed as a formalized complaint process. or any provision of Federal law relating to fraud against shareholders. harass. The Sarbanes-Oxley Act created whistleblower protections for employees of publicly traded companies. discover.

If an employee fails to take advantage of internal grievance procedures. An employer’s inclusion of a complaint-reporting procedure in its employee handbook may assist Oregon employers in defending against Sarbanes-Oxley complaints. and then attempts to initiate litigation. working conditions. or harass. Further. an Oregon employer may still wish to include a separate complaint reporting procedure in its handbook that covers all work-related issues. the employee’s failure to utilize an internal complaint reporting procedure that is fair and consistently applied can be a strong piece of evidence for an employer. an employee who has access to an internal complaint procedure may be less likely to turn to an outside agency or legal assistance prior to following that procedure. An employer who does not include a complaint-reporting procedure in its handbook could be viewed as intolerant of whistleblowers. 248 . under the Act. Further. such as a written complaint. or overtime compliance. quits. Because grievance procedures in a collective bargaining agreement typically place limits on what may be grieved. because the employer can show it was open and receptive to employee complaints. may very likely be used against the employee during the lawsuit). due to its including in the agreement. Note that employers with employees subject to a collective bargaining agreement may already have a grievance procedure in place. or any provision of Federal law relating to fraud against shareholders.Complaint-reporting procedures [federal securities law or the SEC rules and regulations]. regardless of whether the issue is discrimination. employers may not take any kind of retaliatory conduct. Thus. or discriminate against any employee who reports a suspected violation to his/her supervisor or another person with the ability to investigate the suspected wrongdoing. the information an employee provides during a complaint reporting procedure may be of value to an employer if the employee later sues the employer (because the information provided.

The Human Resources manager will assist the employee (if requested) in the presentation of the problem to the president. the employee then has the right to discuss it with the Human Resources manager. penalize you. Therefore. 249 . the reason for the decision will be clearly explained to the employee. Human Resources personnel are available. If the problem is not satisfactorily resolved or the problem is with the supervisor. If an employee has a problem or complaint. No one may criticize you. at any time. the employee has the right to discuss it with his or her department manager. the employee has the right to discuss it with the president of the Company for a final resolution. However. to discuss and/or provide assistance on any complaint. the employee should discuss it with his or her immediate supervisor as soon as possible.Complaint-reporting procedures SAMPLE POLICY (Option 1) Problem-Solving Procedure ABC Company is concerned with any situation affecting the employment relationship. The Company is committed to correcting any condition or situation that may cause unfairness or misunderstanding. the Company has provided an orderly manner for an employee to voice an opinion or discuss a problem with management without prejudice or fear of retaliation. Also. problem. Not all complaints can be resolved to everyone’s satisfaction. or treat you differently in any way for using this procedure. In the event the problem still has not been satisfactorily resolved. If the problem still is not satisfactorily resolved. It is inevitable that problems and misunderstandings may occur. in each case. or concern that an employee may have.

There may be times when the nature of a particular problem is such that you do not feel you can discuss it with your supervisor. working conditions. You may. Third Step. working conditions. having another employee or your supervisor write up the grievance. as set forth below. then you should take your problem directly to the president of the Company by arranging an appointment with him or her. even if you think your supervisor should be aware of your problem. We will do all we reasonably can to make this a good place to work. Once written. Any problem or complaint concerning wages. your problem may not be resolved unless and until you take the appropriate steps. the grievance should be given to your supervisor. If so. hours. First Step. fair treatment. The manager will attempt to resolve your concerns as well. which will be submitted to the president within 24 hours. You have the option of writing up the grievance yourself or. or your supervisor does not give you a satisfactory answer. Your supervisor will then discuss the grievance with you in an effort to resolve your grievance. Procedure 1. to see that the matter is resolved. 2. The facility manager also will make a record of the discussion. Second Step. fair treatment. unless you wish to proceed directly to the Second Step for any reason. 250 . It is important that any problem be discussed with your supervisor immediately – if possible within three working days of the date you first learn of the basis for your complaint. if you wish. if you wish. Remember. hours. If you have a problem or complaint concerning your employment. your supervisor does not give you a prompt answer. or other work-related matters ordinarily should be raised first with your immediate supervisor. then you should take your problem directly to the facility manager by arranging an appointment with him or her. or other work-related matters.Complaint-reporting procedures SAMPLE POLICY (Option 2) Problem-Solving Procedure ABC Company intends to treat each employee fairly. file a formal grievance concerning any complaint about wages. If your problem or complaint has still not been resolved to your satisfaction in the Second Step within three working days. you are expected to take the appropriate steps. or if you believe you are not being treated fairly. 3.

or treat you differently in any way for using this fair treatment procedure. The president’s decision on any grievance or complaint will be final. This procedure is not intended to prevent you from discussing any matter with any level of management. at any time. No Recrimination Statement No one may criticize you. but you are encouraged to follow the procedure as set forth in the First. All employees are encouraged to raise their work-related concerns informally with their supervisor or with any supervisor of their choice as soon as possible after an event that causes concern. including the president. Second.Complaint-reporting procedures The president will give you an answer within 24 hours of the discussion. and Third Steps of this policy. penalize you. 251 . or if he or she is away from Company premises on business. ABC Company is also interested in employees’ constructive ideas and suggestions for improving our business. Employees are encouraged to express their ideas and suggestions. within 24 hours of his of her return. SAMPLE OPEN DOOR POLICY ABC Company’s Open Door Policy is based on our belief that issues are best addressed through informal and open communication.

Complaint-reporting procedures 252 .

750(1)(b). promotion. Several types of records should not be maintained in a personnel file containing “personnel records. arrest or investigation of conduct constituting a violation of the criminal laws of Oregon or another state. ORS 652. Communications from the company’s attorney or in-house counsel regarding a particular employee. and other related documents. Records of an individual relating to the conviction.Chapter 13 Personnel records and recordkeeping requirements Definition of “personnel records” Oregon law defines “personnel records” to include records related to: • • • hiring. The Oregon Bureau of Labor and Industries (BOLI) takes the position that even a “sticky note” attached to a day planner may be a “personnel record” if it directs the employee’s supervisor to discipline or fire the employee. even if the records are identical to those found in the personnel file maintained in the human resources department. and such a note may need to be produced. workers’ compensation claims and injuries.065. demotion or termination decisions pay raises or pay cuts performance evaluations. 253 . including records relating to leaves of absences.” This includes: • • • • Medical records. Payroll records. or to be fully aware of where “personnel records” may be within your organization. disciplinary notices or warnings. certain records related to the State Board of Higher Education maintained in compliance with ORS 351. including timesheets and pay-stubs. This is also true whenever a supervisor or manager keeps his or her own files on particular employees. confidential references or reports from previous employers. if not used to make employment decisions about the employee. There are many good reasons to include all “personnel records” in one place.

In addition. employers should assess every request for records on an individualized basis. employers should not produce records regarding any other employee to a former employee or his or her attorney. as there may be some strategic reasons for producing documents that fall outside of the definition of “personnel records.Personnel records and recordkeeping requirements • I-9 Forms. upon request. to view or receive a copy of his or her “personnel records” within 45 days of receiving an employee’s request. simply because the employee or his or her attorney request it (unless a valid subpoena accompanies it). Regardless. the federal Occupational Safety and Health Act (OSHA) entitles employees who are exposed to toxic substances or harmful physical agents to access certain medical and related records. It is best to simply have someone in the human resources department or an office manager sign a statement indicating that he or she believes she is providing a true and correct copy of the employee’s personnel file. Record review policies In Oregon. Employers are strongly advised to protect the confidential nature of an employee’s “personnel records” by limiting access to those individuals with a need to know (such as a supervisor or manager). 254 . Employers may charge employees a reasonable photocopying fee. and by keeping the “personnel records” in a safe place with limited access (such as a locked filing cabinet). Because the definition of “personnel records” is somewhat narrow. you will be preserving the confidentiality of your employees’ “personnel records” by keeping those records separate from the I-9 forms (because you may be asked to deliver or allow for inspection the entire file). it is not advisable to allow employees the opportunity to “correct” any documents contained in his or her “personnel records. either.” no formal or legal certification of the records is required. leave it there. once a document becomes part of an employee’s “personnel records”. If your company is audited. It is not advisable to remove documents once they are made part of an employee’s official record. In the absence of a subpoena. and the Immigration and Naturalization Service (INS) asks to see your I-9 forms. Records relating to a leave of absence are not required to be produced. Failure to do so could result in penalties or other fines. an employer is not required to produce every record relating to an employee. an employee is not entitled to receive copies of his or her payroll records.” The better practice is to allow the employee the opportunity to provide a “rebuttal” or other statement regarding his or her performance or other employment action with which the employee disagrees.” If an employee requests a “certified” copy of his or her “personnel records. Finally. Employee access to personnel records Oregon law requires employers to provide an employee with the opportunity. The sample policy provides a good example of a means to allow employees such access to their employment files. Further. For example. and possibly consult with legal counsel. an employer has a legal obligation to permit an employee to examine his or her employment records.

Employee will not be paid for the time spent reviewing pay records. No record may be removed from the Human Resources office.Personnel records and recordkeeping requirements From a legal standpoint. Employees may receive copies of any documents in their file at a cost of $. 255 . 5. so employees should make arrangements to view such records during non-working hours and during regular business hours. An employee’s records may be examined only by the employee. 2. promotion. Records may be examined by appointment and prior arrangement with your supervisor and the Human Resources department. Arrangements for Examination of Records For the protection of all. even temporarily. and to maintain employee privacy. 4. or an employee’s personnel file.20 per page copied. disciplinary notices or warnings or other terms and conditions of employment at any reasonable non-working time during regular business hours. the employee recourse provision in the sample policy below may be helpful in defending a claim of an employee who reviewed his or her personnel file without formally challenging any of its contents. or those supervisory personnel with a legitimate need to know. performance evaluations. Employees seeking additional information about their employment history or records should consult with the Human Resources Department. 3. Examination of Personnel Records An employee may examine the records in his or her personnel file relating to the employee’s hiring. records may be examined only in accordance with the following safeguards: 1. the employee’s supervisor or manager. This provision may be used to argue that the employee had no disagreement with any of the negative information contained in his or her file when that information forms the basis for the adverse employment decision over which the employee’s legal claim is asserted. Records may be examined only in the Human Resources office and in the presence of a designated Company representative. discipline. SAMPLE POLICY Examination of Pay Records An employee may examine time sheets and any other records relevant to proper computation of his or her pay or benefits with reasonable notice.

and each analysis produced from the records may be obtained upon request to the Human Resources department. Copies of all medical records. An employee who desires that the Company furnish certain information to a third party may file a written request to that effect with the Human Resources department. you must execute a written authorization on a specific form available upon request from the Human Resources department. and court interpretations of those laws. Furnishing Information to Third Parties The Company assumes no obligation to furnish information about any employee to any third party (other than to verify his or her current employment). Although some of the statutes listed provide for a one-year statutes of limitations. Some of the primary record retention periods. are described below. With respect to the documents described in the box entitled. and analysis prepared from such records. Records relating to discrimination claims. That statement will become a permanent part of the employee’s personnel file.Personnel records and recordkeeping requirements Employee Recourse If an employee disagrees with any of the information in his or her file or records. it is recommended that Oregon employers retain these records for three years. The employee may be required to execute a release before the Company will disclose certain information to third parties. 256 . Examination of Medical Records The Occupational Safety and Health Act provides that employees exposed to toxic substances or harmful physical agents have a right of access to medical records. and the minimum recordkeeping periods for each. require Oregon employers to maintain various personnel and employment-related records for particular periods of time. then the employee may explain his or her position by submitting a written. exposure records. exposure records. some of the other statutes provide for a three-year statutes of limitations. Oregon employers should generally keep personnel records for a period of three years. Recommended recordkeeping periods for employment records Various state and federal laws. to simplify matters and to avoid mistakes. signed statement to the Human Resources department. If you wish to have any other person see your medical records. Thus.

• unemployment claims. • discipline. including: • applications for employment when applicant is not hired and other materials related to the hiring process.to three-year statute of limitations for discrimination claims under federal and state law. • terminations. • evaluations. Oregon employers are advised to retain personnel records for three years. including suspensions. etc. • reassignments.Personnel records and recordkeeping requirements Records related to discrimination claims Type of records Employment and personnel records. • transfers. per Oregon law. etc. documentation of leave taken.e. • promotions. • rate of pay (i. including leave requests. documents explaining payment differential for employees of the opposite sex). given the possibility of a one. • job advertisements • layoffs. They should be kept separately. Personnel files and records Retention period 3 years required (over 6 years recommended. and for the threeyear time period applicable to non-medical leave of absence records 60 days after termination. • requests for reasonable accommodations. But. • leave of absence records. • tests. • training records. warnings. Notes Leave of absence records do not include FMLA/ OFLArelated medical records in an employee’s personnel file. 257 .. • demotions.

Oregon employers are advised to retain all payroll records for 6 (six) years. private location and for three years after an injured worker’s right to reinstatement expires. time sheets. Retention period Three years after an injured worker’s right to reinstatement expires. wage and hour. communications with employees about light duty assignments and other work restrictions. Thus.Personnel records and recordkeeping requirements Type of records Workers’ compensation records. including records of light duty assignments. 200. 301) Employee medical records relating to on-the-job injuries Employee exposure records and analyses using exposure or medical records Retention period 5 years. etc. 258 . These should be kept in a separate. overtime records Type of records Payroll records of all types. summary of occupational injuries and illnesses (OSHA Forms 101. 30 years. 6 years (Oregon law). Retention period 3 years (federal law). Payroll. Notes Do not include an employee’s medical records in a personnel file or with other workers’ compensation records. Notes Occupational safety records Type of records Log. Notes 30 years after termination. 300. including time cards. records of commissions.

Retention period 6 years. including a copy of the EEO-1 Form submitted (whether electronically or in paper format) Retention period While current. records relating to decisions affecting an employee’s entitlement to benefits (“the administrative record”). Federal regulations provide that the EEO-1 forms should be retained in records separate from employees’ basic personnel or human resource files. Includes records relating to an employee’s COBRA rights. depending on the number of employees employed. Notes 259 . Notes Immigration records Type of records I-9 Forms Retention period Full term of employment. Different retention laws apply to covered federal contractors. Notes Employee benefits records Type of records Employee benefit plans. summary plan descriptions. 3 years after date of hire or 1 year after employee termination. whichever is later.Personnel records and recordkeeping requirements Affirmative action information Type of records Information necessary to complete EEO-1 Form.

including contracts for the payment of wages. Retention period Term of employee’s employment.Personnel records and recordkeeping requirements Miscellaneous records Type of records Background checks. 260 . Indefinitely Notes Indefinitely 6 years. Drug test results for transportation employees. Collective bargaining agreements and other documents impacted by the National Labor Relations Act (NLRA) Records relating to an employee’s leave of absence due to military service Contracts of employment. 1-5 years. printouts from consumer reporting agencies – all used for employment decisions.

as a means of boosting employee morale and soliciting valuable employee input. SAMPLE POLICY We welcome your ideas and suggestions. every effort will be made to adopt and utilize any practical suggestion. eliminate unnecessary expenses. improve working conditions.Chapter 14 Miscellaneous issues Employee suggestions An employee suggestion policy is not legally mandated. Please give any suggestions you might have to your supervisor or. Some employers reward employee suggestions that lead to increased productivity or savings to the Company. Such policies are useful. to the Human Resources department. no matter how unimportant they may seem to you. Anything that will help to do the job better or more productively. 261 . or increase our earnings will receive thorough consideration. if you prefer. however. Sometimes the most unusual or even the simplest suggestions are excellent cost-saving or profit-producing ideas. provide better public relations. Although not all ideas can be adopted.

Miscellaneous issues EMPLOYEE SUGGESTION PROGRAM ENTRY FORM DATE:__________________________ EMPLOYEE NAME:____________________ TYPE OF SUGGESTION (check off all that apply): ❏ ❏ ❏ ❏ EXPENSE REDUCTION QUALITY IMPROVEMENT PRODUCTIVITY IMPROVEMENT REVENUE ENHANCEMENT TIME:__________________________ DESCRIBE IDEA: ESTIMATE OF DOLLARS SAVED OR REVENUE INCREASE: I RESPECTFULLY SUBMIT THIS IDEA UNDER THE TERMS OF THE PROGRAM WITH THE FULL UNDERSTANDING THAT THE APPLICABILITY OF THE IDEA AND THE AMOUNT OF THE AWARD IS SOLELY AT THE DISCRETION OF THE AWARDS COMMITTEE. SIGNATURE OF EMPLOYEE: AWARDS COMMITTEE ACTION: APPROVED DATE: DECLINED COMMENTS OF THE AWARDS COMMITTEE: EXPECTED COMPLETION DATE: AMOUNT OF AWARD: TERMS OF PAYMENT: IN FULL DATE OF PAYMENT: INSTALLMENTS OF SIGNATURES OF COMMITTEE: 262 .

Miscellaneous issues

Reference requests
Employers must be extremely cautious when making references to prospective employers of their current or former employees. Many employers adopt a policy of only confirming certain limited information, set forth below, regarding its current or former employees. The employer should designate one person (usually in Human Resources) to provide references, and all employees should be informed of this policy. Significant legal risks exist in providing inaccurate or misleading information about an employee or former employee. Under Oregon law, employers disclosing such information are protected from civil liability for information disclosed as part of a reference check, unless it is proved that the information disclosed was known to be false at the time it was communicated. Unfortunately, particularly where subjective information is communicated (such as the quality of an employee’s job performance), this qualified immunity may offer employers little actual protection from defamation lawsuits, even if it ultimately shields many employers from liability. Employers have also found themselves defending claims of invasion of privacy and negligence when deviating from this policy. Further, an employer who provides any information regarding an employee’s performance cannot selectively provide only the good information regarding the employee; once performance is discussed, the employer may have a duty to disclose any problems with the employee’s performance, especially if the employee engaged in illegal conduct. Thus, it is clearly safest from a legal standpoint to limit all references to an employee’s vital statistics (such as: name, position, and dates of employment), unless the employer obtains a release from the former employee permitting it to provide additional truthful and objective information regarding the latter’s employment with the company. Even with a release, however, the information disclosed must be truthful.

SAMPLE POLICY
(Option 1) All requests for references must be directed to the Human Resources manager. No other manager, supervisor, or employee is authorized to release references for current or former employees. The Company’s policy as to references for employees who have left the Company is to disclose only the dates of employment and the title of the last position held. If the employee authorizes disclosure in writing, the Company also will provide a prospective employer with the information on the amount of salary or wage you last earned. No further information will be disclosed to third parties without an executed release holding the Company and the third party harmless for such disclosure and its use.

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SAMPLE POLICY
(Option 2) All requests for references must be directed to Human Resources. No other manager, supervisor, employee is authorized to release references for current or former employees. The Company’s policy as to references for employees who have left the Company is to disclose only the dates of employment and the title of the position held. If you authorize disclosure in writing, the Company also will provide a prospective employer or creditor with the information on your last salary or wage at the Company, if allowed by the Company.

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REFERENCE RELEASE FORM

Employee Reference Release I, ___________________________________, agree to the release of the following information concerning my employment with {Company Name}, as may be requested by prospective employers: Job Reference Information 1. 2. 3. 4. 5. 6. Dates of Employment Job Title(s) Salary At Time of Termination Attendance Record Performance Review Ratings May Be Released __________________ __________________ __________________ __________________ __________________ May Not Be Released _____________________ _____________________ _____________________ _____________________ _____________________

Reason for Termination ❏ Resignation ❏ Resignation By Mutual Agreement ❏ Retirement ❏ Downsizing ❏ Discharged For _______________________________________________________ ❏ Other (Be Specific) ____________________________________________________ Eligible for Rehire? ❏ Yes ❏ No

7. 8.

Other information that may be requested (be specific)_____________________________ ________________________________________________________________________ ________________________________________________________________________

Signed: Employee_____________________________ Manager _________________________________

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Miscellaneous issues

Employment of relatives
Because employing relatives of current employees often leads to morale and work-relationship problems in the workplace, many employers have anti-nepotism policies like the sample below. Employers choosing to adopt such a policy should state that cases concerning the employment of relatives will be dealt with on a case-by-case basis to ensure maximum flexibility in handling such situations. The policy also should contain an explanation of why the employer discourages the employment of relatives and should describe the circumstances and types of relationships covered by the policy. Employers who choose to adopt the sample policy below or one that is similar should be mindful of ORS 659A.309, which prohibits employers from refusing to hire or employ an individual, or discharging or discriminating against an individual, when the employer already employs another member of that individual’s family (such as a spouse, son, daughter, mother, father, in-laws, aunts, uncles, nieces, nephews, or stepparent or stepchildren). ORS 659A.309(2)(c) specifically states, however, that it is not an unlawful employment practice to refuse to hire or employ, or to discharge, an individual if it would place him or her “in a position of exercising supervisory, appointment or grievance adjustment authority over a member of the individual’s family or in a position of being subject to such authority which a member of the individual’s family exercises.”

SAMPLE POLICY
We are committed to hiring and retaining highly qualified persons. At the same time, we recognize that, despite their qualifications, hiring and retaining close relatives of present personnel might raise serious questions regarding the objectivity – or appearance of objectivity – of work assignments, performance appraisals, and employee treatment. Our employment policies, administered on a case-by-case basis, are based on balancing these concerns. We do not normally employ spouses (or domestic partners), parents, children, brothers, sisters, or corresponding in-laws if: 1. They are seeking full-time, part-time, or temporary employment; and 2. Employment results or may result in having supervisory influence (actual or perceived) over the relative’s evaluations and progress. If an employee and a close relative work in the same office and one of them becomes a manager with supervisory influence over the other, as described above, a transfer will most likely be arranged. Also, if an employment arrangement may be perceived to violate our guidelines prohibiting close relatives from having supervisory influence over one another, a transfer also may be arranged. If a transfer is not feasible, the employees will have 30 days to decide which relative will stay with the Company. If the employees do not make the

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decision within the allotted period, the Company will make the decision based upon the employment history and job performance of both employees, as well as the Company’s needs.

Smoking
Effective January 1, 2009, all Oregon employers (regardless of size) must comply with revisions to Oregon’s Smokefree Workplace Law (OSWL). The OSWL has some little-known provisions that employers will quickly need to familiarize themselves with, such as the prohibition on smoking in work vehicles that are not operated exclusively by one employee, and the requirement that employers post signs prohibiting smoking in the workplace at all building entrances and exits as required by law. Employers are encouraged to utilize free resources provided by the DHS regarding the OSWL’s revisions, found at www.oregon.gov/DHS/ph/smokefree/index.shtml. Nothing in the OSWL requires an employer to adopt a smokefree workplace policy. Regardless, employers are well-advised to educate their employees about the OSWL, and to issue a list of changes that will occur within the workplace because of the OSWL (if any). Some of those changes could include identifying rooms, hallways, lounges or other areas where smoking is no longer allowed, including the scope and a description of the new “smoke-free zone” that all buildings must have effective January 1, 2009 (the OSWL prohibits smoking within 10 feet of building entrances and other openings, including second-story windows). If applicable, employers should identify which “employee lounges” (defined in ORS 433.850) may be used for smoking. Further, because an employer may be subjected to criminal penalties for noncompliance with the OSWL, an employer may wish to revise its progressive discipline policy (if one is used) to clearly state that employees who violate any OSWL-compliant practices within the workplace (such as smoking in the “smokefree zone”), or engage in activity that violates the OSWL, may face discipline, up to and including discharge. Because the OSWL will also impact customers who smoke in the workplace, employers should consider issuing guidelines or providing training to employees about how to address customers who try to smoke in the workplace. The OSWL does not make it easier for an employer to discharge an employee simply because that employee smokes. Oregon employers, for example, remain prohibited by statute from requiring employees or applicants to refrain from using lawful tobacco products during nonworking hours (except when the restriction relates to a bona fide occupational requirement or pursuant to a collective bargaining agreement; see ORS 659A.315). Further, an employer who discharges an employee for using the OSWL’s complaint reporting procedure will likely face a retaliation claim or lawsuit under Oregon law. But the law doesn’t completely strip an employer of its rights to lawfully discipline or discharge a smoking employee who violates other rules of prohibited conduct. Certainly, disciplining or discharging a smoking employee who does not follow the company’s implementation of an OSWL-compliant “smokefree zone” or workplace would likely be permissible under the law. And neither the OSWL nor Oregon law requires an employer to provide employees with a designated “smoking break” (employers must still provide nonexempt employees, regardless of 267

Miscellaneous issues

their smoking status, with paid rest breaks in accordance with Oregon wage and hour law). Similarly, employers may wish to consider publicizing and implementing a policy that prohibits offensive odors or fragrances of any kind in the workplace, such as cigarette smoke or perfume, particularly if that employer can demonstrate a legitimate reason for doing so (health care environments, heavy interactions with customers, etc.) – just be sure to enforce such a policy uniformly, and not just against the smokers.

SAMPLE POLICY
(Option 1) All Company buildings are tobacco-free areas. Smoking is prohibited on work time. If you wish to smoke during your lunch break or other breaks, you must do so outside the Company buildings, only in designated smoking areas, and out of customer view. Smoking is not allowed near the building entrances; Oregon law prohibits smoking within 10 feet of building entrances and other openings, including second-story windows. The Company has established staff smoking areas that your supervisor can show you.

SAMPLE POLICY
(Option 2) Personal hygiene All employees shall maintain a personal cleanliness of clothing and body, which presents a professional and non-offensive appearance to patients and co-workers. It is Company’s advice that each employee maintain cleanliness by bathing and washing with frequency as to assure removal of accumulated soil and perspiration. Special attention should be given to the appearance of hands so that they look neat and clean giving the impression that you are not passing on unwanted bacteria. You should always make sure that offensive body odors are controlled with the use of deodorants or anti-perspirants. Lastly, remember that our Company works with customers-and employs employees-who have different types of complications such as allergies so employees are expected to report to work free of fragrance, colognes, after-shave lotions, and the smell of tobacco smoke. Employees with questions about this policy should contact the Human Resources Department. Violations of the personal hygiene policy may result in discipline, up to and including termination of employment.

268

Failure to abide by the policy may subject the employee to the employer’s discipline policy. But. It is obviously helpful to include such dress code requirements in the employer’s written policies. as long as the employer provides. it is essential that all employees dress in a manner that communicates professionalism and respect. The sample policy might be better suited to office personnel in a retail sales business than production workers in a manufacturing concern. for reasonable accommodation of an individual based on the health and safety needs of the individual. 269 . Keep in mind that clothing with inappropriate content may violate the Company’s anti-harassment policy. Further. Violators of this policy may be subject to discipline. any visual displays of undergarments (or the absence thereof) would be inappropriate. Questions about this topic can be addressed to the Human Resources Director. Any such policy should be drafted with attention to the particular employer’s needs and facilities. up to and including termination. if they choose. in some circumstances. Cell phone usage. Employees who report to work inappropriately dressed may be sent home to change. As such. Employers also may. Although Oregon’s relatively new law prohibiting discrimination on the basis of sexual orientation can. backgrounds. Dress should be in accordance with a professional image and never disruptive or offensive to other employees or visitors. Telephone usage A telephone usage policy addresses how employees should interact with customers on the telephone and stresses customer satisfaction. PROFESSIONAL APPEARANCE We pride ourselves on hiring and retaining exceptional staff in all areas of our business. and professions. charge employees a reasonable cost to purchase company-provided uniforms. on a case-by-case basis. See also page 87. the expressly permits employers to enforce an otherwise valid dress code or policy. We expect that all staff will handle decisions in this area with sensitivity toward our scope of business and our clientele: Good judgment should be the guideline.Miscellaneous issues Dress codes Many employers have a specific dress code that employees are required to follow. because we regularly do business with a wide variety of people of all ages. endless details regarding wardrobe are considered unnecessary. affect an employer’s ability to impose a dress code based on traditional gender considerations.

6. 4. be sure it is recorded correctly and given to the appropriate individual. Because ABC Company’s goal is to serve its customers. the property is subject to inspection by the employer at any time. Avoid needless transfer of calls. employee safety. 2. Personal long distance calls. It is better to offer to return a call than to keep the caller waiting for an indefinite period of time. email and related equipment. when necessity requires. All employees should receive and place their own calls. personal telephone calls should be limited to those that are necessary and should be brief. then the identification of the speaker. and/or message. Thus. an employer may need to search employee-owned property brought onto the company’s premises. Employers also have an interest in maintaining the integrity of their electronic equipment. can only be secured through the search of company-owned property provided to employees for work-related purposes. When a caller leaves a name.Miscellaneous issues SAMPLE POLICY Courtesy and thoughtfulness in using the telephone are not only key elements in good public relations. Employees should be placed on notice that the employer’s property remains the property of the employer at all times even if the employee maintains possession of it. return a call rather than transfer the call when uncertain of the person to whom the caller should speak. it is important that the telephone lines be kept as free as possible so as not to interrupt the daily flow of business. 3. number. The following guidelines are offered for good telephone manners: 1. may be made only with specific supervisor approval. The company’s policy should identify company-owned property available for employee use subject to inspection. Such a policy 270 . This policy should be distributed to all employees. including computers. As such. A good way to answer the telephone is to give the name of the department. The caller will appreciate the promptness. Inspection of property Sometimes. Answer the telephone promptly within the first or second ring. an employer should adopt a written policy describing such searches and reserving the right to conduct workplace searches. In some limited circumstances. but serve as indicators of an employee’s attitude and competence. as well as the overall safety of the facility. voicemail. 5. In order to protect the employer’s right to conduct workplace inspections and searches.

or illegal drugs. Employers also may reserve the right to inspect employees’ personal property upon reasonable suspicion. may be inspected upon reasonable suspicion of unauthorized possession of Company property. and they remain the property of the Company. The written policy should define the employees’ property that is subject to inspection. SAMPLE POLICY (Option 1) Employer Property Cabinets. weapons. are Company property and must be maintained according to Company rules and regulations. and file cabinets are Company property and must be maintained according to Company rules and regulations. vehicles. vehicles. computer equipment. It is critical that employees have advance notice of this employer right and that the employer exercise it with due care and discretion. purses. and vehicles. It may be necessary to assign and/or change “passwords” and personal codes for voicemail. They must be kept clean and are to be used for work-related purposes. desks. computer and other equipment. To ensure compliance with its rules and regulations. Employees are required to provide all passwords/codes used to the Company. The Company reserves the right to listen to voicemail messages and to access email messages as necessary for business purposes. and the Company may override any such password. desks. email. including but not limited to tool boxes. Voicemail and/or electronic mail are to be used for business purposes only. Prior authorization must be obtained before any Company property may be removed from the premises. An employee’s personal property. These items are to be used for Company business. without notice to the employee and/or in the employee’s absence. the Company reserves the right to inspect all Company property without prior notice to the employee and/or in the employee’s absence.Miscellaneous issues will result in a lower expectation of privacy on the part of employees and will prevent them from establishing that the company has committed an invasion of privacy in searching the property. Reasonable suspicion must be based upon specific objective facts and rational inferences drawn from those facts. packages. The Company reserves the right to inspect all Company property to ensure compliance with its rules and regulations without notice to the employee and/or in the employee’s absence. 271 . SAMPLE POLICY (Option 2) Lockers. They must be kept clean and are to be used only for work-related purposes. Prior authorization must be obtained before any Company property may be removed from the premises other than in the normal course of business. telephone equipment and the like.

and reserves to the Company the right to search and access all email messages. Without prior authorization. are considered “business records” subject to disclosure in criminal investigations or litigation. a comment sent as a sarcastic remark may not appear to be so a year. hard drives. The Company provides e-mail to its employees to assist and facilitate business communications. up to and including employment termination. E-mails can be vitally important in litigation. internet usage and email. The e-mail system belongs to the company and may be used for business purposes only. breach of contract. Two sample policies follow. Inappropriate use may result in loss of e-mail privileges. or two. employees are prohibited from using the company’s e-mail system to transmit or store commercial or personal advertisements. it is vitally important for any employer that provides email access to any of its employees to adopt and enforce a computer usage and e-mail policy. The first sample policy addresses email only. regardless of whether the claim is discrimination. including computer systems. SAMPLE POLICY (Option 1) This policy governs the use of the company’s e-mail system. including e-mail. however. including prompt and thorough investigation of employee complaints of policy violations. solicitations. Also. Courts have recognized an employer’s right to access e-mail messages – even those sent in confidence – within the employer’s own computer system. An e-mail that is considered simply a “funny joke” one day. For those workplaces. Both policies. Employees are also prohibited from the following: 272 . The second sample policy addresses not only electronic mail. including email systems. can be used as evidence of a discriminatory atmosphere against the employer at trial. promotions. or political material. Accordingly. but all forms of electronic media. disciplinary action. or parts thereof. the first policy may be sufficient. may be combined. Computer equipment. where employees have computers and can access the internet. It is provided for legitimate business use in the course of your assigned duties only.Miscellaneous issues Use of electronic media Computer records and files. the second policy would be more appropriate. are provided by the employer for businessrelated purposes. in the future when read and considered by a jury. computer files and usage may be monitored and make reasonable efforts to ensure that use of electronic mail is not abused. and/or legal action. If employees are not provided with computers and internet access. Employers should put employees on notice that their e-mail messages. or a business dispute with a customer.

or derogatory remarks in any email message. and disclose any and all employee e-mail. 273 . Never give your user ID or password to another person. or receive. Make sure all messages are addressed only to the intended recipients. E-mail on the company’s e-mail system is not private. even in jest. System administrators that need to access your account for maintenance or to correct problems will have full privileges to your account. 3. transmission of obscene or harassing messages to any other individual. other inappropriate language. In addition. Unwanted messages should be deleted as soon as possible since they take up disk storage space. 4. Employees should have no expectation of privacy in any e-mail that they create. and any other activity that could adversely affect the company. review.Miscellaneous issues unauthorized attempts to access another’s e-mail account. 5. in the course of their duties IS staff may monitor the use of the e-mail system or review the contents of stored e-mail records. transmission of proprietary information to unauthorized persons or organizations. Messages can be printed and/or copied to disk files for record copy or archival. The content and maintenance of an employee’s e-mail mailbox is the employee’s responsibility in the first instance. Never send copyrighted material with an e-mail message. In addition to the above. Never assume that your e-mail cannot be read by others. Never use obscenities. 6. The company reserves the right to monitor. 2. send. the following guidelines must be observed by Company employees when using company e-mail: 1. 7. any illegal or unethical activity.

fax machines. Web sites and other services paid for by the Company are to be used for Company business only. All information and communications in any format. Viruses can be attached to any file including email attachments. stored by any means on the Company’s electronic equipment.Miscellaneous issues SAMPLE POLICY (Option 2) Use of Electronic Media Scope. Ownership. messages. Personal passwords may be used for purposes of security. 274 . The Company will override all personal passwords if it becomes necessary to do so for any reason. facilities or services is the sole property of the Company. facilities or services are subject to inspection at any time without notice. electronic communications should be printed and placed in the files of the Company to which the communication relates. but not limited to computers. telephones. Use. stored by any means on the Company’s electronic equipment. This policy governs the use of such Company property. voicemail and other such material to monitor the use of all of the Company’s electronic equipment. The Company reserves the right to access and review electronic files. Retention. All information and communications in any format. electronic communications should be deleted after they are read. Scanning for viruses. All of the Company’s electronic equipment. online services. but the use of a personal password does not affect the Company’s ownership of the electronic information or the Company’s right to inspect such information. When appropriate. In most cases. facilities and services are intended to be used for Company business purposes only and not for personal matters. Access to the Internet. Inspection and monitoring. cell phones (including text messaging) and the Internet. voicemail. email. facilities and services. facilities and services for producing documents. Any virus detected must be reported to the MIS department even if the virus detection software appears to have corrected the problem. including all communications and internet usage and resources visited. email. All incoming documents and attachments (whether sent electronically or provided on disk or other electronic media) must be scanned with the Company’s antivirus software. The Company uses multiple types of electronic equipment. research and communication including.

facilities or services must not be used to visit Internet sites that contain obscene. All software installed on the Company’s computer systems must be licensed. facilities or services. Sexually explicit images. Approvals needed. staff or clients. its lawyers. harassing or obscene. Employees who use cell phones. hateful or other objectionable materials. confidential. The Company’s electronic equipment. or who engage in defamation. its products or services. trade secret or sensitive information unless appropriate encryption measures are implemented. against Company policy or not in the best interest of the Company. Employees who violate this policy. or otherwise misuse the Company ‘s electronic equipment. facilities or services should not contain: • • • • • Informal remarks that might be potentially embarrassing to another employee. cordless phones. Communications via any electronic media may not be used in any manner that would be discriminatory. fax communications or email sent over the Internet should be aware that such forms of communication are subject to interception and these methods of communicating should not be used for privileged. or for any other purpose which is illegal. proposals or materials. Vulgar. copyright or trademark infringement. Communications made using the Company ‘s electronic equipment. Many forms of electronic communication are not secure. or other types of information that will appear in the electronic media about the Company must be approved by the Company Management Committee or the Technology Committee before the information is placed on an electronic information source. Security. Copyrighted materials which the Company is not authorized to use. discrimination. Unauthorized access. output or user name unless they have explicit authorization. jokes or messages.Miscellaneous issues Personal hardware and software. Violation of this policy. misappropriation of trade secrets. Employees may not install personal hardware and software on the Company’s computer systems without approval from the MIS department. offensive or harassing language. Inappropriate web sites. No employee can examine. cartoons. Standards for communications. change or use another person’s files. 275 . the Company. Employees are not permitted unauthorized access to the electronic communications of other employees or third parties unless directed to do so by Company management. Any information about the Company. Indecent remarks. harassment or related actions will be subject to disciplinary action up to and including immediate termination.

Miscellaneous issues Arbitration agreements Some older employee handbooks included arbitration agreements. it is important for employers to carefully consider well in advance of employment whether they wish to have arbitration agreements with their employees and to ensure that any such agreements comply with applicable legal requirements. whereby employees and employers agreed to arbitrate any disputes arising out of the employment relationship (in lieu of engaging in costly litigation). Some employers choose to distribute paper copies of employee handbooks. or in what format. however. you should consider translating your employee handbook into the other predominant language(s) used in your workplace. Providing access to employee handbooks in electronic format Neither federal nor state law dictates how an employee handbook should be distributed. If you decide to translate your handbook. Because of a new Oregon law. will not be valid unless the following guidelines are met: • All agreements to arbitrate claims or disputes must be presented to a job applicant in a “written employment offer. A poorly translated handbook can be just as ineffective and useless against employment law claims as an out-of-date or haphazardly applied English employee handbook. but will not be enforced unless entered into at the time of a “bona fide advancement” (promotion. This precautionary measure may assist employers who defend against employment lawsuits filed by current or former. non-English speaking employees who claim that certain personnel policies are not applicable to them because the policies were never communicated to them in a way that the employee understood (due to the language barrier). • Thus. Agreements to arbitrate claims or disputes may be presented to current employees.). 2008. etc. simply adding an arbitration provision to an employee handbook will not likely be enforceable under the new laws. do not skimp on the cost. Translation of employee handbooks into non-English languages If your company employs a significant number of employees for whom English is not their first or native language. the “written employment offer” containing the agreement to arbitrate must be “received” by the employee at least two weeks before the first day of the employee’s employment. some provide one central copy that is accessible to all employees. Consult with legal counsel or other human resources professionals to find an appropriate translator.” Further. and some make the handbook 276 . In sum. arbitration agreements entered into between employers and employees after January 1.

Company and personal vehicles If your company provides vehicles for employee use during business hours or for businessrelated reasons. Employees who use their own vehicles are reimbursed by the Company on a mileage basis. No Employee can use a company vehicle for personal use unless given prior approval from the Chief Operating Officer. company resources. Company vehicles are to be used only for company business. Oregon employers who ask their employees to use personal vehicles for business use should also consider having a policy. Employers should decide how it wants to distribute new versions of the employee handbook and in what format based on factors such as the work atmosphere. such as through an intranet. or using a particular size of paper. Regardless of what approach your company takes. Inability at any time to meet the three requirements for an employee whose driving is a necessary part of their job could lead to discipline up to and including termination. Be insurable by the Company’s auto insurer. please make sure the acknowledgement-of-receipt form presented to each employee for his or her signature (discussed in Chapter 16. and other factors. SAMPLE POLICY Company and Personal Vehicles Employees who are assigned the use of Company vehicles or who are asked to use their own vehicles for Company business will be required to: • Submit evidence of a valid driver’s license. and provide the Company with updates as issued. or otherwise conduct company business via automobile. and provide the Company with updates as issued. Acknowledgment-of-receipt of handbook) is accurately recorded and maintained in the employee’s personnel file. Please consult the Human Resources for more information.Miscellaneous issues available electronically. 277 . it is strongly recommended that your handbook includes a policy regarding the use of such vehicles. • • This requirement extends to employees who travel on behalf of the company. Again. Have proof of valid automobile liability insurance. what may work best for one company may not be ideal for another. lease vehicles. The handbook need not be printed on a certain type of paper.

Employees are responsible for reporting to their supervisor any vehicle service required. or withdrawn. when a physical or mental impairment causes the employee to be unable to drive safely. or medication. Employees must immediately notify the Human Resources Department should they receive a notice that their driver’s license has been revoked. The ability and attitude behind the wheel of the vehicle tells the motoring public a great deal about the Company the driver represents. Employees should also avoid other distracting activities while driving. Your personal appearance and the courtesy and attitude of helpfulness you demonstrate speaks loudly. The Company will not pay fines for traffic violations or parking tickets. 278 . under any circumstances. suspended. Further. The expectation of the Company is that our employees who drive on our behalf are prudent drivers and to do otherwise is a liability to our Company. Employees who are assigned the use of Company vehicles should drive so as to afford the utmost economy in fuel. state and local regulations governing the operation of the equipment driven. employees are not permitted. It is expected that all employees will operate Company vehicles or personal vehicles for Company business in a safe and lawful manner and to observe all federal. no later than one business day after having received such notice. Employees should pull over to the side of the road and stop in order to use cell phones and two-way radios. to operate a vehicle for Company business.Miscellaneous issues Vehicle Operation and Safety Everything about your driving reflects back on the Company. tires and brakes. Employees who are assigned the use of Company vehicles or who are asked to use their own vehicles for Company business are required to keep a valid driver’s license. The Company may discipline for tickets and/or accidents caused by aggression while on the job or while driving a company vehicle. Employees are responsible for keeping the tires properly inflated and oil and water at proper levels. circumstances in which the employee is temporary unable to operate a vehicle safely or legally because of injury. This prohibition includes but is not limited to. Always lock doors and side bins (on trucks). and/or check their pager. the employee must immediately report the incident to the Human Resources Department. An employee’s driving record will be checked by our insurance broker at least twice a year to determine their continued insurability. such as eating or drinking. Employees are responsible at all times for any citations or fines associated with use of Company’s vehicles or personal vehicles for Company business. Seat belts are to be worn at all times while driving. We expect the Company’s drivers to be better drivers than the ordinary motorist. illness. If an employee receives a citation or is arrested for any traffic violation while on duty.

• • • • • • • • • Employees must maintain their own automobile liability insurance coverage in at least the minimum amounts required by the state of their residence as long as they are driving a Company vehicle or using their own vehicle for Company business. the goal should be to drive without ever having an accident. company name and address. Avoid moving the vehicles until the police arrive. NEVER offer to settle any claim or damages regardless of the circumstances or apparent smallness of the claim. However. DO NOT MAKE ANY STATEMENTS TO ANYONE OTHER THAN AN AUTHORIZED REPRESENTATIVE OF THE COMPANY. Exchange information with the involved drivers giving them your name. should you be involved in an accident. if at all possible. Automobile accidents resulting in injury or vehicle damage to any party may be the primary responsibility of the employee driving the vehicle . Take positive action to prevent being involved in the “other drivers” errors. Do not discuss details of the accident and do not express any opinions to anyone about who was at fault or how the accident happened. Complete the proper accident report immediately. Report ALL ACCIDENTS TO THE DIRECTOR OF ADMINISTRATION IMMEDIATELY. and vehicle license number.Miscellaneous issues What to do in Case of an Accident As a Company driver. Call the police if necessary. Take the necessary precautions to prevent any further accident by placing the proper warning devices. Render all possible assistance to injured persons. 279 . license number. unless advised to do so by the company representative. take these steps to protect yourself and the interest of the Company: • • Stop immediately. Movement of an injured person should be avoided since this often compounds the injury. NEVER plead guilty to any violation of the law in connection with an accident.

Miscellaneous issues 280 .

Note. An exit interview serves as a good opportunity for the company to determine the basis for the employee’s decision to leave. Including a provision that eligibility for rehire will be lost for failure to provide the required notice may constitute an added incentive for many employees to furnish such notice. A good employee leaving due to job dissatisfaction might be reminded. Second. that a resolution to the problem could be found by exhausting available but untapped avenues of recourse.) Consult with an attorney for further information. for example. Advance notice of an employee’s intent to voluntarily resign helps the employer in replacing the employee. but elected not to do so. Including a termination of employment policy in the employer’s written policies and procedures is advisable for several practical reasons. • First. For more information about COBRA. Even if not included in the termination policy. an exit interview is an essential practice for all employers. If animosity on the part of the employee exists. see Chapter 8. the policy should not withhold a vested benefit. including sample COBRA forms. from an employee who chooses not to give the required notice. with any termination. if the employee later files a claim. a policy encourages employees to provide reasonable notice of their intent to voluntarily leave their employment. Importantly. the employer needs to be sure to notify the employee and/or his or her qualified beneficiaries of their rights to continued health insurance coverage under COBRA. • 281 . the exit interview provides the employer with the ability to argue that the employee had an opportunity to express his or her concerns to management. that employees who are terminated for “gross misconduct” may not be eligible for COBRA benefits. an attempt to reconcile or at least reduce this sentiment might help avoid subsequent litigation. • Finally. such as vacation pay. either by the policy or by human resources personnel. Employee benefits. a sexual harassment charge or other lawsuit. (See also 29 USC § 1132(c). Sample exit interview forms follow the sample termination policy.Chapter 15 Termination of employment All employers deal with employee terminations – whether voluntary or involuntary. Further. a termination policy reminds the dissatisfied employee that there are administrative channels that may be of help in correcting an employment problem.

the company can ask the employee to repay the loan at the time the company pays the employee’s final paycheck (or at any time before. if the employee has voluntarily signed a loan agreement and as long as the loan was for the employee’s sole benefit. the check is due on the next business day) if an employee is discharged. the check is due by the end of the following business day. Such a deduction may not exceed 25% of the employee’s disposable earnings or the amount of disposable earnings in excess of $170 per week. whichever comes first if an employee quits with notice of at least 48 hours. the final check is due on the final day worked. extended a loan to an employee. the final paycheck is due not later than the end of the next business day when an employer and employee mutually agree to terminate the relationship. excluding weekends and holidays. and the employee has not yet paid the company back by his last day of employment. unless the last day falls on a weekend or holiday (in that case. excluding weekends and holidays. for example. for example) deductions authorized by a collective bargaining agreement a deduction from a final paycheck for a cash loan to an employee. assuming a written agreement is not in place). • • • Further. 282 . taxes or garnishments) deductions that are for the employee’s benefit (such as health insurance premiums) as long as the employee has signed a written authorization for the deduction other deductions authorized by the employee in writing as long as the employer is not the ultimate recipient of the money (charitable contributions. If your company. whichever is less. it is important to not use an employee’s final paycheck to make any unauthorized or unlawful deductions. If the employee refuses to pay. as in the case of discharge. It is required by Oregon law to pay a departing employee’s final paycheck on time. or on the next regular payday. Under Oregon law. the Company may pursue repayment in a court of law. the following “final paycheck” deadlines apply: • if an employee quits with less than 48 hours notice. Failure to do so can result in an employer paying the employee “penalty wages” in addition to the employee’s final wages and attorney fees if the employee hires an attorney.Termination of employment • Finally. Oregon law recognizes five categories of lawful payroll deductions: • • • • • deductions required by law (for example. a policy such as the one below notifies the employee that he or she must promptly return all of the employer’s property on or before the employee’s last day of work. the paycheck is due within five days.

keys. If the employee’s decision to terminate is based on a situation that could be corrected. it is anticipated that you will give your manager as much notice as possible – preferably a minimum of two weeks. personal. At that time. vacation. a representative of the Human Resources Department will meet with you to conduct an exit interview. the details of your leaving will be discussed. you will not be eligible for re-employment at a later date.Termination of employment SAMPLE POLICY If you choose to terminate your employment. 283 . and manuals. Employees must return all Company property. to their supervisor or a Human Resources representative on or before their last day of work. including identification cards. If you do not give two-weeks’ notice of your intent to leave the Company. When giving your two-weeks’ notice. and information regarding your insurance coverage and other information relative to your employment will be explained to you. or sick days should not be used in lieu of notice. At the time of your employment termination. the employee is encouraged to discuss it with his or her manager or the Human Resources manager before making a final decision.

Guides ( ) Employee Badge ( ) Keys ( ) Computer Diskettes ( ) Password removed from computer Expense Account checked ( ) Company Credit card returned ( ) COBRA Rights explained Final work time verified and approved Payroll deductions checked Final paycheck issued Other ( ) Not Not Returned Appl. Catalogs.Termination of employment EXIT CHECKLIST Name Employee No.  Quit  Discharge  Transfer  Layoff  LOA Date of Termination Department Other (Explain) Item Returned Tools & Equipment ( ) Personal Protective Equipment ( ) Manuals. ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) Yes No ( ) ( ) ( ) ( ) ( ( ( ( ( ) ) ) ) ) ( ( ( ( ( ) ) ) ) ) Human Resources Manager/Date:____________________________________ 284 .

Has all company property been returned?  Yes  No Does the employee’s personnel file contain a confidential information agreement?  Yes  No Has the employee been reminded of his/her obligation under the agreement?  Yes  No Reason for employee’s termination: What could have been done to retain employee? 7. 12. 6. 9. COBRA Rights/Documents:  Yes Who is employee’s new employer? Interviewer’s comments:  No Interviewer/Date: 285 .Termination of employment EMPLOYEE EXIT INTERVIEW 1. and working conditions? 10. 11. Employee Name: Employee Number: Hire Date: Employee Forwarding Address: 5. What is employee’s attitude towards company pay policies. 8. benefits. 4. 2. 3.

etc. _____________________ Address:______________________________________________ Zip: ______________________ Service Date:_____________________ Last Day Worked: ________________________________ Are you moving or planning to move?  Yes  No New Address:_____________________________________________________________________ ________________________________________________________________________________ Do you want to continue your life insurance?  Yes Medical Insurance?  Yes  No  No  No If not. opportunities. work load._________________ Shift________________ Name:_____________________ Employee No.) ______________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 286 . competence. working environment. please attach Is written resignation attached for voluntary separation?  Yes same.)___________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Company Policies & Practices? (fairness.) _____________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Supervision & Management? (fairness.________ Employee No.Termination of employment EXIT INTERVIEW Dept. etc. supportiveness. etc. Why are you leaving? ______________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Were you satisfied with: Your Job? (fit with interest and abilities.

) ________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ What did you MOST like about working at the company? _________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ What do you feel needs to be improved at the company?___________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Were you treated fairly while with the company?  Yes  No If no. etc. working environment. 287 . what was your complaint? ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ My reason for leaving the company has nothing to do with a work-related problem or grievance:  Yes  No Is there a problem that you know about or you have heard others talking about concerning the company? Remarks: _______________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Must something change for you to come back? If yes. what? _______________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Do you plan to return to work at the company?  Yes  No If Yes.  Remind employee to keep company informed about change of address for tax purposes. when? _______________  Explain final pay policy and give (or arrange for) final checks to employee.Termination of employment Salary & Employee Benefits? (fairness.

288 .Termination of employment Other comments/interviewer’s assessment: _____________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________ Interviewer Date ____________________________________ Supervisor Date *Not to be made part of employee’s personnel records.

please return in the envelope provided. What did you enjoy least about working at {Company Name}? _____________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 4. Once completed. Rate the following: Work Environment Benefits Compensation Performance Review Good ____ ____ ____ ____ Fair ____ ____ ____ ____ Poor ____ ____ ____ ____ 6. What suggestions do you have for improving {Company Name} as a place to work? ________________________________________________________________________ ________________________________________________________________________ 7. What did you enjoy most about working at {Company Name}? ____________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 3. What is your opinion of your supervisor?_______________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 5. What is your overall opinion of {Company Name} as a place to work? _______________ __________________________________________________________________________ __________________________________________________________________________ 2. Name:______________________________________ Supervisor: __________________________ Date of Separation: ________________________________________________________________ 1.Termination of employment SEPARATION SUMMARY We appreciate your time in providing the following information. Your comments are valuable to us and will be shared with appropriate members of management as we strive to improve {Company Name}. _______________________________________________________ Other Comments: ________________________________________________________________________ ________________________________________________________________________ Employee Signature Date 289 .

............................................. Management Approvals & Documentation .....................................................❏ ___________________________________________________ Personnel Department Checklist Expense Account..........................❏ Remind About Confidentiality Agreement.....................................................❏ Return of Company Property Keys/Card Keys............................. etc..........................❏ Continuation of Insurance ........................................................................................................................................................................................................❏ If Involuntary.........................................................................................................................................................................................................................................................❏ Safety Equipment.........❏ Library Material.................................... stock plans................................................................................................................................................................................................................................❏ *Accumulated Vacation Pay............................❏ Parking Card Key.................................................................................................❏ I have received my final paycheck..............................................................................................................................................................................................................................................................................................................................................................................................................................❏ Tools ......................................................................................................................................................................................................................................................................................................................................................................................................................................................... 401(k)......................................................................❏ Computer Diskettes.............................................Termination of employment EMPLOYEE SEPARATION CLEARANCE CHECKLIST Employee Name: __________________________ Last Day Worked:________________________ Department: _______________________ Social Security Number: _________________________ Department Checklist If Voluntary.....................................................................❏ Documents.................................................................................❏ Company Vehicle.........................................................................................................................................................❏ Address Verification ....................................................................................................................................................................................................................................................................................................................................❏ Final Paycheck ................................❏ Credit Cards................................❏ The Company explained and I understand my COBRA rights.....................................................❏ Department Clearance_______________________________________________ (Manager/Date) Employee Identification................................................................................................................................................................................................................................................❏ Personnel Department Clearance (Personnel Manager/Date)_________________________________________________________________________ Retirement Benefits (profit sharing.........❏ Phone Cards......................................................................................................................................................................................................................................................................................................................................❏ Final Change of Status Notice ............... Loans ...........❏ Other ____________________________________________________________________________________________________________________ Employee: 1) 2) 3) I have turned in all Company property assigned to or held by me......................................................................❏ Authorization for Deduction(s)...❏ Signature of Employee/Date __________________________________________________________________________________________________ Distribution: One copy to employee personnel file and one copy to employee 290 ...............................................)..........................................................................................................................................❏ Release of Reference Information Form ............................................❏ *Notice Requirement Fulfilled .. Written Notice From Employee .............................................................❏ Exit Interview ........................................................................................................................................................................................................................................................................................................................................................................................................... which contains all final wages due to me .................................................................................................................❏ Manuals .......................❏ Insurance Conversion Privilege...............................................................❏ Advances................................................................................................................................................❏ Other ...........................

An employee’s express acknowledgement can be an important piece of evidence in litigation to show that the employee was aware. that time should be granted. such as the policies prohibiting discrimination and harassment. when new policies are released or to acknowledge significant changes to certain. or should have been aware. The acknowledgment-of-receipt form should be read and signed by each employee upon receipt of the handbook. Employers may benefit from periodically conducting an audit of the personnel files to make sure that all current employees have received and acknowledged receipt of the employee handbook. it may be a violation of the National Labor Relations Act (NLRA) to compel an employee to sign the acknowledgment form in such circumstances. typically on the employee’s first day of employment. New acknowledgment-of-receipt forms should be signed by employees when a new employee handbook is released. If the employee would like additional time to review the written policies and procedures. The signed acknowledgement form should be retained in the employee’s personnel file. WARNING: If the handbook contains a union-free policy. of the employer’s policies. Some policies should even be separately acknowledged. An employer should either delete the promise-to-abide provision from the acknowledgment form – as the sample policy has done – or specifically exempt the union-free policy from the promise. Prior to adopting a union-free policy. 291 . A signed acknowledgment can also prove that an employee understood that his or her employment was at-will in the face of employee claims to the contrary.Chapter 16 Acknowledgmentof-receipt of handbook All employees should be asked to sign an “acknowledgement of receipt” form when they receive a copy of the employee handbook. please consult legal counsel to make sure that the policy and overall handbook complies with the law. legally required policies (such as anti-harassment policies).

discrimination. and that they are subject to change at any time in the Company’s sole discretion. I acknowledge that the Personnel Policies [use title of handbook] are not an employment contract and are not intended to give me any express or implied right to continued employment or to any other term or condition of employment. I have read this acknowledgement carefully before signing. I acknowledge that no promises have been made to me that are inconsistent with this “at-will” statement. or any trusted manager or supervisor. I will bring any questions or concerns I have regarding equal employment opportunities.Acknowledgment-of-receipt of handbook SAMPLE ACKNOWLEDGMENT FORM Acknowledgment of Receipt of Personnel Policies [Use title and current version date of your company’s handbook] I acknowledge that I have received and will read a copy of the Company’s 2008 Personnel Policies [use title of handbook]. I understand that the Company complies with all applicable laws regarding equal employment opportunity and provides a workplace free from unlawful harassment and discrimination. I understand that it is my responsibility to remain informed about the policies as revisions. and with or without advance notice. for any or no reason. the Human Resources Department. I also understand that the Personnel Policies [use title of handbook] control over any other contradictory statements.]. updates and new polices as issued. A copy will be provided to the Employee upon request. I understand that the Company has adopted the Personnel Policies [use title of handbook] only as a general guide about policies. I also understand that a copy of the Personnel Policies [use title of handbook] is available to me at any time to review in the [Human Resources Office] [on the company’s intranet] [etc. retaliation or harassment to my supervisor. ______________________________________________ Employee Signature _________________ Date The original of this document will be kept in the Employee’s personnel file in the Human Resources Department. with or without cause. During my employment with the Company. I understand that either the Company or I may terminate my employment relationship at any time. 292 . work rules and the work environment.

S. Posters 1 through 6 can be obtained by calling American Chamber of Commerce Resources at (866) 439-2227. Department of Labor Wage and Hour Division. For more information call: 866-487-2365 3.htm. Department of Labor Wage and Hour Division. Family and Medical leave Act Poster provided by the U. Department of Labor Wage and Hour Division.Appendix A Posting requirements Numerous state and federal laws require employers to post notices in the workplace in a location where they are accessible to employees. (Note: Poster images included in this appendix are for sample purposes only.) Federal posters The following postings are required by federal law.S.S. Failure to post such notices is itself a violation of the particular law. For more information call: 866-487-2365 2. Your Rights Under the Fair Labor Standards Act (Federal Minimum Wage) Poster provided by the U.gov/compliance/topics/posters. Many posters are available via the Internet at www. Job Safety and Health Protection Poster provided by the Occupational Safety and Health Administration (OSHA). For more information call: 866-487-2365 4. Actual postings can be obtained from the websites and telephone numbers listed on the following pages. 1.dol. For more information call: 800-321-6742 293 . Employee Polygraph Protection Act Poster provided by the U.

boli.S. Further.shtml. For more information call: 800-669-4000 6. Oregon Family Leave Act poster 3.us/BOLI/CRD/C_Postings. Oregon State Minimum Wage poster 2. at (503) 947-7815. Workers’ Compensation Notice of Compliance Contact the Workers’ Compensation Division.gov/vets/. 1. 2. All state posters are available online at www. Many of these posters have been translated into Spanish.Posting requirements 5.or. Department of Labor. Employer Compliance. Uniformed Services Employment and Reemployment Rights Act (USERRA) Poster provided by the U. For more information. Unemployment Insurance Tax Unit. and employers with a significant Spanish-speaking population should post Spanish versions of each poster as well. No Smoking poster.dol. Equal Employment Opportunity Is The Law Poster provided by the Equal Employment Opportunity Commission (EEOC). Oregon employers are required to post various compliance notices: 1.state. visit www. Job Safety and Health poster 4. Option 3. 294 . at (503) 947-1488. Oregon posters The following postings are required to be posted by Oregon employers. Employment Insurance Notice (Form 11) Contact the Oregon Employment Department.

Posting requirements 295 .

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6 305 . sexual orientation. organization. national origin. that coverage for some of the laws also depends on requirements other than the number of employees. Covers race. Also prohibits Oregon employers from discriminating against other protected classes. such as whistleblowers. or other entity that pays salary or wages for work performed. institution. or that has control over employment opportunities.Appendix B Compliance thresholds The following list does not include all federal and Oregon employment laws. lawful users of tobacco products during off hours. sex. consult further in the book for an explanation of those other requirements. but it does provide a snapshot view of how many employees an employer must have to be covered by these most significant laws.000. and the like. recipients of unemployment benefits. Minimum employees 1 Law Fair Labor Standards Act (Federal) Notes Applies to all employees engaged in interstate commerce who are not expressly excluded by the FLSA. Remember. association with someone in a protected class. Alternatively. color. age (18 years of age or older). If the number places your business on the borderline. it applies to an enterprise with an annual dollar volume higher than $500. religion. an expunged juvenile record. however. Employers are urged to contact their legal counsel if they have any questions about what type of employee may be protected under Oregon’s civil rights laws 1 Oregon civil rights laws 1 1 Oregon wage and hour laws Uniformed Services Employment and Reemployment Rights Act (USERRA) Oregon disability discrimination law Employer “means any person. marital status.

6 15 15 Employer must be “engaged in an industry affecting commerce” and have 15 or more employees for each working day in each of 20 or more calendar weeks in the current or preceding calendar year. or in the year immediately preceding the year in which leave is taken.Compliance thresholds Minimum employees 6 Law Oregon domestic violence leave law Notes Covers employers who employ six or more individuals in Oregon for each working day during each of 20 or more calendar workweeks in the year in which an eligible employee takes the leave. 20 Age Discrimination in Employment Act 20 Oregon Injured Worker Reinstatement Law Breaks to express breast milk Applies to employers who employ 25 or more employees in the State of Oregon for each working day during each of 20 or more calendar workweeks in the year in which the rest periods are to be taken.” Employers with 100 or more employees must annually file EEO1 survey. or in the year immediately preceding the year in which the rest periods are to be taken. Covers employers who employ 25 or more persons in Oregon “for each working day during each of 20 or more calendar workweeks in the year in which the leave is to be taken or in the year immediately preceding the year in which the leave is to be taken. 6 Oregon Injured Worker Reemployment Law Oregon workers’ compensation/ retaliation/ discrimination Americans with Disabilities Act (Federal) Title VII of the Civil Rights Act Employer must be “engaged in an industry affecting commerce” and have 15 or more employees for each working day in each of 20 or more calendar weeks in the current or preceding calendar year.” 25 25 Oregon Family Leave Act 306 . Employer must be “engaged in an industry affecting commerce” and have 20 or more employees for each working day in each of 20 or more calendar weeks in the current or preceding calendar year.

50 Family Medical Leave Act 50 Rehabilitation Act of 1973 50 Vietnam Era Veterans Readjustment Assistance Act of 1974 (Federal) 307 . Also requires annual filing of VETS-100 report. and have contracts worth at least $50.000 must implement a written affirmative action plan.000 or more for all contracts signed on or after December 1. Covers employers who employ 50 or more persons for each working day during each of 20 or more calendar workweeks (not necessarily consecutive) in the current or preceding calendar year.000 or more ($100. Contractors who employ 50 or more persons. Contractors who employ 50 or more persons.Compliance thresholds Minimum employees 50 Law Executive Order 11246 (Federal) Notes Employers with federal government contracts worth $10.000 or more.000 must implement a written affirmative action plan. 2003). and have contracts worth at least $50. Employers with federal government contracts worth $10. Employers with federal government contracts worth $25.000 or more. and have contracts worth at least $50. Contractors who employ 50 or more persons. Eligible employees must also be employed at a worksite where 50 or more employees are employed by the employer within 75 miles of that worksite.000 must implement a written affirmative action plan.

Compliance thresholds 308 .

... subabuse2......................................85 Sample personal conduct policy..31 Interview evaluation........................... intro..........43 New employee checklist ................................37 Form W-4 ........ empref................doc.............................................doc .... I9.........................................67 Sample safety and health policy ..........................................................72 Sample substance abuse policy ............. awapp2.................doc............ attendance2....................................... refinq.......................85 309 .... safetyandhealth..doc...doc ...................doc......................... generalrules2...... empintanal......................................................................... awapp1...................doc ........ FCRA.........................doc .......doc.....................52 Sample employment status policy ..............41 Form I-9 .........doc........................ empstatus.........doc...................................... introduction.................................................66 Interactive process questionnaire...............10 At-will employment application.............55 Sample general rules and regulations policy.....27 Employment interview analysis.......doc ............................... refrelease..............................doc ...................................... generalrules...................................................58 Sample attendance policy.. disaccomm.................... fraternization......84 Sample personal conduct policy.............. safetyandhealth2................................34 Reference inquiry..............................14 At-will employment application.................doc.doc..........................................74 Sample substance abuse policy ...............81 Sample no solicitation/distribution policy ..................................................doc.......doc..............................doc...........................62 Sample disability accommodation policy ..............doc....doc.. awapp4................. attendance...............................54 Sample introduction period .........................doc....................... awapp3................32 Reference release form........... jobdesc...............doc ....... inteval........35 Employment reference ...................................doc .............doc ...........57 Sample general rules and regulations policy......................................................................... subabuse...................doc........70 Sample safety and health policy ...............doc................36 Authorization for release of information......................................................... W4........doc .................................................11 At-will employment application..............................doc...................................Appendix C Index of forms and sample policies Name of form/ sample policy CD-ROM file name Page number Job description..................................doc........................................................................doc............................61 Sample attendance policy............................................... authorizationrelease.................................... personalconduct..................................75 Sample drug free workplace policy – government contractors .......... drugfreegov......................................................................20 At-will employment application............48 Sample introduction.................... personalconduct2................................................... newempcheck....doc................. intproquest................................................doc .........83 Sample non-fraternization policy ............................................doc..............................................................................................23 Fair Credit Reporting Act disclosure and authorization................................................................................................................... solicitationdistribution........

.............. 124 Certification of Health-Care Provider (Family Member).............doc.................. nonfmlaoflaleave2.................................................... 168 Model COBRA Continuation Coverage Supplemental Notice............doc ... 135 Certification for Serious Injury or Illness of Covered Servicemember .......... 101 Sample OFLA/FMLA policy .................. cobraform3..................................doc ................ holiday..................doc .........doc..... ofla.................. paidtimeoff.................... qualexigency.... nonfmlaloflaeave3................doc .....doc...................................................88 Sample equal employment opportunity policy........ 157 Model General Notice of COBRA Continuation Coverage Rights (for use by single-employer group health plans) ........................ 153 COBRA information..............................doc..................... certhealthcareprov2....................................................doc.....doc... 401k...................................... personalleave............doc............. certhealthcareprov.................................... 164 Model COBRA Continuation Coverage Election Notice .. 132 Designation Notice......................................................................... 202 Sample long-term disability plan policy ............................doc..............doc..............98 Sample sick day policy .......................................................................................doc ........doc........doc ........................ 202 Sample 401(k) plan policy . servicemember...................... 181 Model COBRA Continuation Coverage Additional Election Notice ...............................Index of forms and sample policies Sample workplace violence policy .... physrelease..................................................... 104 Employee Rights and Responsibilities under the FMLA .............................................................................................................doc ......doc................................................................ 114 Sample FMLA policy ..... cobraform1..........doc........... 152 Sample health insurance policy ..........................................doc ....... cobraform2.. EEO..93 Sample general harassment policy.......doc ...... 134 Certification of Qualifying Exigency................... noteligrights... cobrainfo............ 128 Notice of Eligibility and Rights and Responsibilities .......................................... 150 Sample military leave policy......................doc...... vacpay....................90 Sample sexual harassment policy ......95 Sample vacation policy ...doc .. militaryleave............ 145 Domestic violence leave ... 156 Model COBRA Continuation Coverage (for use by single-employer group health plans) ..................................................doc ........... 148 Sample personal leave of absence policy.................................... 123 Certification of Health-Care Provider (Employee) .......................................99 Sample paid time off policy .................. cellphone................... 143 Request form for non-FMLA/OFLA leave ........................ 138 Physician’s release to return to work.............................................. nonfmlaoflaleave..... domesticviolence......... designationnotice...........doc ..... 203 310 ....doc................................ sexualharassment..87 Cell phone usage............................................doc........................................................................ violence.................. cobraform........ healthinsurance..... genharassment.. juryduty........................doc........99 Sample holiday policy......................................... 189 Sample short-term disability plan policy ...............doc . cobraform4.......... 144 Request for leave of absence (non-FMLA/OFLA)................ longtermdisability............................................................................................................................................. certhealthcareprov................................................... 142 Sample policy for employers not covered by FMLA/OFLA............................................doc...doc............................doc ... 115 Certification of health care provider ................ fmla....... 150 Sample bereavement leave policy ................................doc......... shorttermdisability............... sickday.........................................................................doc....................doc...........................................doc................ bereavementleave......................doc............ 152 Sample jury duty leave..............

.. 266 Sample smoking policy.................. 286 Separation summary.... salarychange..doc ..............doc........................................ 249 Sample complaint/grievance policy............................... 289 Employee separation clearance checklist..... 263 Sample reference requests policy ......... inspectionproperty..doc ................... 212 Sample timekeeping requirements policy ...... 208 Notice to employees regarding meal and rest periods ......doc............ 251 Sample examination of records policy. 255 Sample employee suggestions policy .......doc .. perfappraisal3.................... elecmedia2.................................................... 270 Sample inspection of property policy ..................doc........................... 284 Employee exit interview .... 207 “Undue hardship” notice to employees regarding meal and rest periods ......................................................................................... perfevaluation........ layoffrecall............................................................................................ empsepchecklist........ 222 Performance appraisal........................ 236 Sample layoff and recall policy ................................doc.....................................................doc ..................................................................................................doc ...........................doc.............................................................................................doc...............doc................................................................... termination......................................................................................................................................................................................................................................... dresscode..doc............ suggestions.....doc........... 250 Sample open door policy...doc......... vehicles......doc.doc.doc ........ 214 Payroll direct deposit form.............................................doc ......doc .............. perfappraisal................... 269 Sample telephone usage policy ................................doc...doc ....................... payadvance..................................................... exitinterview2.......................... examofrecords............................... inspectionproperty2....... 236 Sample promotion and transfer policy............. 265 Sample employment of relatives policy................................... 244 Sample complaint/grievance policy........Index of forms and sample policies Sample continuing education policy...............doc...................doc.. perfreview.doc ...........................doc ................. exitinterview......................................doc .......... compreview................................ hoursofwork.. 211 Request and agreement to waive meal periods.. 209 Sample nursing mothers policy .......... 264 Reference release form............. 271 Sample use of electronic media policy ...... timekeeping.... directdepositform...................................... employrelatives..............................................................................................doc......... mealrest......................... promotiontransfer........doc................... 290 311 ........................... 238 Sample confidential information policy...................................doc .................doc ............. nursingmom... telephoneuse... 219 Sample performance review policy ...... 239 Sample confidential information policy.................................... referencerequests2... 268 Sample dress code policy ....... 271 Sample inspection of property policy ............ 217 Salary change recommendation form ................ 233 Sample compensation review policy .................doc.................. 218 Sample payroll advances policy ..................................................... payrollchange...... suggestions2........ referencerequests.................... 261 Employee suggestions program entry form .......................doc ............................ 223 Performance appraisal summary .......................... mealrest3.......... conflict................. 285 Exit interview ............ 274 Sample use of company vehicles policy ........ 241 Sample conflict of interest policy................ 262 Sample reference requests policy ..... hygiene...............................doc ........................................................doc............................................. contedu....... mealrest2...doc..................... 204 Sample hours of work policy............................................................................... 213 Sample overtime policy ...... perfappraisal2.... complaint2................. separationsummary.doc .................doc.......... 230 Performance evaluation............. confidentiality2.................................................doc................ refreleaseform..................... exitchecklist..............doc ..................... 283 Exit checklist ........................... confidentiality... elecmedia..........................doc .............................. opendoor......................................... overtime. complaint....doc ...............doc.....................doc.............................doc ... 216 Employee payroll change notice......... 227 Performance appraisal..........doc....... smoking.................................doc......................doc .................. 277 Sample termination policy ....... 272 Sample use of electronic media policy ............................................ 268 Sample personal hygiene policy.........................

........ 303 No smoking posters .......................................... oshaposter.............doc ..........................doc.........................doc ................................................. 301 Oregon Family Leave Act poster........... 292 Federal minimum wage poster ............... eppaposter.....doc..................doc..... eeoposter........................ 302 Oregon OSHA poster..Index of forms and sample policies Sample handbook acknowledgment .. 297 OSHA poster ...............................................................................................................................doc ............ 304 312 ....... oroshaposter... mwposter................ userraposter.....................doc ................... fmla...............................doc ...................................doc..................................................................................... nosmokingposters..... 296 Employee Polygraph Protection Act poster ........................doc ....... 298 EEO poster ................................... orflaposter...................... 300 Oregon minimum wage poster ......................doc............. 299 USERRA poster.......... 295 FMLA poster ................................ handbookacknowledgment.................................................................... ormwposter..........................

....................................... 292 ADA............................................................................................. 253 recordkeeping requirements ................................................................................................................................................................................................................ See Americans with Disabilities Act (ADA) affirmative action..............36 FCRA disclosure and authorization ................................................................................ 291 sample policy.......................................... job.................................... 203 A acknowledgment of receipt of handbook ............................................................................................................................................ 62 unemployment compensation ...................................................................................................................... 276 current employees .......................................................................................9 personnel records .................. 149 ADA Amendments Act of 2008 .................................60 disability laws .....................7 arbitration agreements.................................................................................................................... 20...............................................................................37 employment reference.......................................................................... 33.............................................................................................................................................................. 263 authorization for release of information.. 61............................................................................................................................................................................................................................. 11... 276 attendance policies.....................51 authorization for release of information.................................60 FMLA/OFLA.....35 313 .............................................................................. 260 reference inquiry....... 149 applications..9 arbitration agreements.....60 at-will employment ..............................................................64 disability accommodation policy................................... 203 sample policy.... 14....................................................................................64 Americans with Disabilities Act (ADA).................................Index Index Symbols 401(k) plans.......................................................................................................................................................................................................................................................27 job applications.......................... 276 job applicants.............................................................................................................................................................................................................................................................................................................................................................................. 259 Amendments Act of 2008......................................................................................................................................................................................................................9 job descriptions......................................... 23 employee handbooks...........................................................................................................61 sample policy........................................................................................................................................... ADA (ADAAA)......................................................................................................................................................64 workers’ compensation ...................................................................................................................37 B background and reference checks............................................................ 276 background checks.........................................................9 FCRA ......................................................................................... 60...........................................................................................................

......................... 135 314 .................Index reference release form .................................... 203 COBRA ...........................................33 disability ..................................................................................................................................................................................................................................................................................................................................................................................................56 no solicitation/distribution policies................................................................................................................................................82 non-fraternization policy .................................................................................................... 203 employee handbooks.................................................................................................................................................................... 202 recordkeeping requirements .....................................................88 certification for serious injury or illness of covered servicemember ..................51 health insurance .................................................................................................................................................................................................................................................................... 102 candidate screening...................................................................................................................................................53 general rules and regulations ........................................................................................................................................................................................................................................................................................................................................................................................87 sample policy.................................................31 employment reference........................................................................................................................ 202 bereavement leave........................................................................................84 safety and health policies ............................................................... 265 reference requests............................................................51 attendance policies .................................................................................................29 discrimination ............................................................ 153 401(k) plans .......... 123-124.................................................................................................................................................................................................................27 interviewer evaluation.........................................................................................29 ADEA....................86 C call to active duty leave.............29 employment interview analysis ................................................................................................................................................................36 FCRA disclosure and authorization .....................29 care for a sick child........................................... 263 sample policy......................................................................................................32 interviews ........................ 153 long-term disability plans..... leave.............. 138 certification of health care provider.......................................................................34 Title VII............................................................... 156 continuing education ....................................................................................................................................................................................................................................................................83 personal conduct policy................................................................................................................................................................................................................................................................................................................................................................................................................... 128 certification of qualifying exigency..60 cell phone usage................................................................................. 153.................................................................................................................................................................................................69 benefits ....................................................................................................................................................................................................................................................................................................................................35 reference release form ........................................ 108 cell phone usage.................................................................................................................................................................................................................263-264 basic company policies ..........................87 drug-free workplace ....... 150 sample policy...........................................80 employment status ..................................29 ADA ..................... 150 bullying in the workplace...... 259 short-term disability plans ..............................................................................29 authorization for release of information................................................................................................................29 reference inquiry........................................37 background and reference checks ........

..........................................................................................................................95 gender ...... 249.......................... 145 sample policy............................................................................................................................................................................................................ 242 sample policy.......................................95 bullying. 156 information .......................................................................... 236 sample policy....................................................................... 134 direct deposit ......... 149 request for non-FMLA/OFLA leave................................................................................................... 204 contracts...............................................................95 recordkeeping requirements .................................................................... 254 protecting Social Security Numbers ........................................................................................................................ 203 sample policy......................................................................................................................................................................................................................................... See Consolidated Omnibus Budget Reconciliation Act (COBRA) compensation reviews ....................................................... employee handbooks.......................... 244 Consolidated Omnibus Budget Reconciliation Act (COBRA) .............................................................. 247 sample policy......................................................................................................................................................................................................................................................................... 153 COBRA information ............................................................................................................................................................................................................. 168 model COBRA continuation coverage supplemental notice.............................................................................. 236 complaint/grievance procedures .......................................................................................................................................................................... 202 workers’ compensation .......................... 216 disability .............................................................................................................................................................................................................................................................................................................................................................. 241 notification of a security breach ................................................................................................................................................................................................................................................................................................................................................................................ 143......................................................... 241 personnel records ...... 241 conflicts of interest................................................................................ 260 D designation notice.................................................................... 189 model COBRA continuation coverage election notice ........................ 149 accommodation policy .............64 candidate screening ............................... 253 discrimination age ................. FMLA............................... 144...........95 racial................................................................................................................................................................................................................................................................................................................................................................... 202 short-term plans .........................89 FMLA.................................................................................................................... 156 model COBRA continuation coverage additional election notice.........................................90 315 ................................................... 202 Oregon laws......................................................... 239.............................................. 157..........................................................................................................................................................................................................................86 employee handbooks......................................................... 164 continuing education.............................................................................................................................................................................95 sexual harassment ........................................................................................................................................................... 181 termination. 215 form.......................................................................................................... 257 religious... 243 sample policy.......................... 241 safeguarding personal information ..... 149 discipline .........................................................................................................................29 long term plans ............................................................................................................. 239 employee information ........Index COBRA ..................................... 250 confidentiality of company information ........................

................................................. 123 disabilities..... 293 316 ............. 109 paid time off / paid leave bank .......................... 109 holidays ..................................................................................................................................................................................................................................................................................................................81 testing ............................................................................................................................................................................. 272 sample policy................................................. 217 Employee Polygraph Protection Act.. 149 bereavement leave...... 108 request for leave of absence ......................................................................... 276 equal employment opportunity policy ................................................................................................................................. 260 E electronic format........................................................................................................................................................................................................................................................................................................................... 144 sick days ...............................................................................................................................................................................Index documentation...................................................................................................97 employee payroll change notice .................................................................................................................................................................................................... 141 FMLA and military leave...................................... 149 domestic violence leave ........................................................................................................................................................................................................................................................................................ 276 electronic media................................ 272..................................................................................97 ADA ..................................................................................... 147 sample policy...................................................................... new employees..................98 vacation ........... 141 Employer Response to Employee Request for FMLA............... 148 pregnancy leave .............................................................................................................................................................................................................................................................................................. 148 dress codes...................................................................................................................................................................... 152 leave request ..................... 150 OFLA and workers’ compensation.....99 personal leave .....................................................................................................................................................................................................................................80 sample policy............................................. 141 employers not covered by FMLA/OFLA............................................................................. 147 employee leave request ....................................................................................................................................................................................................................................................................................................................... 269 drug-free workplace....................... 142 Pregnancy Discrimination Act........ 274 employee handbooks at-will employment .................89 introduction................................................................................................................................................................................................................................................................................. 149 physician’s release to return to work .................................................................................. 145 request for non-FMLA/OFLA leave................. 108 Certification of Health Care Provider .............................................................................................................................................................................................................48 domestic violence ...............................................51 benefits ........................................................................................... 276 employee leave .............................................................................................................. 141 medical leave ........................90 translation into non-English languages ............................................................................................................... 102 military leave ............................................................................................................................................................................................................................................... 150 care for a sick child ...................... 101 jury duty ................................................. 143 family leave tracking form ................52 sexual harassment ................................................................................................................................ employee handbook.....................................51 electronic format ..........................

............................................................................................... 128 certification of qualifying exigency .. 260 employment interview analysis ...........37 Certification of Health Care Provider ..............................................................................................................................................................................................................................................................................................................................................................................................................53 full vs....................................................................................................................31 employment of relatives.............................................................................................. 261 sample form .............................................................................................. 205 Family and Medical Leave Act (FMLA) .................................................................................................. part time employees............................................................................................................................................................................................................................................................................................................................................................................................................................95 examination of records........................................................................89 posting requirements ....................................................................................................................................................................................................... 255 exit checklist............................................................................................................. 254 sample policy................................................................................................................................................................................. 138 certification of health-care provider............................................................................................................................................................................36 employment status ....... 128 317 . 290 employee suggestions ....................................................................................................................................... 132 posting requirements ................................... 262 sample policy.............................9 job descriptions..................................................61 certification for serious injury or illness of covered servicemember.............................................. 134 discrimination ......Index employee separation clearance checklist .............................................................................................................................................................................. 285................... 123 certification of health-care provider..................................................................................................................................................................................................................................................................... 109 notice of eligibility and rights and responsibilities.......................................................................................................... 257 serious health condition............................. 141 FCRA ...................... 141 employment contracts ............................................................................................................................. See Fair Labor Standards Act (FLSA) FMLA.................................................................................. 284 exit interview.............................................................................................. See Fair Credit Reporting Act (FCRA) FLSA............................................................................................... 109 time off and leaves of absence.................... 293 recordkeeping requirements .........................95 military leave ........................................................... 261 Employer Response to Employee Request for FMLA ........................................................................................................................... 124.................................................................................... 109 family leave tracking form ..............................................................................................54 equal employment opportunity employee handbooks.......................................................................53 exempt vs..................................................................9 Fair Labor Standards Act (FLSA) ................................ non-exempt employees .................................27 job applications... 286 F Fair Credit Reporting Act (FCRA) authorization and disclosure ............................................. See Family and Medical Leave Act (FMLA) forms authorization for release of information........................................................................................................................................53 sample policy... 266 sample policy...................................................................................... 135 designation notice .................................. 294 sample policy... 124.................. 266 employment reference.................................................

....................................................................................................................27 I-9...........................31 employment reference................................................................Index COBRA continuation coverage ................................................................................................ 145 request for non-FMLA/OFLA leave................................................................................................................................................................................................................................................................ 217 employee separation clearance checklist..95 racial.......................................................................................................................................................................................................................................................................... 284 exit interview ..................................................................................................... 142 reference inquiry.......................................................89 FMLA..................... 144 salary change recommendation form .......................................................... 164 COBRA information .................................... 290 employee suggestions.................................... 141 employee payroll change notice ........... 218 separation summary ........................... 156 direct deposit form .......................................................................................................................41 G general rules and regulations.................................................................................................... 14............................................................................................................................................................................. 189 model COBRA continuation coverage election notice .................................................................................................................................................... 157................................................................................................................................................43 interviewer evaluation.............................................36 exit checklist ...................................................................................................................................................................................................................................................95 gender .............................95 sexual harassment ................................................................. 265 request for leave of absence ................................................... 230 performance appraisal summary........................................................................................................................................................95 bullying...............................................................................................................................................57 H harassment age ...........95 recordkeeping requirements ............................................................................................................................................................................ 34...........................................................................................................................................................................10 model COBRA continuation coverage additional election notice................56 sample policy........... 216 employee leave request ................. 23 employment interview analysis .......................................................... 257 religious.............................................................................................................................................................................................................. 223........................................................................................................................................................... 141 FCRA disclosure and authorization ................. 262 Employer Response to Employee Request for FMLA... 233 physician's release to return to work.........................285-286 family leave tracking form .............................. 20...................................................... 141 employment application ..............32 job description ....................................................................................................................................90 318 ........... 181 performance appraisal ............................................................................................................................................................................................................... 168 model COBRA continuation coverage supplemental notice............ 227 performance evaluation .............35 reference release form ................................................................................................................................................................................................................................................................... 289 W-4.... 11..................................................................................86 employee handbooks.............................................................................................................

.............................................................................................................. 11............................................................................39 I-9..................................................................................................................7 arbitration agreements........................................................................................................................................................... 152 sample policy................................... 253 W-4 form ...............................4 what information must be included in a handbook.............. 213 I I-9 form ...............................................................39 documentation....................................................................................................................................................................................................................................................... 259 immigration .....................32 introduction ......................................................................................... 271 interviews .................................................................................................... 254 inspection of property ..................................................................................... 254 recordkeeping requirements ............................... 153 hiring ............................................................................... 101 sample policy...........................7 background checks................................... 152 319 ................................215-216 employee payroll change notice ....................................10................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................9 sample .............................. 259 Immigration and Naturalization Service (INS) ............................................................................................................ 205 meal and rest periods.....................................................................9 job descriptions............................. 205 overtime................................................................................................................................................................. 218 sample policy............................................................................................................................................................... 153 sample policy...................................................... 254 recordkeeping requirements .........................3 J job applications............................................3 enforcement of handbooks ....................................................................................................43 new employee checklist ...............................................................................................................................................................................9 FCRA ....................... 217 FLSA..................................................................................................................................9 FCRA ......................... 14................................................................................29 employment analysis................................................................................................................................................................................................................................ 276 background checks............................................................................... 20........................................................................ 207 timekeeping requirements ....................... 213 salary change recommendation form ..................................31 interviewer evaluation..............Index health insurance ............ 101 hours of work................................................................ 23 jury duty .............................................. 205 direct deposit......................................................41 holidays ..................................................................................................................................................................................................................................................................................................................................................................................................43 personnel records ........................................................................................................................................................................................................................................................................................................................ 270 sample policy.........................................................................................................................................................................................................................................48 personnel records ...................................................................................................................................................................4 why have a handbook........................................................................................................................................................

.................................................................................................................... 150 recordkeeping requirements ....................................................................................................................... 151 320 ....................................................................................................... 238 leaves of absence ......................................................................................................................................................................................................................................... 237 sample policy................................................99 personal leave .......................................................................... 205 medical leave .................. 102. 141 employers not covered by FMLA/OFLA.................................98 vacation ...................................................... 109 holidays ........................................................................................................................................................................................ 104 physician's release to return to work........................................................................................ 149 domestic violence leave ........................... 144 sick days .......................................................................................................................................... 123 disabilities..................................... 148 pregnancy leave .. 141 FMLA and military leave.......................97 ADA ...........................66 L layoff and recall ...........................................................................................................Index K known disabilities ....................................................................................... 108 Certification of Health Care Provider .................................................................................................. 152 medical leave .................................................................................................................. 143 family leave tracking form .............................................................................................................................................................................................. 260 sample policy............................... 150 OFLA and workers’ compensation.................................................. 108 military leave................... 102 military leave .............................................................................................................................. 142 Pregnancy Discrimination Act........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ 149 bereavement leave................................................................................................................................................................................................................... 147 employee leave request .................................................................................................................................................................................. 149 physician's release to return to work... 142 pregnancy leave ...............................97 M meal periods .......... 152 USERRA ............. 108 employers not covered by FMLA/OFLA....................................................................................................................................................................................... 143 notice/certification requirements .......................................................................................................................... 109 paid time off / paid leave bank ............................................................................ 108 request for leave of absence .................................................................................................................... 141 Employer Response to Employee Request for FMLA................................................................................................................................... 101 jury duty ................ 102 care for a sick child ........................................................... 150 care for a sick child ....................................... 109.................................................................................................................................................................................................................................... 145 request for non-FMLA/OFLA leave.............................................................

...................... 253 performance evaluations ..........................85 notice of FMLA eligibility and rights and responsibilities .................................................................................................................................................. 132 O Occupational Safety and Health Act (OSHA)............................................ 221 appraisal...... 253 I-9 Form................................................................................................................................................................................61 time off and leaves of absence....................................................48 no solicitation/distribution policies.....................................................................................See Occupational Safety and Health Act (OSHA) overtime....... 253 employee access............................................................................. 253 Oregon Family Leave Act (OFLA) ............ See Oregon Family Leave Act (OFLA) Oregon Bureau of Labor and Industries............................................................... 253 promotion ..... 258 sample policy..................................................................... 253 demotion............................................................................................................................................................................................................................................................ 254 medical records...................................................................................................................................55 OSHA................................................................................................................................ 253 Oregon Bureau of Labor and Industries.................................... 219 performance reviews........................................................................................................................................... 219 sample policy................................................................................... 109 orientation period............ 230 performance appraisal summary........................................................................ 253 321 ........................... 293 OFLA ............................................................................................... 227 personnel records ........................................................................99 sample policy................................................................................................................................................................................. 253 recordkeeping requirements ...........................................................................................................................................................................................99 payroll advances ................................................................................................ 253 payroll records .......................................................................................... 254 immigration records ...................................................................................................................................... 253 sample ............................................................................................................................................................................................................................................................................................ 150 personnel records ............................................................................................................................................................................. 260 new employee checklist ... 69........................................................................................................................................................................ 254 hiring ................................................................. 222... 233 personal leaves of absence .............................................................................................................. 230.............. 213 recordkeeping requirements ....... 253 definition ..................82 sample policy................................................................................................................................................................Index N National Labor Relations Act (NLRA)................................................................................................................... 214 P paid time off / paid leave bank ................................................. 253 discipline ................................................................................................................................................................................................................................................................................................................................................................... 253 arrest and conviction records....................................................................................................83 sample policy.................................................................................................. 223................................................55 sample policy................................................................................................ 149 sample policy...................................................................................................................................................................................83 non-fraternization policy...........................................................................................

...................... 258 payroll ........... 108 promotions....................................................................................................... 257 immigration ....35 322 ......................Index references.............................................................................................................................................................................. 259 employment contracts ..............................................................................................9 job descriptions.....................................................................37 employment reference....... 260 employee benefits ................................................................................................................................. 102................................. 258 unions .. 258 overtime........................................................................................... 33............. 236 Q qualifying exigency..................................................... 253 workers’ compensation ......................................................................................... 260 discrimination ........................................................................ 255 recordkeeping requirements ....................64 record review policy ...................................................... 260 OSHA................................................................................................................................................................................................................................................................................... 259 background checks.................... 258 personnel records ...............64 sample policy...................................................................................................................................................................................................................................................................................................................................................... 148 pregnancy leave ................................................................................ 293 Oregon........................................................................................................................................................................................................................................................................ 256 affirmative action....................................................................................................................................................................................... 135 R reasonable accommodation ............................................................................................................................ 253 physician’s release to return to work ................... 260 FMLA................................................................. 253 termination......................................................................................................................................................................................... 253 safety in the workplace............................................................................................................. 254 reference checks........................................ 293 federal.....27 job applications......................... 236 sample policy........................................................................ 263 authorization for release of information......................................................... 142 posting requirements...............................................................................................36 FCRA disclosure and authorization ...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................9 personnel records ......................................... 257 drug testing ............................................................................................................................ 260 wages and hours. 258 workers’ compensation ....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... 260 reference inquiry............................................................................. 254 sample policy.................................................................................................................. 258 records......... 294 Pregnancy Discrimination Act ................................................................. 221... 253 recordkeeping requirements .................................................................................................................. 253 wages and hours............................................................................................................................... 259 military leave ...............................................................................................................................................................................

........................................................................................................................... 264 bereavement leave............................................................................ 263............................................. 143.................. 218 sample policies 401(k) plans .............................................................. 274 employee suggestions....................................................................................................................................................................................................................................................................................................................................................................................... 265 request for leave of absence ........................................................88 compensation reviews ......................................................................................................... 219 performance reviews ................................................................................................................................................................................................... 255 general rules and regulations ........55 overtime..................... 145 request for non-FMLA/OFLA leave...................... 272................................................................................................................................................................................................................................................................................Index reference release form ................. 144 rest periods .............................81 electronic media..........................................263-264 reference inquiry.........................................................54 equal employment opportunity................................................... 202 drug-free workplace ............................................................................................................. 292 attendance policies ................... 238 military leave .............................................................. 222 323 .................................................................................................................83 non-fraternization policy ........................................................................ 261 employment of relatives ..................................................................................................................................................................................................................................................................85 orientation period................................................57 health insurance .................... 70....................................................................................... 101 hours of work............................................................................................................................................................................................................. 271 introduction........................................................ 263 sample policy....................................................................................................................................................................................................................... 266 employment status ............................... 241 conflicts of interest........................................................................... 265 reference requests............................. 249....................................................................................................... 152 layoff and recall .............................. 236 complaint/grievance procedures ........................................................................................................................................................................................................................................................................... 61............................................................................................. 244 continuing education ............................................................................................................................... 239.........................52 jury duty ............................ 150 cell phone usage.......................................................... 204 disability .............. 152 no solicitation/distribution policies.............................................................................. 62 background and reference checks ..................................................... 205 S safety and health policies ............................................................................................................................................................. 214 paid time off / paid leave bank .............................................. 153 holidays ......................................................... 203 acknowledgment of receipt of handbook ............................................................................................................................ 250 confidentiality of company information................................................................. 72 salary change recommendation form.................95 examination of records..........................69 sample policy.......................................................................................................................................................................................................................................................................................99 payroll advances ...................................... 34.............................. 207 inspection of property ...............................................................................................35 reference release form.....................................................................................................................

..............................................................................................................................................29 discrimination .......................37 background and reference checks .....................................36 FCRA disclosure and authorization .................................................................................................... 102..........................29 reference inquiry........... 74......................................................................... 75 telephone usage..................................................................33 disability ........................................................................................................................................................................................................ 268 substance abuse policy ...................................................................................................................................................................Index personal leaves of absence .......................................... 138 sexual harassment ................................................................................. 268 social security numbers......................27 interviewer evaluation.................... 75 324 .......................... 109 servicemember leave......................................... 267 sample policy............29 ADEA.............................................................98 screening................................................................................................................................... 236 vacation .....................................................................................................................................................................64 record review policy........................ 236 reasonable accommodation ............................................................96 FMLA..................................................................................................... 95 false claims ......................................................................................................................................................... 270 termination..................................................................................................................................................................................................................................................................................................................................29 employment interview analysis ..................................................................................................................99 smoking in the workplace .........................................35 reference release form ............. 70......................................... 72 sexual harassment ........................................................................................... 255 safety and health policies ......................................................................................................................................................................................................................... 74.....................................................................................................................................................................................................................93 sick leave .... 283 timekeeping requirements ...................................................................93 sick leave ......................................................................... job candidate................................................................................................................................................29 separation summary ................................................................................................................................................................................................................................................................................. 90............................................................... 213 transfers .................................................................................................................................................................................................................................................................................32 interviews .....................................................................................................29 authorization for release of information..34 Title VII............................................................................... 150 promotions..............................................................................................................................................................................................................................98 sample policy...............................................................................29 ADA ..................................................................... 245 substance abuse policy .............................................99 smoking ..............................................................................................................................................................................................................................31 employment reference. 289 serious health condition ...............................................................................................................................................72 sample policy...........................................................95 sample policy....................................................................................................

................................................................................................................................................................................60 Uniformed Services Employment and Re-employment Rights Act (USERRA) ............................................................................................. 108 Certification of Health Care Provider ............................................................................................................................................................. 143 family leave tracking form .................... 270 termination...................................................................... 151 unions .............................................................................. 150 care for a sick child ....................................................................................... 236 translation of employee handbook into non-English languages............. 141 employers not covered by FMLA/OFLA................................................ 269 sample policy................................. 149 physician’s release to return to work ................................................................................................................................................................................................................................................... 152 leave request .. 144 sick days . 145 request for non-FMLA/OFLA leave.................................................................................................................................................. 164 employee separation clearance checklist.................................................................................................................................................................................................................................................................................................... 109 holidays ............................................................................................................................98 vacation .............................................................. 142 Pregnancy Discrimination Act..... 108 request for leave of absence ............................................................................................................................... 283 separation summary ............................................................................................................................................................................................................................................................... 276 U unemployment compensation...................................................................................................................................................................................... 253 sample policy........................................................................Index T telephone usage................................................................... 141 medical leave .................................. 101 jury duty ...............99 personal leave ................................ 286 personnel records ............................................................. 148 pregnancy leave .... 260 325 .............. 157.....................................................................................................................................................................................................................97 timekeeping requirements ................................................................................................................................................................................................................................................................................................. 102 military leave ............... 221............................................................................................................................................................................................................................ 141 FMLA and military leave...................................................................................................................................... 236 sample policy...... 141 Employer Response to Employee Request for FMLA......................................... 281 COBRA continuation coverage .......................... 213 transfers . 213 sample policy.............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................. 290 exit checklist ......................................................... 289 time off and leaves of absence.................. 149 domestic violence leave .................................................................................................................................... 284 exit interview ... 109 paid time off / paid leave bank ............................................................................................................................................................................................... 150 OFLA and workers’ compensation...................... 237.........................97 ADA .................................................................................... 147 employee leave request ............................. 149 bereavement leave....... 285....................................................................................... 123 disabilities...................................

.......................................................................................................................................................97 accumulating vacation time....................................................................................................... 109 326 ..............................................................................................................................................................................................................................................................................................................97 violence......................................................................................................................................................................................................................................................................... 293 payroll advances .......................................................................................... 258 vacation pay................. domestic .............................................................................................. 149 FMLA........................... 147 W W-4 form..41 wages and hours compensation reviews ......................................................................................................... 149...........................................................................98 vacation pay................................... 253 recordkeeping requirements .97 sample policy........................... 236 minimum wage .................. 258 ADA .................................. 253......................................................................................................................................................................................................................Index V vacation ....97 workers’ compensation ............................................................................................................................ 219 personnel records ...............................................................97 when vacation can be taken...................................................................................

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