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

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

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

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

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

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

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

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

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

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

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

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Read it straight through Once you’ve addressed your immediate needs.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. The comprehensive nature of our books will prepare you for what would otherwise be unexpected. begin to explore other sections of the book. Once you understand the benefits of having handbooks and policies. Using the CD-ROM All of the policies and forms you find in the book can be found on the CD-ROM. We’ve organized this book to fit your needs. helping you make sure your policies and business practices are in compliance with the law. There may be other areas you are overlooking and this is where the trouble can start. 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. • • • 1 . Simply insert the disc into your computer. and headaches. and personalize and print what you need. find the file on your desktop. and the risk of litigation is minimized. • 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. This is even a tall order for the experienced attorneys who write our books. money. making printing and copying policies incredibly easy.

How to use this book 2 .

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

.. the employee handbook at issue contained language stating that “either party may wish to terminate the relationship at some time. Thus. even if the employer did not intend to do so. Democrat-Herald Publishing Co. and have given employers an extra “shield” against breach of contract claims. and any other place in the handbook where appropriate. and the employee sued the employer under a breach of contract theory. On the other hand.. What information must be included in an employee handbook The following are good. Because of these court opinions. In Yartzoff v. employee handbook provisions have been upheld. Tektronix. in Gilbert v.” The handbook further stated that the employer “reserves the discretion to determine whether in our judgment the termination. For example. and the right to enforce an otherwise at-will employment status. if not carefully drafted.” The defendant-employer discharged the plaintiff-employee during this probationary period. 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. or any other disciplinary action. Inc. The employee handbook must include a statement that the employment relationship is at-will. and some are required by law (as noted). 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. with or without notice. meaning that the employer or the employee may end the relationship at any time. Oregon courts have held that an enforceable contract can be created through a policy in an employee handbook. Inc.” The Oregon Court of Appeals held that the employer had. It is recommended that the handbook include this statement in the handbook receipt/acknowledgement form as well. retained the right to discharge employees at any time and for any reason and that the parties had not modified the at-will relationship. was justified. • Statement of at-will employment.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. the employee handbook in question stated that a new employee would be “on probation” for three to six months. But. [Employer] intends to preserve the right of either party to do so. an employee handbook provision can be construed as a contract. general subjects for an employer to include in a handbook. via disclaimer language. claiming that she had been able to properly handle her job and had become a productive member of the team. 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. 4 .

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

Introduction 6 .

it could lead to claims of age discrimination by the applicant if he or she was not chosen for the position. with or without a reasonable accommodation. Finally. screening or interviewing process. Employers should not to request any information that would provide the employer with the age of the applicant. 2009. A thorough. 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. 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. If such information is provided. 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 . such as the applicant’s birth date. When listing the functions of the job.Chapter 2 Job descriptions and applications Job descriptions Before beginning the employment application and hiring process. .” Employers may ask applicants about their ability to perform essential functions of a job. family background and the like should not be sought at any point during the advertising. Finally. A template for a job description is included in this chapter. an employer should write a job description for the position needing to be filled. . essential.” Under the Americans With Disabilities Act and corresponding Oregon law. applications should include a statement indicating that if the employer discovers any 7 . This will allow the employer to pinpoint the exact qualifications required for the position and will assist greatly in the hiring process. Information about an applicant’s marital status.2(n). an employer should carefully consider whether the functions should are “essential” or “marginal. See 29 CFR § 1630. according to new FMLA regulations that went into effect January 16. (For more information. in fact. this description shall be considered evidence of the essential functions of the job. because the person must be able to perform only the “essential” functions. Employers should consider identifying “attendance” as an “essential job function” for positions where attendance is.. The ADA and the EEOC regulations suggest ten reasons or factors to be considered.

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

the employer must secure written permission from the applicant to do so. 9 . 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. Fair Credit Reporting Act Disclosure and Authorization). This is required under the Fair Credit Reporting Act (FCRA). A sample authorization is included at the end of this chapter (see page 27. or other background check on an applicant.Job descriptions and applications If a company intends on performing a criminal background check.

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

Job descriptions and applications AT-WILL EMPLOYMENT APPLICATION 11 .

Job descriptions and applications 12 .

Job descriptions and applications 13 .

please explain  Yes  No Conviction will not necessarily disqualify an applicant from employment. age. national origin. give date If Yes. color. gender. (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. disability.)  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. 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. sexual orientation or any other legally protected status. 14 . This application will remain active for 180 days. marital or veteran status. religion. creed.Job descriptions and applications AT-WILL EMPLOYMENT APPLICATION (SECOND VERSION) We consider applicants for all positions without regard to race.

apprenticeship or skills. read. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Describe any job-related training received in the United States military. and/or write Course of Study Years Completed Diploma Degree FLUENT SPEAK READ WRITE GOOD FAIR Describe any specialized training. _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ 15 .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.

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

You may exclude memberships that would reveal gender. business. _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 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. or civic activities and offices held.Job descriptions and applications List professional. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 17 . religion. national origin. age. sexual orientation or other protected status: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ Additional Information Other Qualifications Summarize special job-related skills and qualifications acquired from employment or other experience. trade. disability. ancestry.

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. _________________________________________( )________________ Name Phone # ___________________________________________________________________________________________ Address 2. This application for employment shall be considered active for a period of time not to exceed 45 days. 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. IF HIRED. _________________________________________( )________________ Name Phone # ___________________________________________________________________________________________ Address ___________________________________________________________________________________________ *WE ARE AN AT-WILL. IT IS FURTHER UNDERSTOOD THAT THIS “AT WILL” EMPLOYMENT RELATIONSHIP MAY NOT BE CHANGED BY ANY WRITTEN DOCUMENT OR BY 18 . MY EMPLOYMENT RELATIONSHIP WITH THIS ORGANIZATION WOULD BE OF AN “AT WILL” NATURE. I HEREBY UNDERSTAND AND ACKNOWLEDGE THAT. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.Job descriptions and applications References 1. 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 ___________________________________________________________________________________________ 3.

I understand.Job descriptions and applications CONDUCT UNLESS SUCH CHANGE IS SPECIFICALLY ACKNOWLEDGED IN WRITING BY AN AUTHORIZED EXECUTIVE OF THIS ORGANIZATION. that I am required to abide by all rules and regulations of the employer. 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. Signature of Applicant Date *WE ARE AN AT-WILL. also. EQUAL OPPORTUNITY EMPLOYER* 19 . In the event of employment. I understand that false or misleading information given in my application or interview(s) may result in discharge.

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

Job descriptions and applications 21 .

Job descriptions and applications 22 .

THE COMPANY IS AN AT-WILL EMPLOYER. 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. Position Applied For:_______________________________ Date of Application: ______________ Date You Can Start:_______________________________ Please note that this application will only remain active for six months. 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 .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.

Job descriptions and applications EDUCATION: NO. please state citation. 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. management experience.) If so. Whom You Have Known For At Least One Year. 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. or qualifications you feel will be helpful to us in considering your application: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ REFERENCES: Three Individuals Not Related To You. equipment operation. training.

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

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

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

Job descriptions and applications 28 .

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. 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. but one that also is filled with many legal pitfalls. Oregon’s disability law. 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. 29 . pregnancy. the Age Discrimination Act in Employment (ADEA). Laws such as the Americans with Disabilities Act (ADA).Chapter 3 Candidate screening Interviewing applicants The job interview is a process of candidate screening that is necessary. 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 interviewer needs to refocus the interview into jobrelated areas. If a candidate begins providing such unsolicited information.Candidate screening Questions concerning any of these topics should be avoided at all costs. 30 .

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

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. 5. 6. If offered and accepted. 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. 2.Candidate screening INTERVIEWER EVALUATION Interviewer Comments: 1. 9. Starting Salary:___________________________ 1st Evaluation Date:_______________________ 1st Salary Review Date:____________________ Accepted Position:  Yes  No 8. 3. 7. when will employment commence? Date: Time:_________________ 32 .

Employers that thoroughly check every job applicant’s background can limit their negligent hiring liability. (See page 37. employers should have candidates provide proof of any diplomas. Authorization for release of information.) 33 . In addition. you must secure the necessary authorization from the applicant first. Such authorization can help protect former employers and others from defamation claims and thus might make them more willing to provide any requested information. etc. transcripts. 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. licenses. 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. if education or licensure is a job requirement.Candidate screening Background and reference checks One potential lawsuit facing employers today is negligent hiring. The employer should then verify with the corresponding institutions or agencies that the information provided is accurate and/or current. 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.

6. ___________________________________. 8.Candidate screening REFERENCE RELEASE FORM Employee Reference Release I. 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. 3. 2. 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. 5. 4.

/Title) ______________________________________ (Date) 35 . ______________________________________ (Company Rep. Thank you for your assistance. We would greatly appreciate your furnishing the information requested on the attached form for the type of reference checked above. a self-addressed stamped envelope is enclosed.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. Very truly yours. 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.

6. 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. 5. 3. 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.

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

Candidate screening 38 .

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

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

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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 .

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.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 .

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

President ABC Company 52 . SAMPLE POLICY Welcome to ABC Company – we’re glad to have you on our team. and maintain a motivated and productive workforce. we believe that our employees are our most valuable asset. 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. Sincerely. If you have any questions about any of the provisions in the handbook.General policies Finally. 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. John Doe. 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. This handbook supersedes any prior handbooks or written policies of the Company that are inconsistent with its provisions. In fact. Our employment relationship remains at-will notwithstanding any provision in this handbook. This handbook does not create a contract of employment between ABC Company and its employees. All employment at ABC Company is “at will. for any reason. in summary form. please ask your supervisor or the Human Resources Manager. No supervisor. This employee handbook describes.” That means that either you or the Company may terminate this relationship at any time. You may receive updated information concerning changes in policy from time to time. we attribute our success as a company in significant part to our ability to recruit. and those updates should be kept with your copy of the handbook. At ABC. We hope that during your employment with ABC you will become a productive and successful member of the ABC team. 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. the personnel policies and procedures that govern the employment relationship between ABC Company and its employees. This provision also prevents anyone in the company other than the president from modifying an employee’s at-will status. hire. with or without cause or notice. manager. Supervisors also should be instructed that they may not change the terms and conditions of employment for their subordinates.

dol. such classification will not affect an employee’s eligibility under the FMLA. 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. For instance. if the employer is covered by that statute and the employee is otherwise eligible. if a part-time employee works more than 1. While classification as a part-time employee may affect discretionary benefits. the employee may still be eligible for a job-protected leave of absence under the federal Family and Medical Leave Act (FMLA). can be found at www. Probationary periods can also be considered inconsistent with at-will employment.General policies Employment status Appropriate employee classifications are essential for every organization. (For more information. Employers are strongly advised to consult with an attorney regarding the exempt status of any employee. along with criteria relevant to each exemption. 53 . seq. see also Oregon Administrative Rules 839-0200004 et.250 hours in a designated 12-month period. and such periods may be better defined as “introductory” rather than “probationary.gov. compensation. and affect eligibility for benefits. Full and part-time employees Employers may define part-time employment status at any level they wish. duration of employment. or less than whatever maximum number of hours chosen by the employer. Introduction period. and employment expectations. employers should never refer to as an employee’s status as “permanent” because this language is inconsistent with at-will employment. For instance.) Employers should note the specific minimum salary requirements and the exercise of independent discretion and judgment are required in most exempt positions. 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). Part-time employment may be defined as any employee scheduled to work less than 40 hours per week. less than 32 hours per week. Similarly. OFLA or federal/state overtime laws. Exempt categories.” See page 55. 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. The employer’s designation is not controlling.

or professional capacity.General policies SAMPLE POLICY ABC Company classifies employees as follows: 1. are subject to all Company rules and procedures. Participation in paid. for a specific period of time. if the employee works over 1. 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. administrative. Regular Full-time: Employment in an established position requiring 40 hours or more of work per week. 54 . or for the duration of a specific project or group of assignments. will be established. 2. Participation in benefits programs for temporary employees is limited to eligibility for workers’ compensation. or other legally exempted categories of employees. Temporary: Employment in a job established for a specific purpose. all employees are defined as either: 1. or 2. company-observed official holidays. Full-time employees are eligible for full participation in benefit programs. administrative. All employees.000 hours in a year and is at least 21 years of age. Participation in benefits programs for part-time employees is limited to: • Participation in the retirement plan. such as portions of days or weeks. and who are covered by the federal minimum wage and maximum hours law. Normally a part-time schedule. or other legally exempted categories of employees. Non-Exempt: Those employees who are not employed in an executive. regardless of employment classification. Exempt: Those employees who are employed in an executive. Additionally. or professional capacity. Temporary employment can either be full-time or parttime. Eligibility for workers’ compensation benefits. • • 3.

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

These policies put employees on notice as to what behaviors will not be tolerated. to preserve the principle of at-will employment. Nor should a policy provide that an employer will engage in “progressive discipline” prior to termination. is a vital part of any employee handbook or personnel manual. 56 . and/or suspension prior to termination. thereby allowing for the uniform implementation of rules throughout the facility. 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. “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. Maintaining employer discretion in deciding when and how to discipline employees is essential. 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. and clearly advise employees of the general rules. The uniform application of these rules can also provide a strong defense against claims of discrimination based solely on circumstantial evidence (for example. employers should not include any provision stating grounds for discipline or discharge (for example. in any specific case. regulations and disciplinary procedures the employer intends to follow. Thus. the policy should contain an express statement that discipline is discretionary. treatment of similarly situated employees differently). the employer should retain the discretion to immediately terminate any employee without prior utilization of lesser discipline. Finally. written warning. The sample policy is intended for manufacturing settings. and the employer retains its right to determine appropriate discipline. While an employer may decide to provide a verbal warning.General policies General rules and regulations A statement of general rules and regulations. as well as the company’s policy for administering discipline. It is important to individually tailor the provisions of this policy to meet each employer’s own business needs and objectives. up to and including termination. Supervisors are also provided guidance as to when to take disciplinary action.

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

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. 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. fighting or other acts of violence Engaging in physical.General policies SAMPLE POLICY (Option 2) ABC Company expects every employee to adhere to the highest standards of job performance and personal conduct. state. This expectation extends to interactions with ABC Company personnel and outside business contacts. entering with. 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. 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 . profane. or federal laws Conduct endangering the health. destroying or stealing Company property or another person’s property Possessing on or in. 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. or obscene language.

up to and including discharge. ABC Company retains the right to terminate any employee’s employment at any time and for any reason. practice. discharge.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. written warning. ABC Company retains sole discretion to determine the nature and extent of any discipline based upon the circumstances of each individual case. or other action. suspension. demotion. 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. And at all times. Discipline may be in the form of a verbal warning. with or without advance notice or other prior disciplinary action. are described elsewhere in this Handbook. or rule of conduct or for any other reason. Other examples of prohibited conduct that may result in discipline. 59 . In all cases.

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

or other absences from scheduled hours are disruptive and must be avoided. early departure. and prepared to start work. or discharge an employee absent on an FMLA/OFLA-protected leave.” depending on the facts and circumstances. on time. 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 must provide their supervisor with an honest reason or explanation. that absences from work may be viewed as a “reasonable accommodation. When an employee is absent. even one unexcused absence may be considered excessive. Where medically necessary. discipline. 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. Absent extenuating circumstances.General policies attendance as an essential job function in all job descriptions. Employees also must inform their supervisor of the expected duration of any absence. and medical certification – employers covered by this law should not assess points to. Excessive absenteeism (excused or not) may be grounds for discipline up to and including termination of employment. Each situation of excessive absenteeism or tardiness will be evaluated on a case-by-case basis. 61 . Employees also are expected to remain at work for their entire work schedule. depending on the circumstances. such leave may even be taken intermittently or on a reduced hours leave schedule. Employees are expected to report to work as scheduled. However. SAMPLE POLICY (Option 1) Punctuality and regular attendance are essential functions of each employee’s job at ABC Company. Note. In all cases of absence or tardiness. Any tardiness or absence causes problems for fellow employees and supervision. however. except for break periods or when required to leave on authorized Company business. Although the FMLA/OFLA does impose certain requirements upon employees with respect to eligibility for leave – notice to the employer. and the Company will not retaliate against an employee who has taken or is taking an FMLA/OFLA leave of absence. Late arrival. Documentation of the reason may be required. 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. his or her work must be performed by others.

Therefore. Lack of a telephone or absence from town is not an excuse for failing to notify your supervisor of absence or tardiness. you are expected to properly notify your supervisor on duty at least one hour in advance of your scheduled work time. The absenteeism and tardiness records are kept on a point system basis. Each employee’s absenteeism and tardiness records are kept on file with the Human Resources Department. When an employee reaches various point totals. that there are times when absences and tardiness cannot be avoided. unexcused absenteeism or tardiness will not be tolerated and will be cause for disciplinary action up to and including discharge. As with any group effort. and warnings are issued. a certain number of points are accumulated by an employee on their personnel record. Unreported and unexcused absences of two consecutive work days will be considered a voluntary termination of employment with the Company. Regardless of the reason for your absence. Any employee who accumulates 24 or more points in a 12 month period under this system will be discharged. the employee will begin a new 12-month period for purposes of earning another day off under this program. or will be discharged depending upon the number of points he or she accumulates. On the first day of each month. certain notice and disciplinary actions will be taken. a final written warning. he or she will receive one day off with pay. Upon earning a day off with pay. it takes cooperation and commitment from everyone to operate effectively. An employee may receive a written notice. Good attendance is something that is expected from all employees. It is only when points become excessive. Depending upon the nature of the absence.General policies SAMPLE POLICY (Option 2) You are hired to perform an important function at ABC Company. Absences from work will accumulate points in the following manner: 62 . You should call every day that you are absent unless you are on an approved leave of absence. that an employee need be concerned about his or her attendance practices. We do realize. You should be at your work station by the start of each workday at the time designated by the department. If only three points or less are accumulated during any rolling 12 month period by an employee. a written warning. points accumulated during that same month one year prior will be removed from the employee’s record for purposes of this policy. It is expected that everyone will accumulate some points under this system. your attendance and punctuality are very important. Excessive. however. 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.

Absence for any reason not excused above with proper call-in. Leaving work more than two hours before the end of your scheduled workweek for any reason not excused above after notifying your supervisor. subpoenas. 2. Late to work by 15 minutes or less for any reason not excused above. military leave. 63 . Two (2) Points 1. 4. Late to work by more than 15 minutes for any reason not excused above. 3. 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. 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. FMLA/OFLA leave. Leaving work two hours or less before the end of your scheduled work time for any reason not excused above after notifying your supervisor. Absence for any reason not excused above without proper call-in. or any other absence expressly authorized by the Company. 2. Off work due to jury duty. or the law. Car trouble is not excused. Three (3) Points 1. lack of work. Twelve (12) Points 1. medical leave.General policies No Points 1. One (1) Point 1. Off work due to a work-related injury with medical verification that the employee is unable to work. 2. scheduled vacation. the terms of Company policy.

now. you will receive such notice or warning. because Oregon’s disability discrimination laws closely follow the ADA. more than ever. 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. Oregon employers with 15 or more employees became subjected to new laws affecting the Americans With Disabilities Act (ADA). However.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. 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. 24 Points: The employee will be discharged. 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. and an employee currently holds the position. 16 Points: A written warning to the employee. each time you re-accumulate enough points to trigger a notice or warning. Although too detailed to explain here. job descriptions and lists of “essential functions” should be up-to-date and accurate. 20 Points: A final written warning to the employee. The new laws. will also likely affect Oregon employers who are covered by Oregon’s disability discrimination laws (employers with six or more employees). and has three reported absences that are not excused. due to passage of the ADAAA. sometimes referred to as the ADA Amendments Act of 2008 (or ADAAA). You also may check with the Human Resources Department at any time to determine your point status. Disability accommodation policy Effective January 1. In light of the ADAAA. and given the greater spotlight placed on employees with disabilities. EXAMPLE: Employee is late on one occasion by 30 minutes. 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 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). courts and fact-finders have still given deference to job 64 . Accordingly. leaves work 1 hour early on another occasion. 2009. If a job description is not up to date. it is recommended that employers work with that employee to create a job description that is accurate and complete.

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

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

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

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. and why not? 8. or reduce it to an acceptable level: 10. If medical leave is one of the possible accommodations listed above.)? Yes No If yes. which job functions can not be performed. 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. 7. members of the general public. Signature: Title: Date: Printed Name and Address: 68 . 7: 9.General policies 6. Attached is a job description for the [POSITION NAME] position. Please review the job description and assess whether [EMPLOYEE] can perform all job functions: Yes No If not. etc. 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.

all employers should at least adopt a short statement that demonstrates the employer’s concern for health and safety. the employer may request clarification from the physician or a second professional opinion regarding the employee’s ability to perform essential job functions. Finally. and in particular the specific job functions performed by the individual employee in his or her job. This may be very helpful under the ADA and/or Oregon’s disability law in dealing with employees whose disabilities create such risks. If the physician’s statement is ambiguous. Without this information. 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. Employers should be careful to ensure complete compliance with all applicable federal and state occupational safety and health laws throughout the facility. and workers’ compensation claims. As to medical releases. All such documents should be kept confidential and separate from the employee’s personnel file. An alternative policy is provided for this purpose. 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.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. thereby reducing the employer’s potential exposure to criminal. The policy should also address under what circumstances documentation (including releases) from the employee’s physician will be required. 69 . civil. the employer may provide the employee’s personal physician with information regarding the types of work performed at the company. 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. While the first sample policy is intended to apply to a manufacturing setting.

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.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. 70 . on the first Monday of each month. injuries. A safety committee comprised of two supervisors and three employees appointed by the health and safety office will meet on paid time. safety and other equipment issued to them. listing them specifically. The doctor’s release must state that you are released to return to work either: (a) without limitation. 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. 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. Promptly Report Accidents and Injuries On-the-job accidents. and are responsible for. Note: Effective January1. or (b) with limitations. must be reported to your supervisor immediately. not to exceed two hours unless otherwise agreed. all Oregon employees subject to Oregon OSHA and regardless of size. 2008. All employees are required to use properly. and illnesses. regardless of how minor. are required to establish safety committees or hold and administer safety meetings. Failure to do so may disqualify you from receiving workers’ compensation benefits or an excused absence and may result in disciplinary action. 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.

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

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

and suspicion-based testing of individual employees. If an employer does test employees in a proper. regardless of whether the employer intends to conduct drug testing. randomized drug testing of all employees. even if that employee shows the presence of marijuana in his or her system while at work. Once the policy is prepared and given to the employees. Further. for “cause” testing (such as when the employer has a reasonable suspicion of drug use). The policy includes provisions for pre-employment drug testing. and employers should consult their attorney for the latest laws applicable to accommodating OMMA-covered employees. however. The law in this area is changing.shtml. the employer may discipline or terminate employees who test positive for current use of illegal drugs. 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. employers may have an obligation to accommodate a disabled applicant or employee who lawfully utilizes medical marijuana during non-working hours.oregon. such as pre-hiring testing. The second policy is appropriate only for those employers who intend to require drug testing as a condition of employment. because such individuals are not protected by the Americans With Disabilities Act or Oregon disability laws.General policies addictions or are otherwise protected by law. If you test employees randomly. 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.” See www. the policy should advise employees how they can be selected for testing.’ be certain you can articulate the facts (not merely rumors or gossip) which gave you reasonable suspicion of an employee’s drug use. be certain you can document that your selection methods are truly random. enforce your drug testing policy in a fair and consistent manner. Finally. random testing. consistent manner. or when an employee is involved in a workplace incident or accident. Employers are cautioned to adopt only those provisions of the policy which they intend to utilize. Obligations under the Drug Free Workplace Act do not recognize any obligations an Oregon employer may have under the OMMA. but still contains strong language regarding prohibited conduct. The sample policies below are optional. 73 . employers with certain federal contracts are required to adopt a “Drug Free Workplace” policy with certain provisions mandated by the government. As BOLI notes. The first policy is appropriate for all employers. “To avoid charges of discrimination or wrongful discharge. Under the Oregon Medical Marijuana Act (OMMA). This policy does not address the testing issue. If you test employees ‘for cause. apply it consistently. The next section addresses the Drug Free Workplace Act.gov/BOLI/TA/T_FAQ_ Drugtesting.

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

and implementing substance abuse testing of employees and job applicants to detect use of illegal substances. from whatever source or by whatever process produced. propoxyphene. however. Definitions As used in this policy.General policies The Company will encourage and reasonably accommodate employees with chemical dependencies (alcohol or drugs) to seek treatment and/or rehabilitation. opiates. The company also recognizes drug and alcohol dependency as an illness and a major health problem. methadone. providing employees access to information concerning drug and alcohol abuse programs. The Company is not obligated. or a metabolite of any such substances. Drug means amphetamines. cocaine. To this end. Alcohol means ethyl alcohol. Although it is not the supervisor’s job to diagnose personal problems. 75 . the term: A. Everyone shares responsibility for maintaining a safe work environment. 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. SAMPLE POLICY (Option 2) ABC Company recognizes that the future of the company is dependent on the physical and psychological health of its employees. benzodiazepines. methaqualene. or spirits of wine. phencyclidine (PCP). rehabilitation is an option for an employee who acknowledges a chemical dependency and voluntarily seeks treatment to end that dependency. employee education. the supervisor should encourage such employees to seek help and advise them about available resources for getting help. barbiturates. including supervisor training. hydrated oxide of ethyl. B. methamphetamines. cannabinoids. and coworkers should encourage anyone who has a drug problem to seek help. employees desiring such assistance should request a treatment or rehabilitation leave. Rather. This policy on treatment and rehabilitation is not intended to affect the Company treatment of employees who violate the regulations described above. 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. ABC Company will utilize every reasonable means to maintain a drug-free work environment for its employees. to continue to employ any person whose performance of essential job duties is impaired because of drug and alcohol use.

or injuries. wages. 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. Once a conditional offer of employment has been made. nothing in this policy precludes the appropriate use of prescription or non-prescription medications. or offer to buy illegal drugs or otherwise engage in the illegal use of drugs on or off the job. D. offer for sale. and drug-free working environment. 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. E. Employee means any person who works for salary. productive. It is a violation of company policy for anyone to use prescription medication illegally. Violations of this policy are subject to disciplinary action up to and including termination. B. will release ABC Company from liability connected to the pre-employment drug testing. 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 required to submit voluntarily to a drug test at a laboratory chosen by this company and. Substance means drugs or alcohol. the company has established the following policy: A.General policies C. job applicants will be notified that they will be required to submit to a drug test as a condition of employment. 76 . or other remuneration for ABC Company. Prohibited Conduct The primary goal of ABC Company is to maintain a safe. the job applicant will undergo testing for the presence of drugs as a condition of employment. B. Prior to an offer of employment being made. It is a violation of company policy for any employee to use. G. Pre-Employment Drug Testing A. sell. For this reason. by signing a consent agreement. C. trade. However. possess. Prescription medication means a drug or medication lawfully prescribed by a physician for an individual and taken in accordance with such prescription. F. ailments.

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

Evidence that an employee has used. An employee who has been asked to undergo reasonable suspicion testing may be required to transfer to another position at the company’s discretion. All employees are subject to random testing. 5. As part of ABC Company’s random drug testing policy. When there is reasonable suspicion to believe that an employee is using illegal drugs. 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. machinery. 2. c. or e. possessed. 4. d. As part of a follow-up program of treatment for drug abuse. When employees have caused or contributed to an on-the-job injury that resulted in a loss of worktime for any employee. 3. It shall be a condition of employment for all employees to submit to drug testing under the following circumstances: 1. 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. b. solicited. sold. 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. Abnormal conduct or erratic behavior while at work or a significant deterioration in work performance. 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. Employees will be notified if they have been 78 . or equipment. The following circumstances could cause reasonable suspicion: a.General policies Employee Drug Testing A. A report of drug use provided by a reliable and credible source. Evidence that an individual has tampered with any drug test during his or her employment with ABC Company. pending the results of the testing.

Employees with a confirmed positive test result may. 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. C. D. Employees must provide a specimen within 12 hours from the time of notification. or 2. If a decision not to terminate is made. If the physician. the employee is suspended without pay pending a confirmed negative test result. 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. 79 . whether on duty or not and whether on ABC Company business or property or not. at their option and expense. have a second confirmation test made on the same specimen. the employee has a blood alcohol level of .05 or higher.General policies randomly selected for substance abuse testing.” 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. as defined in subpart B. B. An employee who is under the influence of alcohol. by means of the drug testing method selected by the company. E. the employee’s normal faculties are impaired due to the consumption of alcohol. The employee must provide a confirmed negative test result. B. An employee will be suspended without pay pending the results of the second confirmation test. within 30 days from the date of the positive test result. ABC Company may terminate any employee with a confirmed positive test result. medical official. shall be guilty of misconduct and is subject to discipline up to and including termination. the employee is subject to disciplinary action up to and including termination. or lab personnel has reasonable suspicion to believe that the employee has tampered with the specimen. An employee will not be allowed to submit another specimen for testing. An employee shall be determined to be under the influence of alcohol if: 1. Alcohol Abuse A. at the employee’s own expense.

Each year. and local laws. In addition. and how to refer substance abusing employees to the proper treatment providers. which is located in the administrative department of each of the divisions of ABC Company. consistent with the provisions of the Drug-Free Workplace Act. Such a policy serves purposes similar to the substance abuse policy discussed previously. we will distribute this information to employees for their confidential use. Except as provided therein. 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. Confidentiality ABC Company shall treat as confidential all information received by the company through its drug and alcohol testing program. release of such information shall be solely pursuant to a written consent form signed by the person tested. 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. Employers should therefore have employees sign the acknowledgment and consent form. including but not limited to drug and alcohol abuse programs. how to document and collaborate signs of employee substance abuse. and other applicable federal. 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. Employees are encouraged to use this resource file. Employee Education and Supervisor Training A. B.General policies Employee Assistance ABC Company offers resource information on various means of employee assistance in our community. In addition. Drug-free workplace policy – government contractors Employers who have federal or state government procurement contracts in the amount of $25.000 or more must publish and distribute to all employees a drug-free workplace policy such as the sample policy. state.

We also expect our employees to report to work each day fit to perform their jobs. and 2. 2. we have established a Drug-free Awareness Program to inform employees about: 1. The penalties that may be imposed upon employees for drug abuse violations. rehabilitation. Policy Statement The unlawful manufacture. To meet these objectives. 3. The Company’s policy of maintaining a drug-free workplace. Drug-free Awareness Program To assist in ensuring compliance with the Company’s Drug-free Workplace Policy. each employee must: 1. Any violation of this policy will result in either discipline. or use of a controlled substance while on the Company’s premises or in the performance of services for the Company is strictly prohibited.General policies SAMPLE POLICY Purpose ABC Company is committed to providing a safe and productive work environment. we must take a firm and positive stand against substance abuse. As a condition of continuing employment with the Company. depending on the nature and seriousness of the offense. Abide by the terms of this policy. dispensation. 81 . Any available drug counseling. and/or a requirement of satisfactory participation in a drug abuse assistance or rehabilitation program. and 4. The dangers of drug abuse in the workplace. distribution. This policy is intended to ensure a drug-free work environment for the benefit of our employees and customers. possession. 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. as well as our obligations under applicable federal and state laws. and employee assistance programs. Participation in our Drug-free Awareness Program by all employees is mandatory.

1. without reservation. Although this may seem petty. or expand upon this policy in whole or in part. 82 .General policies Reservation of Rights The Company reserves the right to interpret. Nothing in this policy alters an employee’s at-will status. A no solicitation/distribution policy must be enforced uniformly to be effective. The sample policy is carefully tailored to meet the requirements for curtailing union solicitations. religious or otherwise – try to recruit or solicit employees at work. I agree. the employer may be prevented from relying upon it to prevent subsequent organizing efforts. to abide by the policy. The employer must prohibit even such minor solicitations as candy and cosmetic sales. the overall benefit of uniform enforcement may well be worth the price. however. with or without notice. It can help prevent union organizers from attempting to organize employees during company time. Once the employer has deviated from the policy. modify. 3. 2. Its uniform application can help avoid a discrimination claim if some organizations – whether political. ___________________ Date: ________________________________ Employee’s Signature ________________________________ Employee’s Name (Printed) No solicitation/distribution policies A no solicitation/distribution policy serves several important purposes. 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. Acknowledgment and Consent I hereby acknowledge having received a copy of ABC Company’s Drug-free Workplace Policy.

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

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

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. The following types of outside employment are strictly prohibited. duties and responsibilities. reputation or credibility. For this reason. (1) Employment that conflicts with an employee’s work schedule. 85 . inconsistent with expectations of our employees. SAMPLE POLICY (Option 2) While the Company does not seek to interfere with the off-duty and personal conduct of its employees. or otherwise adversely affects our legitimate business interests. 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. Therefore. 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. 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. (2) Employment that creates a conflict of interest or is incompatible with the employee’s employment with the employer. if such conduct is determined by management to be harmful to our corporate image. even while off-duty. In addition. While employed by the Company. employees who engage in unprofessional or criminal conduct or other serious misconduct off-duty may be subject to disciplinary action by the Company. second jobs are strongly discouraged. all employers should consider whether a policy prohibiting off-duty employment jobs is appropriate or necessary. they represent the Company to the public and should strive to preserve the Company’s reputation. certain types of off duty conduct may interfere with the Company’s legitimate business interests. unless the employee received prior approval. Nonetheless. including termination of employment. employees are expected to devote their energies to their jobs with the Company. For this reason. employees should keep in mind that.General policies off-duty conduct.

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. Further. Some employers may also wish to include a policy prohibiting violence in the workplace. Authorization to engage in outside employment can be revoked at any time. A sample policy follows. At a minimum. because even the “equal opportunity offender” can result in liability to a company.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. even minor incidents of workplace bullying can create a hostile and intimidating environment for employees. the handbook should contain language that required all employees to treat each other with respect. 86 . The Company will not provide workers’ compensation coverage or any other benefit for injuries occurring from or arising out of outside employment. This is a valid consideration. Policies prohibiting “bullying” in the workplace Companies often consider whether to include a policy that prohibits workplace bullying in the workplace. thereby decreasing their productivity. the Company assumes no responsibility to the outside employment. (4) Employment that directly or indirectly competes with the business interests of the Company. depending on the facts and circumstances of the case. If the outside employment is authorized.

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

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

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

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

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

thoroughly and. 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. Complaints should be investigated and resolved promptly. Therefore. courts have found that when sexual harassment has a physical component. employers must consider each claim with the utmost seriousness. 92 . 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. 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. confidentiality may be difficult if not impossible to maintain in many situations. an employer can monitor possible incidents of harassment in the workplace. 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. Additionally. to the greatest extent possible.EEO policies Whether the employer has a stated anti-harassment policy is relevant to the first element of the defense. If the employer concludes that improper conduct has occurred. Obviously. then the alleged harasser should be disciplined accordingly. confidentially. • • When facing specific complaints of sexual harassment. 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. This enables the employer to take action to stop the harassment and thereby accomplish its goal of eliminating workplace harassment. the employer may be liable for not only statutory civil rights claims but also for physical torts such as battery. With a policy in place that encourages employees to request that any perceived harassment be stopped. and remedy problems before they result in litigation. 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.

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

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

color. national origin. age and other protected class statuses While sexual harassment is the most well-known form of prohibited harassment. age. or threatening. color. And as with sexual harassment policies. including harassment on the basis of race. 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. 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. color. sexual orientation. SAMPLE POLICY In providing a productive working environment. national origin. hostile. or otherwise adversely affects an individual’s employment opportunities because of the applicant or employee’s inclusion in any legally protected category. intimidating or hostile acts. religion. negative stereotyping. friends. national origin. disability as well as other protected statuses. ABC Company believes that its employees should be able to enjoy a workplace free from all forms of discrimination. or that is circulated in the workplace. to harass another employee. disability and sexual orientation. disability or sexual orientation. age. gender. age. but is not limited to: • Epithets. interferes or is intended to interfere with an individual’s work performance. It is against Company policy for any employee. Written or graphic material that defames or shows hostility or aversion toward an individual or group because of race.EEO policies Harassment based on race. national origin. age. whether a manager. religion. religion. religion. or offensive working environment. religion. Prohibited harassment occurs when verbal or physical conduct that defames or shows hostility toward an individual because of his or her race. gender. gender. or that of the individual’s relatives. Harassing conduct includes. color. slurs. federal and Oregon law prohibit harassment based on race. It is ABC’s policy to provide an environment free from such harassment. disability or sexual orientation and that is placed on walls. or coworker. In addition. 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. age. bulletin boards. creates or is intended to create an intimidating. • 95 . 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. or elsewhere on the Company’s premises. national origin. color. which relate to race. supervisor. gender. and any other status protected by law. gender. or associates. gender. color. religion.

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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Time off and leaves of absence

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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Time off and leaves of absence

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. FMLA and military leave. see page 109. 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. child. under certain circumstances) for the following purposes: • to care for a newborn. parent. FMLA also provides leave for members of the Armed Services and their guidelines. Under OFLA. parent-in-law. newly adopted. or to care for an injured servicemember (up to 26 weeks). 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. or newly fostered child or • to care for a spouse. injury or condition related to pregnancy or child birth that disables the employee or • “call to active duty” or “qualifying exigency” leave (12 weeks). child. or newly fostered child (parental leave) or • to care for a spouse. Under FMLA. For more information. 102 . newly adopted. child.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. or parent with a serious health condition or • to care for the employee’s own serious health condition. but not seriously ill. Employers with 25 or more employees in Oregon are covered by the Oregon Family Leave Act (OFLA). Eligible employees must be employed for at least 12 months (which may be based on separate stints of employment) and have worked at least 1.250 hours during the 12 months preceding the date leave is to begin. including an illness. same-sex domestic partner.

Employees need not meet the hourly requirement to be eligible for parental leave. 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. It has to be a grandparent or grandchild of the employee. this provision does not extend coverage to grandparent-inlaws. FMLA. something that further complicates the administration of this already complicated law. 2008.Time off and leaves of absence Effective January 1. this change adds a category that is not addressed under federal law. the definition of “family member” expanded to include a grandparent or a grandchild of an eligible employee. Unlike other provisions of OFLA. 103 . In addition.

If an employee fails to give notice as required by law or the employer’s policies. an employer having reason to believe the continuing absence may qualify as OFLA leave must request additional information. including an explanation of the need for leave. Leave anticipated less than 30 days in advance Employees must give notice as soon as practicable. and employers may ask the employee to give reasons why 30 days notice is not practicable. Employees should give as much notice as practical. Employee must follow employer’s policy. 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.Time off and leaves of absence Notice/certification requirements Under OFLA and FMLA. and may not treat a continuing absence as unauthorized unless requested information is not provided or does not support OFLA qualification. 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. when an authorized period of OFLA leave has ended and an employee does not return to work. Employer may require written notice within three days after employee returns to work FMLA – Notice employee may be required to give Same.” Note that under both OFLA and FMLA. Any written notice requirements should be flexible. 104 . 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 employee is not required to specify that the leave is for OFLA or FMLA in order to be eligible for leave. Employees or someone acting on their behalf must give verbal or written notice within 24 hours of starting leave. Under OFLA.

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

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

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

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. domestic partner. a female employee is entitled to use up to 12 weeks’ of leave for any period of disability related to her pregnancy or childbirth.gov/ esa/whd/forms/wh-382. If an employer wants an employee returning from FMLA leave to provide a fitness-for-duty (FFD) certification.oregon. 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. 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. injury. Such leave is not available to a nonspouse father of the child (for example. if appropriate) the latest version of BOLI’s OFLA “Notice to Employees and Employers.pdf. 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”). which will be provided to the physician responsible for completing the FFD certification (see page 134).dol. 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. Covered employers must also provide notice to the employee of the designation of leave as OFLA-covered. or condition that is not a serious health condition but that requires home care. OFLA Employers covered by OFLA must post in English (and Spanish. a statement to that effect must be included in the designation notice. unmarried father of the child). It is available for download at: www.gov/BOLI/TA/2009_OFLA_English_ poster. 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.pdf (see page 302). boyfriend. Pregnancy leave Under OFLA.Time off and leaves of absence form must include a statement to that effect. Not particular form is required. 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. 108 . fiancée. and of any requirements regarding use of paid leave. The leave can commence before actual birth or placement. along with a list of the employee’s essential job functions. In the revised FMLA regulations.

Thus. even if the work-related injury might also be considered a “serious heath condition” under OFLA/FMLA. employees may be eligible for up to 12 weeks of FMLA leave for a “qualifying exigency” arising from a spouse.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. OFLA and FMLA leave cannot run concurrently with leave for a workers’ compensation injury. new federal laws and regulations expanded FMLA to create two new categories of protected leave: 1. he may take only 4 weeks of additional leave for any other purpose. leave to employees who care for family members injured in the line of duty (also known as “military caregiver leave”) and 2. 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). 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. OFLA. 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. FMLA and military leave In 2008 and 2009. FMLA and workers’ compensation Employers may not count a work-related injury against OFLA or FMLA leave. employees will still have a full OFLA “bank” after a workers’ compensation-related absence. child. BOLI and/or the DOL regarding the leave of absence laws. For example. 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. Qualifying exigency leave (QE leave) Under the new regulations. but if he takes only 8 weeks of parental leave. or parent being on active duty or called to active duty. Employers are strongly encouraged to consult with legal counsel.

An employee is not eligible for Qualifying Exigency leave relating to a servicemember who is a member of the Regular Armed Forces.Time off and leaves of absence provisions of 10 U. The new regulations establish seven “specific and exclusive” reasons for which an employee can take qualifying exigency leave. Employees seeking QE leave must give reasonable and practicable notice where foreseeable. First. 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. child or parent” are more broadly defined than for regular FMLA (and. 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. a child for the purposes of QE leave is a biological.C. cite one of the 7 listed reasons for QE leave. These calls to active duty are only made to members of the National Guard or Reserve. or to retired members of the regular Armed Forces or Reserve. A copy of the military member’s active duty 110 . The eligible family members for QE leave of “spouse. While “spouse” and “parent” are self-explanatory. 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. The notice must inform the employer of the active duty status or call. or for “in loco parentis” situations. adopted. 688. 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.S. is different than for Military Caregiver Leave). and provide an anticipated duration of the absence. notably. foster or step-child or legal ward.

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

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

however. Then.” During any single 12-month period. daughter.” In addition.pdf. the employee’s total leave entitlement is limited to a combined total of 26 weeks for all qualifying reasons under FMLA and military leave. including those on the temporary disability retired list (the TDRL).” 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. Department of Labor web site: www. once a single 12-month period expires. Regardless of which 12-month calculation period/rule for establishing the leave year that an employer follows.Time off and leaves of absence leave shall qualify as an exigency. or a nonnetwork authorized private health care provider. to be used for certification of MC leave situations. In general. an employer may require information from the health care provider and from the employee and/or covered servicemember to support military caregiver leave. 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.S. National Guard or Reserve. or on a reduced schedule basis). the covered servicemember must be receiving medical treatment or oversight by a Department of Defense health care provider. a Department of Defense TRICARE network.” A “covered servicemember” for MC leave is a current member of the Regular Armed Forces. and agree to both the timing and duration of such leave. entitled “Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave”. A copy of WH-385.dol. is available for downloading by going to the U. 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. 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. New Form WH-385 – Certification for Military Caregiver Leave The Department of Labor has developed a prototype form.gov/esa/whd/forms/WH-385. WH-385. per-injury basis (which may be taken continuously. 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. Military Caregiver Leave is available to an eligible employee who is the spouse. parent or next of kin of a “covered servicemember. 113 . son. intermittently. a Veterans Affairs health care provider.

consult with your company’s legal counsel to determine which provisions apply to your company. 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. For example. the following sample policy states that health insurance will continue during the course of the leave. absent unusual circumstances. however. need not provide continuing benefits during family medical leave unless the employer has a policy or practice to continue benefits. Oregon employers with fewer than 50 employees should remove references to FMLA (and leaves provided under FMLA). and this is because during a FMLA-qualified leave. 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. Both certifications must be provided within 15 days. Employers who fall under OFLA only. and discuss with legal counsel other provisions included in this policy that may not apply. or a DOD TRICARE network or non-work authorized private health care provider.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. Again. SAMPLE OFLA/FMLA POLICY The following sample policy could be used by an employer who is subject to both OFLA and FMLA.

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

and cosmetic treatments (without complications). 2.. dialysis for kidney disease. chemotherapy or radiation for cancer.e. c. This type 116 . The common cold. permanent or long-term incapacity for which treatment may not be effective but is under the continuing supervision of a health care provider (i. Parental leave must be completed within 12 months of the birth of a newborn or placement of an adopted or foster child. routine dental or orthodontia problems. severe stroke.. epilepsy. are examples of conditions that are not generally defined as serious health conditions. diabetes. Employee’s Serious Health Condition Leave: To recover from or seek treatment for an employee’s serious health condition. 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. etc. etc. Alzheimer’s. d. minor ulcers. 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. upset stomach. any period of incapacity due to pregnancy or prenatal care.e. 3. b.e.. Reasons for Taking Leave Family Medical Leave may be taken under any of the following circumstances: 1.). headaches other than migraine. terminal stages of a disease. including pregnancy-related conditions and prenatal care. flu. or e. any period of incapacity or treatment for a chronic serious health condition (i.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. physical therapy for severe arthritis. etc. periodontal disease. 4.). earaches. 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. which results in a regimen of continuing treatment under the supervision of a health care provider. Family Member’s Serious Health Condition Leave: To care for a family member with a serious health condition. asthma.).

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. This type of leave is available under FMLA only. A “covered servicemember” is a current member of the Armed Forces. arranging for alternative childcare. 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. If a part-time employee works a varying schedule. 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. addressing certain financial and legal arrangements. or is on the temporary disability retired list. including a member of the National Guard or Reserves. an employee must have been employed for at least 180 days (no per-week hourly minimum is required). and attending post-deployment reintegration briefings. or therapy. for 1. 117 . This type of leave is available only to employees who are eligible under OFLA. and if they are employed at a worksite where 50 or more employees are employed by the employer within 75 miles of that worksite. attending certain counseling sessions. or is in outpatient status.250 hours during the 12 months preceding the date leave is to begin. Eligible Employees OFLA – To qualify for Oregon Family Leave for a serious health condition or sick child leave. 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). the leave entitlement is based on the average weekly hours over the twelve weeks worked prior to the beginning of the leave period. 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. an employee must have been employed for at least 180 days and worked an average of at least 25 hours per week. Call to Active Duty Leave: Eligible employees with a spouse. Sick child leave is not available if another family member is able and willing to care for the child. 6. son.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.” “Qualifying exigencies” may include attending certain military events. 5. To qualify for parental leave under Oregon law. recuperation.

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

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

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

Reinstatement is not guaranteed if the position has been eliminated under circumstances where the law does not require reinstatement. Please see ____ for more information regarding health insurance coverage. the employee may qualify for workers’ compensation time-loss benefits. Employees wishing to maintain health insurance during a period of approved OFLA leave will be responsible for bearing the cost of coverage. If the position has been eliminated.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. reinstatement shall not be considered if the leave period exceeds the maximum allowed. 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. 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. Employees are expected to promptly return to work when the circumstances requiring Family Medical Leave have been resolved. If the employee’s serious health condition is the result of an on-the-job injury or illness. Benefits While on Leave If an employee is on approved Family Medical Leave under FMLA. If an employee is on approved OFLA Leave. the employee may be reassigned to an available equivalent position. even if leave was originally approved for a longer period. 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. Job Protection Employees returning to work from Family Medical Leave will be reinstated to their former position. With the exception of employees on leave as the result of an on-the-job injury or illness or otherwise required by law. 121 .

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

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 .

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 . the employee may return to work without restriction on: ________________  In my opinion. specific job duties the employee may perform on a limited basis.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. hours of work. 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. including but not limited to.

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

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. Type of leave of absence requested: (Medical or non-medical) _______________________ __________________________________________________________________________ __________________________________________________________________________ 2. 145 . Reason for leave of absence:___________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 3.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 of leave of absence: FROM: _____________________ Day leave begins TO: ___________________ Day leave ends 4. DATE: TO: FROM: {Date} PERSONNEL DEPARTMENT {Employee Name} GENERAL INFORMATION 1.

any of the positions offered to me upon my return. my employment will be terminated. I further understand that if I refuse. 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. without reasonable cause. 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.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. Employee’s Signature/Date 146 .

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. 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. An “authorized purpose” includes seeking legal or law enforcement assistance or remedies – seeking medical treatment or recovering from injuries.Time off and leaves of absence Domestic violence leave In 2007. Depending on the circumstances. an employer is not required to grant paid leave – however. collective bargaining agreement or employer policy. including the fact the employee requested or obtained leave. Except where it would impose undue hardship. Unless required by contract. or relocating or taking steps to secure a safe home for the employee or minor child. an employer must provide domestic violence leave to an eligible employee. including family and medical leave. an employer must permit the employee to use any accrued vacation or other paid leave. 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. domestic violence leave may overlap with other types of unpaid leave. and leave for victims of crime. The law applies to victims. sexual assault or stalking to take unpaid leave from work for a reasonable period of time to seek assistance. as well as parents or guardians of minor children who are victims. leave provided as a reasonable accommodation under disability laws. must be kept strictly confidential and cannot be released without the employee’s express authorization. Employers should review and revise leave and other affected policies to ensure immediate compliance. an employer is prohibited from discriminating or retaliating against an employee who requests and or takes leave. a new Oregon law went into effect that permits employees who are victims of domestic violence. obtaining counseling or services from a victim services provider. 147 . Moreover. 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. 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. All information and documentation pertaining to the leave.

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. sexual assault. or to relocate or secure an existing home. healthcare professional. Leave is generally unpaid. Moreover. to obtain services from a victim services provider. It constitutes a disability leave due to the medical aspects of pregnancy and childbirth. Pregnancy leave is unique because it may encompass two different types of leave. Company will then generally require certification of the need for the leave. When seeking this type of leave. unless giving the advance notice is not feasible. protective order or other evidence of a court proceeding. childbirth. or documentation from a law enforcement officer. or victim services provider. or stalking of the employee or his or her minor dependants. member of the clergy. you should give Company notice as soon as is practicable prior to the end of the authorized leave. The PDA amended Title VII to provide that discrimination on the basis of pregnancy. such as a police report. you should provide as much advance notice as is practicable of your intention to take leave. 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. In essence. to seek counseling from a licensed mental health professional. 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. 148 . you must give oral or written notice as soon as is practicable. employers cannot treat pregnancy leave less favorably than they treat other types of disability leave. but you may use any accrued vacation or similar paid time off while on this type of leave. When leave is unanticipated. 1. this notice may be given by any other person on your behalf. indicating the time needed and when it is needed and the reason for the leave.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. When taking leave in an unanticipated or emergency situation. Reasons for taking leave include the need to seek legal or law enforcement assistance or remedies. If more leave than originally authorized needs to be taken. to seek medical treatment for or recover from injuries. Pregnancy Discrimination Act (PDA) Employers of 15 or more employees should be aware of the Pregnancy Discrimination Act (PDA). or related medical conditions is a form of prohibited sex discrimination. attorney.

Additionally. Personal leaves of absence Employers are not obligated by either federal or state law to provide personal leaves of absence to their employees. 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. Therefore. might be considered a qualified individual with a disability upon his or her return to work. if an employer not covered by FMLA/OFLA does not wish to allow its male employees leave to care for a newborn child. Under the ADA and Oregon’s disability law.Time off and leaves of absence 2. its policy should state whether the employee will be entitled to pay during this period and the conditions for taking such 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. if applicable. 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. including a leave protected by the FMLA/OFLA. an employee who takes a medical leave. 149 . 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. If an employer chooses to voluntarily provide such leave. 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. If an employer allows its female employees to take this latter type of parenting leave. the employer should draft the policy carefully so as to avoid any apparent promise of reinstatement upon completion of an employee’s personal leave. that leave also must be made available to male employees on an equal basis. 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. except to the extent required by FMLA/OFLA. Employers are advised to consult with an attorney regarding these overlapping laws.

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

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. then the employee has up to 90 days to apply for reinstatement under USERRA.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. then the individual must apply for reinstatement within 14 days of completion of service. After 31 days. 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. Finally. Reinstated employees also are entitled to full seniority benefits. If the military leave is more than 30 but less than 181 days. in some circumstances. and pay. or. status. if an employee is absent for more than 180 days for military duty. the employee may not be discharged for one year subsequent to the employee’s return except for just cause. If the military leave is 30 days or less. to an alternative position of like seniority. Upon return from military leave. annual. in a position of like seniority. If the period of service is between 31 and 180 days. In addition. If unqualified for such a position. the employee must be reinstated to the position he or she held when the military leave began. and pay for which the employee is qualified. Under very limited circumstances in which the employer can show that reinstatement would be impossible or unreasonable. the employer may be able to avoid the legal requirement to reinstate an employee upon return from military leave. 151 . to the extent such coverage is otherwise provided. an employee is entitled to reinstatement in a position that the employee would have obtained if he or she had been continuously employed or. Employers are advised to consult with legal counsel regarding USERRA rights and responsibilities. or similar leave in lieu of unpaid leave. in some circumstances. Employees who desire reinstatement under USERRA must apply for reinstatement within a limited period following termination of their military service. status. the employee generally must report for reinstatement on the first regularly scheduled working day following his or her completion of the service. If the length of service is 181 days or more. then the employee may not be discharged without just cause for a period of six months after reinstatement. employees taking military leave under the USERRA may use any accrued vacation. Employees taking military leave also are entitled to elect to continue health care coverage. for a period of up to 31 days. or in which reinstatement would pose an undue hardship on the employer.

SAMPLE POLICY ABC Company will grant employees time off for mandatory jury duty and/or jury duty orientation. many employers elect to supplement jury duty pay so that employees continue to receive their regular compensation during this time. Time spent on military leave will not be counted as vacation time used. As in the sample policy. Regular part-time and temporary employees do not qualify for military leave compensation. Jury duty Although neither federal nor state law requires employers to pay employees for jury duty. and may elect to continue health-care benefits to the extent permitted by law. A copy of the court notice must be submitted to the employee’s manager to verify the need for such leave. however. 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. 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. 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. against an employee who is absent from work because of jury service. federal law prohibits employers from taking any adverse action. The employee is expected to report for work when doing so does not conflict with court obligations. 152 . The amount of the military leave compensation paid is the difference between military pay and regular pay based on a 40-hour workweek. As a measure of goodwill towards employees. employees who request a military leave of absence may elect to use any accrued vacation pay in lieu of unpaid leave. In addition. any requirements for receiving jury duty pay from the employer should be outlined in the policy. including discipline or discharge. besides the military leave benefits discussed above. during their leave of absence.

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

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

dol.html (see pages 157-201). The notice informs them about their extended COBRA election period and the availability of the subsidy.gov/ebsa/COBRAmodelnotice. This includes persons who never elected COBRA. These forms can be downloaded from www. and when those notices should be provided. For those employers utilizing an external health care administrator. 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 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. these notices may be provided by that administrator. 155 . (Note: Given the complexity of COBRA laws and regulations.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. employers are strongly encouraged to seek legal guidance on this law’s notice requirements. or who elected COBRA but subsequently discontinued it.

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. 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. NUMBER: _____________________ DATE OF BIRTH: ______________ If dependent. no coverage P Death of employee ADDITIONAL INFORMATION: ____________________________________________________ EMPLOYEE SIGNATURE:_________________________________________________________ Date Received:______________________________________ Date Entered: __________________ 156 .

To elect COBRA continuation coverage. [Add.] You do not have to send any payment with the Election Form. Please read the information contained in this notice very carefully. 157 . follow the instructions on the next page to complete the enclosed Election Form and submit it to us. 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. If you do not 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). if appropriate: You may elect any of the following options for COBRA continuation coverage: [list available coverage options].Employee benefits MODEL COBRA CONTINUATION COVERAGE (FOR USE BY SINGLE-EMPLOYER GROUP HEALTH PLANS) [Enter date of notice] Dear: [Identify the qualified beneficiary(ies). Important additional information about payment for COBRA continuation coverage is included in the pages following the Election Form. 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. which will continue group health care coverage under the Plan for up to ___ months [enter 18 or 36. COBRA continuation coverage will begin on [enter date] and can last until [enter date]. 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. as appropriate and check appropriate box or boxes.

Under federal law. complete this Election Form and return it to us. 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]. COBRA Continuation Coverage Election Form Instructions: To elect COBRA continuation coverage. If mailed. 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. However. your COBRA continuation coverage will begin on the date you furnish the completed Election Form. _________________________________________________________________________ [Add if appropriate: Coverage option elected: _______________________________] b. you must 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].Employee benefits If you have any questions about this notice or your rights to COBRA continuation coverage. _________________________________________________________________________ [Add if appropriate: Coverage option elected: _______________________________] c. you will lose your right to elect COBRA continuation coverage. if you change your mind after first rejecting COBRA continuation coverage. you should contact [enter name of party responsible for COBRA administration for the Plan. _________________________________________________________________________ [Add if appropriate: Coverage option elected: _______________________________] _____________________________________ Signature ______________________________________ Print Name ______________________________________ ______________________________________ ______________________________________ Print Address ______________________________ Telephone number _____________________________ Date _____________________________ Relationship to individual(s) listed above 158 . you may change your mind as long as you furnish a completed Election Form before the due date. with telephone number and address]. Read the important information about your rights included in the pages after the Election Form.

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

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

When and how must payment for COBRA continuation coverage be made? First payment for continuation coverage If you elect continuation coverage. you should take into account that you have special enrollment rights under federal law. you will lose all continuation coverage rights under the Plan. 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. TTD/TTY callers may call toll-free at 1-866-626-4282. 161 .doleta. you do not have to send any payment with the Election Form. including continuation coverage. eligible individuals can either take a tax credit or get advance payment of 65% of premiums paid for qualified health insurance. If you have questions about these new tax provisions. However.Employee benefits In considering whether to elect continuation coverage. 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. 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. (This is the date the Election Notice is post-marked. you may call the Health Coverage Tax Credit Customer Contact Center toll-free at 1-866-628-4282. You may contact [enter appropriate contact information. Second.g. More information about the Trade Act is also available at www. How much does COBRA continuation coverage cost? Generally. each qualified beneficiary may be required to pay the entire cost of continuation coverage..cfm. 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). and election of continuation coverage may help you not have such a gap. 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. 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. The amount a qualified beneficiary may be required to pay may not exceed 102 percent (or. you must make your first payment for continuation coverage not later than 45 days after the date of your election. 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. The required payment for each continuation coverage period for each option is described in this notice. [If employees might be eligible for trade adjustment assistance. you should take into account that a failure to continue your group health coverage will affect your future rights under federal law.gov/tradeact/2002act_index. First. Finally. You are responsible for making sure that the amount of your first payment is correct. in the case of an extension of continuation coverage due to a disability. Under the new tax provisions. e. the Plan Administrator or other party responsible for COBRA administration under the Plan] to confirm the correct amount of your first payment.

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

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

or both). Your spouse’s employment ends for any reason other than his or her gross misconduct. qualified beneficiaries who elect COBRA continuation coverage [choose and enter appropriate information: must pay or are not required to pay] for COBRA continuation coverage. This notice generally explains COBRA continuation coverage.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). Part B. you should review the Plan’s Summary Plan Description or contact the Plan Administrator. After a qualifying event. This notice contains important information about your right to COBRA continuation coverage. 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. or Your employment ends for any reason other than your gross misconduct. Your spouse’s hours of employment are reduced.” You. 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.” Specific qualifying events are listed later in this notice. 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. which is a temporary extension of coverage under the Plan. The right to COBRA continuation coverage was created by a 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. COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. If you are an employee. or You become divorced or legally separated from your spouse. the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). For additional information about your rights and obligations under the Plan and under federal law. 164 . Your spouse becomes entitled to Medicare benefits (under Part A. your spouse. COBRA continuation coverage must be offered to each person who is a “qualified beneficiary. and what you need to do to protect the right to receive it. when it may become available to you and your family. If you are the spouse of an employee. Under the Plan.

or both). the employer must notify the Plan Administrator of the qualifying event. add the following paragraph:] Sometimes. The parents become divorced or legally separated. and that bankruptcy results in the loss of coverage of any retired employee covered under the Plan. 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. [Add description of any additional Plan procedures for this notice. COBRA continuation coverage will be offered to each of the qualified beneficiaries. 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. and parents may elect COBRA continuation coverage on behalf of their children. When the qualifying event is the end of employment or reduction of hours of employment. Each qualified beneficiary will have an independent right to elect COBRA continuation coverage. 165 . If a proceeding in bankruptcy is filed with respect to [enter name of employer sponsoring the plan]. surviving spouse. Part B. You must provide this notice to: [Enter name of appropriate party]. The retired employee’s spouse.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. including a description of any required information or documentation. death of the employee. and dependent children will also become qualified beneficiaries if bankruptcy results in the loss of their coverage under the Plan. The parent-employee’s employment ends for any reason other than his or her gross misconduct. The parent-employee’s hours of employment are reduced.] or the employee’s becoming entitled to Medicare benefits (under Part A. Part B. or both). [add if Plan provides retiree health coverage: commencement of a proceeding in bankruptcy with respect to the employer. the retired employee will become a qualified beneficiary with respect to the bankruptcy.” [If the Plan provides retiree health coverage. filing a proceeding in bankruptcy under title 11 of the United States Code can be a qualifying event. 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. 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. 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).

or both). if a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates. 166 . the employee’s becoming entitled to Medicare benefits (under Part A. 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. When the qualifying event is the end of employment or reduction of the employee’s hours of employment. When the qualifying event is the death of the employee. COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare entitlement. you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage. 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. This extension may be available to the spouse and any dependent children receiving continuation coverage if the employee or former employee dies. 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. for a total maximum of 29 months. including a description of any required information or documentation. COBRA continuation coverage lasts for up to a total of 36 months. or a dependent child’s losing eligibility as a dependent child. for a maximum of 36 months. the name of the appropriate party to whom notice must be sent. There are two ways in which this 18-month period of COBRA continuation coverage can be extended. or both). Part B. becomes entitled to Medicare benefits (under Part A. COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. the spouse and dependent children in your family can get up to 18 additional months of COBRA continuation coverage. if notice of the second qualifying event is properly given to the Plan.Employee benefits COBRA continuation coverage is a temporary continuation of coverage. your divorce or legal separation.] 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. and the time period for giving notice. Otherwise. or if the dependent child stops being eligible under the Plan as a dependent child. For example. Part B. or gets divorced or legally separated. and the employee became entitled to Medicare benefits less than 18 months before the qualifying event. [Add description of any additional Plan procedures for this notice. COBRA continuation coverage generally lasts for only up to a total of 18 months. which is equal to 28 months after the date of the qualifying event (36 months minus 8 months).

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

and obligations and the “Application for Treatment as an Assistance Eligible Individual. reference the “Summary of the COBRA Premium Reduction Provisions under ARRA” with details regarding eligibility. To elect COBRA continuation coverage. 2009. To help determine whether you can get the ARRA premium reduction. In particular. 2008 and ends with December 31. Please read the information contained in this notice very carefully.) [Enter date of notice] Dear: [Identify the qualified beneficiary(ies).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 . follow the instructions on the following pages to complete the enclosed Election Form and submit it to us. complete the “Application for Treatment as an Assistance Eligible Individual” and return it with your completed Election Form. You are receiving this election notice because you experienced a loss of coverage that occurred during the period that begins with September 1. 2009 and you may be eligible for the temporary premium reduction for up to nine months. 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). you should read this notice and the attached documents carefully. 2008 and ends with December 31. The American Recovery and Reinvestment Act of 2009 (ARRA) reduces the COBRA premium in some cases.” If you believe you meet the criteria for the premium reduction. If you do not elect COBRA continuation coverage. restrictions.

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. vision coverage. If you have any questions about this notice or your rights to COBRA continuation coverage.] [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. 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]. complete the “Form for Switching COBRA Continuation Coverage Benefit Options” and return it to us. 169 . counseling coverage. a flexible spending arrangement (FSA). 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. you should contact [enter name of party responsible for COBRA administration for the Plan. including a health reimbursement arrangement that qualifies as an FSA. 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]. with telephone number and address].Employee benefits Each person (“qualified beneficiary”) in the category(ies) checked below is entitled to elect COBRA continuation coverage. COBRA continuation coverage will begin on [enter date] and can last until [enter date]. [Add. 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. be offered to active employees. as appropriate and check appropriate box or boxes. which will continue group health care coverage under the Plan for up to ___ months [enter 18 or 36. 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. You do not have to send any payment with the Election Form. and cannot be limited to only dental coverage.

Under federal law. complete this Election Form and return it to us. 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. _________________________________________________________________________ [Add if appropriate: Coverage option(s): _______________________________ _____________________________________ Signature ______________________________________ Print Name ______________________________________ ______________________________________ ______________________________________ Print Address _____________________________ Date _____________________________ Relationship to individual(s) listed above ______________________________ Telephone number 170 . you may change your mind as long as you furnish a completed Election Form before the due date. you will lose your right to elect COBRA continuation coverage. you have 60 days after the date of this notice to decide whether you want to elect COBRA continuation coverage under the Plan. _________________________________________________________________________ [Add if appropriate: Coverage option(s): _______________________________ c. if you change your mind after first rejecting COBRA continuation coverage. If you do not submit a completed Election Form by the due date shown above. your COBRA continuation coverage will begin on the date you furnish the completed Election Form. If you reject COBRA continuation coverage before the due date. However. If mailed.Employee benefits COBRA Continuation Coverage Election Form Instructions: To elect COBRA continuation coverage. _________________________________________________________________________ [Add if appropriate: Coverage option(s): _______________________________ b. 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]. it must be post-marked no later than [enter date].

it must be post-marked no later than [enter date]. 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 had on the last day of employment. *THIS IS NOT YOUR ELECTION NOTICE* YOU MUST SEPARATELY COMPLETE AND RETURN THE ELECTION NOTICE TO SECURE YOUR COBRA CONTINUATION COVERAGE. If mailed. _________________________________________________________________________ Old Coverage Option: ____________________________ New Coverage Option: __________________________ b. you have 90 days after the date of this notice to decide whether you want to switch benefit options. 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. _________________________________________________________________________ Old Coverage Option: ____________________________ New Coverage Option: __________________________ _____________________________________ Signature ______________________________________ Print Name ______________________________________ ______________________________________ ______________________________________ Print Address ______________________________ Telephone number 171 _____________________________ Date _____________________________ Relationship to individual(s) listed above . _________________________________________________________________________ Old Coverage Option: ____________________________ New Coverage Option: __________________________ c. 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]. 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.

divorce or legal separation. or the employer ceases to provide any group health plan for its employees. coverage may be continued for up to a total of 36 months. add the following three paragraphs:] 172 . “qualified beneficiaries” can include the employee (or retired employee) covered under the group health plan. In the case of losses of coverage due to an employee’s death. 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. Continuation coverage will be terminated before the end of the maximum period if: • • • • any required premium is not paid in full on time.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. 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. 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). When the qualifying event is the end of employment or reduction of the employee’s hours of employment. Depending on the type of qualifying event. Part B. and the employee became entitled to Medicare benefits less than 18 months before the qualifying event. a qualified beneficiary first becomes covered. Continuation coverage is the same coverage that the Plan gives to other participants or beneficiaries under the Plan who are not receiving continuation coverage. [If the maximum period shown on page 1 of this notice is less than 36 months. after electing continuation coverage. Each qualified beneficiary who elects continuation coverage will have the same rights under the Plan as other participants or beneficiaries covered under the Plan. and the dependent children of the covered employee. coverage generally may be continued only for up to a total of 18 months. under another group health plan that does not impose any preexisting condition exclusion for a preexisting condition of the qualified beneficiary. COBRA continuation coverage for qualified beneficiaries other than the employee lasts until 36 months after the date of Medicare entitlement. or both) after electing continuation coverage. This notice shows the maximum period of continuation coverage available to the qualified beneficiaries. including [add if applicable: open enrollment and] special enrollment rights. the covered employee’s spouse.

] Each qualified beneficiary who has elected continuation coverage will be entitled to the 11-month disability extension if one of them qualifies. The employee or the employee’s spouse can elect continuation coverage on behalf of all of the qualified beneficiaries. If the qualified beneficiary is determined to no longer be disabled under the SSA. the covered employee’s becoming entitled to Medicare benefits (under Part A. Continuation coverage may be elected for only one. Part B. 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. Failure to provide notice of a disability or second qualifying event may affect the right to extend the period of continuation coverage. You must notify the Plan within 60 days after a second qualifying event occurs if you want to extend your 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. 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. 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. Such second qualifying events may include the death of a covered employee. [Describe Plan provisions for requiring notice of disability determination. you should take into account that a failure to continue your group health coverage will affect your future rights under federal law. divorce or legal separation from the covered employee. or for all dependent children who are qualified beneficiaries. In considering whether to elect continuation coverage. 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. A parent may elect to continue coverage on behalf of any dependent children. several. First.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. The maximum amount of continuation coverage available when a second qualifying event occurs is 36 months. For example. 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. 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. you must notify the Plan of that fact within 30 days after that determination. and election of continuation 173 . the employee’s spouse may elect continuation coverage even if the employee does not. or a dependent child’s ceasing to be eligible for coverage as a dependent under the Plan. including time frames and procedures. or both). Each qualified beneficiary has a separate right to elect continuation coverage.

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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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complete the “Form for Switching COBRA Continuation Coverage Benefit Options” and return it to us. 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). or an on-site medical clinic.” If you believe you meet the criteria for the premium reduction. You are receiving this notice because you experienced a loss of coverage at some time on or after September 1. counseling coverage. ] 181 .” The different coverage must cost the same or less than the coverage the individual had at the time of the qualifying event. reference the “Summary of the COBRA Premium Reduction Provisions under ARRA” with details regarding eligibility. To help determine whether you can get the ARRA premium reduction. including a health reimbursement arrangement that qualifies as an FSA. Available coverage options are: [insert list of available coverage options]. and cannot be limited to only dental coverage. In particular. and obligations and the “Application for Treatment as an Assistance Eligible Individual.) [Enter date of notice] Dear: [Identify the qualified beneficiary(ies). 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. 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. The American Recovery and Reinvestment Act of 2009 (ARRA) reduces the COBRA premium in some cases. vision coverage. complete the “Application for Treatment as an Assistance Eligible Individual” and return it to us at [insert mailing address]. 2008 and chose to elect COBRA continuation coverage. [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. Please read the information contained in this notice very carefully. a flexible spending arrangement (FSA). be offered to active employees.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. 2008 to advise them of the availability of the premium reduction. restrictions. you should read this notice and the attached documents carefully.

If you qualify for the premium reduction. 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. This premium reduction is available for up to nine months. e. in the case of an extension of continuation coverage due to a disability. The amount a qualified beneficiary may be required to pay may not exceed 102 percent (or. See the attached “Summary of the COBRA Premium Reduction Provisions under ARRA” for more details. 2009. 2008 and ending with December 31. The required payment for each continuation coverage period for each option is described in this notice. eligible individuals can either take a tax credit or get advance payment of 65% of premiums paid for qualified health insurance. 182 . you will have to pay the full amount to continue your COBRA continuation coverage. including continuation coverage. If your COBRA continuation coverage lasts for more than nine months. All periodic payments for continuation coverage should be sent to: [enter appropriate payment address] You may contact [enter appropriate contact information.. restrictions. including an increase in the amount of the credit to 80% of premiums for coverage before January 1.] When and how must payment for COBRA continuation coverage be made? Other than the amount. 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. 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). [If employees might be eligible for trade adjustment assistance. 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. and obligations as well as the form necessary to establish eligibility.doleta. 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.gov/tradeact. ARRA made several amendments to these provisions. nothing else about the payment has changed.Employee benefits Important Information about Your COBRA Continuation Coverage Rights How much does COBRA continuation coverage cost? Generally. If you have questions about these provisions. More information about the Trade Act is also available at www.g. Under the tax provisions. you may call the Health Coverage Tax Credit Customer Contact Center toll-free at 1-866-628-4282. you need only pay 35 percent of the COBRA premium otherwise due to the plan. each qualified beneficiary may be required to pay the entire cost of continuation coverage. The American Recovery and Reinvestment Act of 2009 (ARRA) reduces the COBRA premium in some cases. TTD/TTY callers may call toll-free at 1866-626-4282.

183 . or from the Plan Administrator.gov/COBRAContinuationofCov/ or NewCobraRights@cms. Private sector employees seeking more information about rights under ERISA. with telephone number and address]. your rights to coverage. the Health Insurance Portability and Accountability Act (HIPAA). or if you want a copy of your summary plan description.hhs. 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. More information about continuation coverage and your rights under the Plan is available in your original COBRA election notice. and other laws affecting group health plans.gov. you should keep the Plan Administrator informed of any changes in your address and the addresses of family members.hhs. Department of Labor’s Employee Benefits Security Administration (EBSA) at 1-866-444-3272 or visit the EBSA website at www. you should contact [enter name of party responsible for COBRA administration for the Plan. You should also keep a copy.cms. can contact the U.dol. 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.S. If you have any questions concerning the information in this notice. the summary plan description.gov/ebsa. including COBRA.

complete this Form and return it to us. 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]. 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]. Under federal law. If mailed. _________________________________________________________________________ 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 184 .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 have. _________________________________________________________________________ Old Coverage Option:____________________________ New Coverage Option: __________________________ b. you have 90 days after the date of this notice to decide whether you want to switch benefit options.

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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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2008 through February 16. Failure to provide notice of a disability or second qualifying event may affect the right to extend the period of continuation coverage. The duration of the premium reduction is determined separately and may not last for the entire length of your COBRA coverage. Part B. a qualified beneficiary becomes entitled to Medicare benefits (under Part A. under another group health plan that does not impose any pre-existing condition exclusion for a pre-existing condition of the qualified beneficiary. How can you extend the length of COBRA continuation coverage? If you elect continuation coverage. you are not entitled to this second election period. Information about the amount of the premium reduction and how it affects your premium payments can be found below under the question. Am I eligible for the premium reduction? If you lost group health coverage from September 1. 2009 due to an involuntary termination of employment that occurred during that period. 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. after electing continuation coverage. 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. 2008 through February 16.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. “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. 193 . an extension of the maximum period of coverage may be available if a qualified beneficiary is disabled or a second qualifying event occurs. a qualified beneficiary becomes covered. or the employer ceases to provide any group health plan for its employees. 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. 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. or both) after electing continuation coverage. you are entitled to receive the premium reduction. are entitled to elect coverage at this time. 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). 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). 2009] and can generally continue for up to 18 months from the date of your involuntary termination of employment.

In considering whether to elect continuation coverage. 194 . including time frames and procedures. If you do elect continuation coverage under this additional election period. or for all dependent children who are qualified beneficiaries. You must notify the Plan within 60 days after a second qualifying event occurs if you want to extend your continuation coverage.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 has a separate right to elect continuation coverage. How can you elect COBRA continuation coverage? To elect continuation coverage. or both). The employee or the employee’s spouse can elect continuation coverage on behalf of all of the qualified beneficiaries. The maximum amount of continuation coverage available when a second qualifying event occurs is 36 months. Continuation coverage may be elected for only one. Second. or a dependent child’s ceasing to be eligible for coverage as a dependent under the Plan. For example. the covered employee’s becoming entitled to Medicare benefits (under Part A. First. you must notify the Plan of that fact within 30 days after that 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. divorce or separation from the covered employee. 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. and election of continuation coverage may help prevent such a gap. several. the employee’s spouse may elect continuation coverage even if the employee does not. Part B.] Each qualified beneficiary who has elected continuation coverage will be entitled to the 11-month disability extension if one of them qualifies. you must complete the Election Form and furnish it according to the directions on the form. A parent may elect to continue coverage on behalf of any dependent children. 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. 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. 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. Such second qualifying events may include the death of a covered employee. If the qualified beneficiary is determined to no longer be disabled under the SSA. 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. you should take into account that a failure to continue your group health coverage will affect your future rights under Federal law.

You are responsible for making sure that the amount of your first payment is correct. ARRA made several amendments to these provisions. 2008 and ending with December 31. you do not have to send any payment with the Election Form. See the attached “Summary of the COBRA Premium Reduction Provisions under ARRA” for more details. and obligations as well as the form necessary to establish eligibility. If you have questions about these provisions. including continuation coverage.Employee benefits How much does COBRA continuation coverage cost? Generally. If you qualify for the premium reduction. You may contact 195 . 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. 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. 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. (This is the date the Election Notice is post-marked.doleta. you will have to pay the full amount to continue your COBRA continuation coverage. 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 mailed. The required payment for each continuation coverage period for each option is described in this notice. each qualified beneficiary may be required to pay the entire cost of continuation coverage. restrictions. More information about the Trade Act is also available at www. including an increase in the amount of the credit to 80% of premiums for coverage before January 1.] When and how must payment for COBRA continuation coverage be made? First payment for continuation coverage If you elect continuation coverage. If your COBRA continuation coverage lasts for more than nine months. 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). TTD/TTY callers may call toll-free at 1866-626-4282. eligible individuals can either take a tax credit or get advance payment of 65% of premiums paid for qualified health insurance. [If employees might be eligible for trade adjustment assistance. Under the tax provisions. you will lose all continuation coverage rights under the Plan. you must make your first payment for continuation coverage not later than 45 days after the date of your election. The amount a qualified beneficiary may be required to pay may not exceed 102 percent (or. However. This premium reduction is available for up to nine months.) If you do not make your first payment for continuation coverage in full not later than 45 days after the date of your election. in the case of an extension of continuation coverage due to a disability. 2009.gov/tradeact. you need only pay 35 percent of the COBRA premium otherwise due to the plan.

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

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

Employee benefits 198 .

Employee benefits 199 .

Employee benefits 200 .

Employee benefits 201 .

As in the case of health insurance. 202 . reference should be made to the plan documents for the details of coverage. 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. This coverage applies to any disability that prevents the employee from working for more than 90 days.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). full-time employees who have worked for the Company for at least one year. The Company pays the cost of coverage for this benefit. 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. the Company pays 60 percent of the employee’s regular compensation for each week the employee is disabled. Part-time employees are not eligible for long-term disability coverage.Employee benefits Short. SAMPLE POLICY Long-term Disability Plan ABC Company provides long-term disability insurance for all of its regular. after a waiting period of five working days. 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. Part-time employees are not eligible for short-term disability coverage. full-time employees. to a maximum of 90 days. Those documents govern all issues relating to the long-term disability insurance. Under this plan. 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. To maintain eligibility for benefits. The Company pays the full cost of this benefit.

The Company also may make additional profit-sharing contributions to the plan in its discretion. Employers who do provide the benefit should make reference to the plan’s availability and that it is governed by the plan documents. Most plans reimburse the employee at the conclusion of the course if it is successfully completed and related to the employee’s job. because education programs encourage employees to obtain additional skills and knowledge in their respective fields of specialization. The terms of the plan and eligibility requirements are set out in the written plan document and summary plan description issued to employees. Most employers offering a 401k plan utilize an external plan administrator for the plan. Employers should not attempt to include all the provisions of the 401k plan in a handbook. however. Some employers choose to do so. and the payments are recorded in employer’s books or records. employees may elect to make contributions to the plan through salary deferral. up to two percent of that employee’s compensation. A sample policy is provided below. Employers should. 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. If tuition costs are advanced. Continuing education Employers are not obligated to reimburse employees for continuing education. deductions from an employee’s pay may occur if the employee authorizes the deduction in writing. Under Oregon law. The Company may make matching contributions in an amount equal to one-third of each employee’s salary deferral. 203 . Employees should be given – and referred to – the plan documents for complete information regarding the benefit. however. Under the plan. SAMPLE POLICY ABC Company sponsors a 401(k) profit-sharing plan for all eligible employees. 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. Any tuition reimbursement program should be in writing and contain the requirements for receiving reimbursement. also obtain the employee’s express written consent to deduct 401k contributions from the paycheck for deposit into the 401k account. the deduction is for the employee benefit. Employees must be compensated for time spent attending mandatory on-the-job training programs or seminars. 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.

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

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

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. minors must receive paid. 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. employees must still be provided with adequate time to consume a meal.gov/BOLI/WHD/docs/WH-161S. nature or structure of the employer’s business. 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. Under the new rule. to rest. As used in the revised meal period rule.oregon. this is in addition to all rest periods required by rule for the number of hours worked on any given shift. 2009.gov/BOLI/WHD/docs/WH-161. Effective January 12.pdf (a Spanish version can be found at: www. uninterrupted rest breaks of at least 15 minutes for each four-hour segment worked. 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. In addition. Minors must receive at least a 30-minute meal period no later than five hours and one minute after beginning work. Oregon employers became obligated to follow new state administrative rules regarding meal periods and rest breaks. In addition.” 206 . Specifically. unpaid meal period where the employee is relieved of all duties would impose an undue hardship on the operation of the employer’s business. undue hardship means: “significant difficulty or expense when considered in relation to the size.pdf ).Hours of work and overtime employee may take per shift worked is included. and to use the restroom and must be paid for this time. 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.oregon. and would need to be modified to specify the meal and break periods unique to minors. A copy of the notice is included at the end of this chapter and can be downloaded from: www. Note that this policy does not address the break laws applicable to minors. financial resources.

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

rest. There are some exceptions to this requirement.oregon. 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. and use the restroom.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.pdf).oregon. Employers claiming an undue hardship exception must still provide employees with adequate time to consume a meal.pdf (Spanish) or upon request from any BOLI office. 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. The required notices are available at www.gov/BOLI/WHD/docs/WH-161. In addition.oregon. and employees must be paid for this time.gov/BOLI/LEGAL/docs/Meal_and_Rest_ Periods_Final_Rule_January2009. effective March 16. 2009.Hours of work and overtime “UNDUE HARDSHIP” NOTICE TO EMPLOYEES REGARDING MEAL AND REST PERIODS Pursuant to OAR 839-020-0050 (www. 208 . 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.pdf (English) and www.

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

See the form at the end of this chapter. 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.pdf New hires may not seek a waiver until they have worked seven calendar days. must pay the employee for the usual 10-minute break period (leaving the other 20 minutes unpaid). 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. up to and including termination. and that employees who waive their meal periods and do not sign waiver forms will be subjected to discipline. however. 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.Hours of work and overtime Restaurant and beverage service industries Beginning January 1st 2008. 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. 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. however. ORS 653. and they are not required to provide employees with an additional ten-minute paid rest break in addition to the 30-minute period – employers. Employers are not required to pay the employee for the full 30-minute rest period. This translates into no less than 30 minutes during each four-hour work period. in close proximity to the employee’s work station.oregon. 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. or download the form from: www. The waiver. where the employee may express milk concealed from view and without intrusion by other employees or the public. other than a public restroom or toilet stall. Further. An employer subject to the breast milk break law. a 30-minute break is mandatory and can not be waived. BOLI states that a “private location” is “a place.077. 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. If the employee works 8 hours or more. paid. 10-minute break periods for work shifts of 4 hours or more.

These rest periods shall. if feasible.). if one is offered to other employees for the storage of food. 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. SAMPLE POLICY Nursing mothers may take a thirty-minute rest period to express milk during each four-hour work period. Finally.Hours of work and overtime • • conference room storage space. 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. 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. 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. beverages. be taken at the same time as rest periods that are otherwise provided to the employee. 211 . etc.

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

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

it generally will be assigned in order of seniority to the employees who regularly perform the particular work involved.Hours of work and overtime not excuse the employer from paying the employee for that time. 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. or a holiday. 214 .) will not be counted toward the 40 per workweek required to receive overtime pay. holidays. Limitation on Overtime Pay Overtime pay (premium rates) shall not be paid twice for the same hours (pyramiding). Any violations of this policy shall subject the offending employee to discipline under the Company’s progressive discipline policy. There is no requirement under the law to pay employees “double time” under any situation. 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. Supervisor Authorization No overtime may be worked by (non-exempt) employees unless specifically authorized by supervision or management. 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. etc. Sunday. When overtime work is assigned by the Company on a Saturday. 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. The following sample policy includes a double time provision for illustrative purposes only. Non-exempt employees are those who work in positions for which an overtime premium must be paid under the Fair Labor Standards Act. Paid hours not actually worked (for example. Double Time The Company pays two times a non-exempt employee’s hourly rate for all hours worked on any Company-designated holiday. vacation. Sunday. When overtime is required by the Company on a Sunday or on a holiday. or holiday. the employee will be subject to discipline under the employer’s policy.

and a salary change recommendation form. BOLI. This chapter also includes a sample employee payroll change notice. according to BOLI. both of which may fall under Oregon’s “personnel records” statute. Under Oregon law. “an employer and an employee may agree to authorize an employer” to pay wages due to the employee by direct deposit. 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. 215 . The law states that a final paycheck may be paid by direct deposit “provided the employee and the employer have agreed to such 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). Neither the law nor BOLI explicitly prohibit employers from requiring all new hires to use direct deposit. however. Employers who use direct deposit should be mindful of the following: • • • the law requires that any direct deposit of wages be “without discount. In other words. The attached sample payroll direct deposit form is for illustrative purposes only. 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. an employer.Hours of work and overtime Direct deposit Oregon law does not clearly specify whether an employer may require all employees to use direct deposit.” 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. 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.

216 . (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 PAYROLL DIRECT DEPOSIT FORM DATE: (Employee’s Name) I hereby authorize the payroll direct deposit actions described below.

: Employee No.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 .

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 .

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

Hours of work and overtime 220 .

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

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

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

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

Employee’s significant weak points: C. Development of future potential: If applicable. Employee’s significant strong points: B.Performance reviews. 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. E. SUMMARY COMMENTS A. 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. promotion and layoff III. Overall Assessment of employee’s performance 225 . Necessary improvements: D.

***THE COMPANY IS AN AT-WILL EMPLOYER. promotion and layoff V.*** 226 . THE RATINGS REFLECTED BY THIS FORM DO NOT ALTER THE PARTIES’ AT-WILL RELATIONSHIP. MEANING THAT EITHER THE COMPANY OR EMPLOYEE CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON. EMPLOYEE COMMENTS Employee Comments: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ VI.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.

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.Performance reviews. coaching. Consider the major responsibilities or objectives for the period being reviewed. cost/profit consciousness. etc. affirmative action. ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 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. and behaviors demonstrating commitment to and an awareness of the regulated aspects of the job (safety. environmental concerns. delegating.) COMMENT: 227 . 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.

etc. working with appropriate resources. COMMENT: DEVELOPMENT PLAN Please indicate career/development plans discussed with employee. program/seminar titles. Be sure to include any program/seminar titles. dates. Consider ability to observe and remain alert to changing conditions that affect the work. dates. peers or subordinates to be persuasive. PARTICULAR STRENGTHS: AREAS NEEDING ATTENTION: CAREER/DEVELOPMENT PLAN Indicate career/development plans discussed with employee. 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. PARTICULAR STRENGTHS: AREAS NEEDING ATTENTION: 228 . Be sure to include any special project responsibility.Performance reviews. creativity and balanced judgment. 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. etc. and taking initiative and demonstrating innovation.

and note supporting comments.Performance reviews. promotion and layoff OVERALL EVALUATION OF PERFORMANCE: Considering both the performance against objectives and the evaluations given on the section of Factors Affecting Performance. please indicate by checking the appropriate box your overall appraisal of this individual’s contribution. 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 .

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. Meets performance standards of the job. Improvement is necessary. G – Good – Competent and dependable level of performance. thorough and neat. U – Unsatisfactory – Results are generally unacceptable and require immediate improvement. Supportive Details or Comments Points Points 230 . 2. 3. Points will be totaled and averaged for an overall performance score. 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. Performance is of high quality and is achieved on a consistent basis. Job Knowledge – The extent to which an employee possesses the practical/technical knowledge required on the job. General Factors 1. Quality – The extent to which an employee’s work is accurate. Indicate N/A if not applicable. N/A – Not Applicable or too soon to rate. Check rating box to indicate the employee’s performance. No merit increase should be granted to individuals with this rating. Definitions of Performance Ratings O – Outstanding – Performance is exceptional in all areas and is recognizable as being far superior to others. V – Very Good – Results clearly exceed most position requirements.Performance reviews. Productivity – The extent to which an employee produces a significant volume of work efficiently in a specified period of time. Assign points for each rating within the scale and write that number in the corresponding points box.

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

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

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

This performance evaluation should be discussed with each employee. Shows initiative. ATTENDANCE. administration. etc. 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. This evaluation will also be used in selecting qualified individuals for further assignments and in administering an equitable compensation program. Cooperation with others. promotion and layoff EXPECTATION CATEGORY BELOW INTERPERSONAL RELATIONSHIPS. does not waste time when he/she could assist others. 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. Interacts well with coworkers. 234 . tactfulness. Staff member is a team player.) DO NOT CONSIDER ABSENCES COVERED BY THE FAMILY & MEDICAL LEAVE ACT OR OTHER APPLICABLE FEDERAL OR STATE LAW. and coworkers.Performance reviews. Cooperation is given fully. Exhibits a positive attitude towards firm. breaks. tardiness. Conscientious about attendance and punctuality (sick leave. ability to get along with co-workers and superiors. ABOVE AT ATTITUDE. Your ratings and comments should be kept as objective as possible. Please note that “at expectation” completely describes satisfactory performance.

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

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

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

If possible.Performance reviews. SAMPLE POLICY Under some circumstances. though not provided. ABC Company may need to restructure its operations or reduce its workforce. employers should consider consulting with legal counsel prior to any layoff. If an employee on layoff has fulfilled the orientation period requirements at the time of layoff. past performance. and attendance of those involved. Information concerning employee rights under COBRA is available from the Human Resources Department. the terms of which will be governed by the actual group insurance contract in effect at the time the employee returns to work. 238 . This rule does not apply to the group insurance plan. When workload increases to the extent that additional employees are needed. employees subject to layoff will be informed of the nature of the layoff and the foreseeable duration of the layoff. the Company will consider. All Company benefits will terminate 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. benefits and time of service will be fully reinstated on the date of return to work. 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. In determining which employees will be subject to layoff. the Company may recall individuals according to these same selection criteria. promotion and layoff Because of the legal requirements of WARN and the potential for litigation associated with any layoff. productivity. Insurance coverage. operational requirements. among other things. whether short-term or indefinite. the skill. will remain available under the provisions of COBRA.

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

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

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

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

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

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

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.Confidentiality and conflicts of interest Social security numbers Employees are often asked for their social security numbers in the employment context. More and more. and personnel action forms. a few states have already adopted legislation prohibiting such use of social security numbers. health insurance forms. Indeed. 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. including social security numbers and health information. 245 . only the last four digits can be printed on any document mailed or transmitted to the employee (with the exception of tax reporting documents. When discarding old personnel files or other information that may contain private employee information. at most. including pay stubs. of course). employers should take measures to ensure that the documents are actually destroyed (burned or shredded) and not simply discarded. many employers rely upon social security numbers as a de facto “employee identification number” used throughout the employment relationship. Accordingly. and requiring that if social security numbers are used.

Confidentiality and conflicts of interest 246 .

discover. threaten. 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]. participate in. The Sarbanes-Oxley Act created whistleblower protections for employees of publicly traded companies.Chapter 12 Complaint-reporting procedures In addition to the complaint reporting procedure available to employees with complaints about harassment (discussed in Chapter 6. contractor. employee. an employee handbook should also contain a complaint reporting procedure to address other work-related complaints. 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. Such a procedure can be as simple as an “open door policy” or as detailed as a formalized complaint process. EEO policies). suspend. or agent” of such company may not “demote. 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 . and provides that a publicly traded company or any “officer. subcontractor. or any provision of Federal law relating to fraud against shareholders. sample complaint reporting procedures are included in this chapter. harass. cause information to be provided. 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. cause to be filed. or terminate misconduct) or • to file. 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. testify.

Further. working conditions. employers may not take any kind of retaliatory conduct. under the Act.Complaint-reporting procedures [federal securities law or the SEC rules and regulations]. 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. or harass. quits. because the employer can show it was open and receptive to employee complaints. an Oregon employer may still wish to include a separate complaint reporting procedure in its handbook that covers all work-related issues. If an employee fails to take advantage of internal grievance procedures. 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. due to its including in the agreement. An employer’s inclusion of a complaint-reporting procedure in its employee handbook may assist Oregon employers in defending against Sarbanes-Oxley complaints. 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. or overtime compliance. and then attempts to initiate litigation. may very likely be used against the employee during the lawsuit). regardless of whether the issue is discrimination. 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 employer who does not include a complaint-reporting procedure in its handbook could be viewed as intolerant of whistleblowers. Thus. Further. 248 . or any provision of Federal law relating to fraud against shareholders. Because grievance procedures in a collective bargaining agreement typically place limits on what may be grieved. Note that employers with employees subject to a collective bargaining agreement may already have a grievance procedure in place. such as a written complaint.

If the problem is not satisfactorily resolved or the problem is with the supervisor. Not all complaints can be resolved to everyone’s satisfaction. penalize you. the employee should discuss it with his or her immediate supervisor as soon as possible. at any time. No one may criticize you. If an employee has a problem or complaint. 249 . in each case.Complaint-reporting procedures SAMPLE POLICY (Option 1) Problem-Solving Procedure ABC Company is concerned with any situation affecting the employment relationship. However. to discuss and/or provide assistance on any complaint. Also. Therefore. the employee then has the right to discuss it with the Human Resources manager. Human Resources personnel are available. The Company is committed to correcting any condition or situation that may cause unfairness or misunderstanding. or concern that an employee may have. In the event the problem still has not been satisfactorily resolved. If the problem still is not satisfactorily resolved. The Human Resources manager will assist the employee (if requested) in the presentation of the problem to the president. the employee has the right to discuss it with his or her department manager. the reason for the decision will be clearly explained to the employee. the employee has the right to discuss it with the president of the Company for a final resolution. 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. It is inevitable that problems and misunderstandings may occur. or treat you differently in any way for using this procedure. problem.

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

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. 251 . The president’s decision on any grievance or complaint will be final. or treat you differently in any way for using this fair treatment procedure. within 24 hours of his of her return. but you are encouraged to follow the procedure as set forth in the First. This procedure is not intended to prevent you from discussing any matter with any level of management. and Third Steps of this policy. Second. or if he or she is away from Company premises on business. including the president. Employees are encouraged to express their ideas and suggestions. No Recrimination Statement No one may criticize you. penalize you. ABC Company is also interested in employees’ constructive ideas and suggestions for improving our business. at any time. 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 The president will give you an answer within 24 hours of the discussion.

Complaint-reporting procedures 252 .

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

Failure to do so could result in penalties or other fines. If your company is audited. employers should assess every request for records on an individualized basis. upon request. once a document becomes part of an employee’s “personnel records”. as there may be some strategic reasons for producing documents that fall outside of the definition of “personnel records. 254 . 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). 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. Records relating to a leave of absence are not required to be produced.” 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. Regardless. and possibly consult with legal counsel. and by keeping the “personnel records” in a safe place with limited access (such as a locked filing cabinet).” If an employee requests a “certified” copy of his or her “personnel records.Personnel records and recordkeeping requirements • I-9 Forms. 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.” no formal or legal certification of the records is required. leave it there. Finally. Employers may charge employees a reasonable photocopying fee. 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). Employee access to personnel records Oregon law requires employers to provide an employee with the opportunity. either. employers should not produce records regarding any other employee to a former employee or his or her attorney. to view or receive a copy of his or her “personnel records” within 45 days of receiving an employee’s request. an employee is not entitled to receive copies of his or her payroll records. Further. It is not advisable to remove documents once they are made part of an employee’s official record. In the absence of a subpoena. an employer is not required to produce every record relating to an employee. it is not advisable to allow employees the opportunity to “correct” any documents contained in his or her “personnel records. In addition. simply because the employee or his or her attorney request it (unless a valid subpoena accompanies it). Record review policies In Oregon. For example. Because the definition of “personnel records” is somewhat narrow. an employer has a legal obligation to permit an employee to examine his or her employment records. The sample policy provides a good example of a means to allow employees such access to their employment files. and the Immigration and Naturalization Service (INS) asks to see your I-9 forms.

4. the employee’s supervisor or manager.20 per page copied. and to maintain employee privacy. 3. promotion. disciplinary notices or warnings or other terms and conditions of employment at any reasonable non-working time during regular business hours. An employee’s records may be examined only by the employee. or those supervisory personnel with a legitimate need to know. 5. or an employee’s personnel file. Employees may receive copies of any documents in their file at a cost of $. performance evaluations. 255 . 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. Records may be examined by appointment and prior arrangement with your supervisor and the Human Resources department. even temporarily.Personnel records and recordkeeping requirements From a legal standpoint. Employee will not be paid for the time spent reviewing pay records. so employees should make arrangements to view such records during non-working hours and during regular business hours. 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. Employees seeking additional information about their employment history or records should consult with the Human Resources Department. records may be examined only in accordance with the following safeguards: 1. 2. 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 the Human Resources office and in the presence of a designated Company representative. No record may be removed from the Human Resources office. Arrangements for Examination of Records For the protection of all. 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. discipline.

to simplify matters and to avoid mistakes. The employee may be required to execute a release before the Company will disclose certain information to third parties. 256 . Records relating to discrimination claims. That statement will become a permanent part of the employee’s personnel file. 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. and court interpretations of those laws. Copies of all medical records. 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). Thus. exposure records. If you wish to have any other person see your medical records. require Oregon employers to maintain various personnel and employment-related records for particular periods of time. exposure records. it is recommended that Oregon employers retain these records for three years. and the minimum recordkeeping periods for each. Some of the primary record retention periods. Although some of the statutes listed provide for a one-year statutes of limitations. and analysis prepared from such records. Oregon employers should generally keep personnel records for a period of three years. Recommended recordkeeping periods for employment records Various state and federal laws. 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.Personnel records and recordkeeping requirements Employee Recourse If an employee disagrees with any of the information in his or her file or records. signed statement to the Human Resources department. and each analysis produced from the records may be obtained upon request to the Human Resources department. are described below. With respect to the documents described in the box entitled. some of the other statutes provide for a three-year statutes of limitations. then the employee may explain his or her position by submitting a written. you must execute a written authorization on a specific form available upon request from the Human Resources department.

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

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

whichever is later. including a copy of the EEO-1 Form submitted (whether electronically or in paper format) Retention period While current. Includes records relating to an employee’s COBRA rights. Notes Immigration records Type of records I-9 Forms Retention period Full term of employment. 3 years after date of hire or 1 year after employee termination.Personnel records and recordkeeping requirements Affirmative action information Type of records Information necessary to complete EEO-1 Form. Retention period 6 years. summary plan descriptions. Notes 259 . 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. Different retention laws apply to covered federal contractors. depending on the number of employees employed. Notes Employee benefits records Type of records Employee benefit plans.

including contracts for the payment of wages. 1-5 years. 260 . Drug test results for transportation employees. Indefinitely Notes Indefinitely 6 years. Retention period Term of employee’s employment. 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. printouts from consumer reporting agencies – all used for employment decisions.Personnel records and recordkeeping requirements Miscellaneous records Type of records Background checks.

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

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 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.

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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Miscellaneous issues

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

because we regularly do business with a wide variety of people of all ages. it is essential that all employees dress in a manner that communicates professionalism and respect. 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. affect an employer’s ability to impose a dress code based on traditional gender considerations. Although Oregon’s relatively new law prohibiting discrimination on the basis of sexual orientation can. if they choose. It is obviously helpful to include such dress code requirements in the employer’s written policies. the expressly permits employers to enforce an otherwise valid dress code or policy. 269 . for reasonable accommodation of an individual based on the health and safety needs of the individual. Cell phone usage. as long as the employer provides. up to and including termination. The sample policy might be better suited to office personnel in a retail sales business than production workers in a manufacturing concern. endless details regarding wardrobe are considered unnecessary. Violators of this policy may be subject to discipline. Further. PROFESSIONAL APPEARANCE We pride ourselves on hiring and retaining exceptional staff in all areas of our business. Employers also may. See also page 87. Any such policy should be drafted with attention to the particular employer’s needs and facilities. Questions about this topic can be addressed to the Human Resources Director. and professions. Employees who report to work inappropriately dressed may be sent home to change. in some circumstances. Keep in mind that clothing with inappropriate content may violate the Company’s anti-harassment policy. any visual displays of undergarments (or the absence thereof) would be inappropriate. on a case-by-case basis. As such.Miscellaneous issues Dress codes Many employers have a specific dress code that employees are required to follow. charge employees a reasonable cost to purchase company-provided uniforms. backgrounds. But. 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. Failure to abide by the policy may subject the employee to the employer’s discipline policy.

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

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

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

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

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

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

If you decide to translate your handbook.” Further. 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). simply adding an arbitration provision to an employee handbook will not likely be enforceable under the new laws. you should consider translating your employee handbook into the other predominant language(s) used in your workplace. Because of a new Oregon law. however. Providing access to employee handbooks in electronic format Neither federal nor state law dictates how an employee handbook should be distributed. 2008. and some make the handbook 276 . Some employers choose to distribute paper copies of employee handbooks. • Thus. etc.). 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.Miscellaneous issues Arbitration agreements Some older employee handbooks included arbitration agreements. but will not be enforced unless entered into at the time of a “bona fide advancement” (promotion. Consult with legal counsel or other human resources professionals to find an appropriate translator. 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. 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. This precautionary measure may assist employers who defend against employment lawsuits filed by current or former. 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. or in what format. In sum. arbitration agreements entered into between employers and employees after January 1. whereby employees and employers agreed to arbitrate any disputes arising out of the employment relationship (in lieu of engaging in costly litigation). Agreements to arbitrate claims or disputes may be presented to current employees. some provide one central copy that is accessible to all employees. 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.

277 .Miscellaneous issues available electronically. Employees who use their own vehicles are reimbursed by the Company on a mileage basis. Be insurable by the Company’s auto insurer. Acknowledgment-of-receipt of handbook) is accurately recorded and maintained in the employee’s personnel file. it is strongly recommended that your handbook includes a policy regarding the use of such vehicles. Please consult the Human Resources for more information. Have proof of valid automobile liability insurance. Company vehicles are to be used only for company business. 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. or using a particular size of paper. and provide the Company with updates as issued. Oregon employers who ask their employees to use personal vehicles for business use should also consider having a policy. 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. Regardless of what approach your company takes. • • This requirement extends to employees who travel on behalf of the company. Company and personal vehicles If your company provides vehicles for employee use during business hours or for businessrelated reasons. such as through an intranet. and provide the Company with updates as issued. 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. or otherwise conduct company business via automobile. Again. lease vehicles. and other factors. what may work best for one company may not be ideal for another. please make sure the acknowledgement-of-receipt form presented to each employee for his or her signature (discussed in Chapter 16. No Employee can use a company vehicle for personal use unless given prior approval from the Chief Operating Officer. The handbook need not be printed on a certain type of paper. company resources.

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

NEVER plead guilty to any violation of the law in connection with an accident. if at all possible. unless advised to do so by the company representative. Automobile accidents resulting in injury or vehicle damage to any party may be the primary responsibility of the employee driving the vehicle . 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. NEVER offer to settle any claim or damages regardless of the circumstances or apparent smallness of the claim. the goal should be to drive without ever having an accident. take these steps to protect yourself and the interest of the Company: • • Stop immediately. 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. Report ALL ACCIDENTS TO THE DIRECTOR OF ADMINISTRATION IMMEDIATELY. 279 . Take positive action to prevent being involved in the “other drivers” errors. should you be involved in an accident. and vehicle license number. Render all possible assistance to injured persons. • • • • • • • • • 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. Movement of an injured person should be avoided since this often compounds the injury.Miscellaneous issues What to do in Case of an Accident As a Company driver. company name and address. Call the police if necessary. However. Complete the proper accident report immediately. Avoid moving the vehicles until the police arrive. Take the necessary precautions to prevent any further accident by placing the proper warning devices. license number.

Miscellaneous issues 280 .

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

extended a loan to an employee. excluding weekends and holidays. assuming a written agreement is not in place). for example. It is required by Oregon law to pay a departing employee’s final paycheck on time. 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 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 refuses to pay. or on the next regular payday. it is important to not use an employee’s final paycheck to make any unauthorized or unlawful deductions. If your company. excluding weekends and holidays. 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. 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. the final check is due on the final day worked. the check is due on the next business day) if an employee is discharged. for example) deductions authorized by a collective bargaining agreement a deduction from a final paycheck for a cash loan to an employee. 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 by the end of the following business day. 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. whichever comes first if an employee quits with notice of at least 48 hours. whichever is less. 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. 282 . Oregon law recognizes five categories of lawful payroll deductions: • • • • • deductions required by law (for example.Termination of employment • Finally. 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. and the employee has not yet paid the company back by his last day of employment. • • • Further. unless the last day falls on a weekend or holiday (in that case. the paycheck is due within five days. as in the case of discharge. Under Oregon law.

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

( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) Yes No ( ) ( ) ( ) ( ) ( ( ( ( ( ) ) ) ) ) ( ( ( ( ( ) ) ) ) ) Human Resources Manager/Date:____________________________________ 284 .Termination of employment EXIT CHECKLIST Name Employee No. Catalogs.  Quit  Discharge  Transfer  Layoff  LOA Date of Termination Department Other (Explain) Item Returned Tools & Equipment ( ) Personal Protective Equipment ( ) Manuals. 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.

What is employee’s attitude towards company pay policies. 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. 3. 8. COBRA Rights/Documents:  Yes Who is employee’s new employer? Interviewer’s comments:  No Interviewer/Date: 285 . 12. 4. benefits. and working conditions? 10. 11. Employee Name: Employee Number: Hire Date: Employee Forwarding Address: 5. 9. 6.Termination of employment EMPLOYEE EXIT INTERVIEW 1. 2.

Termination of employment EXIT INTERVIEW Dept.________ Employee No. working environment. Why are you leaving? ______________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Were you satisfied with: Your Job? (fit with interest and abilities. competence.) _____________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Supervision & Management? (fairness. etc._________________ Shift________________ Name:_____________________ Employee No. etc. etc. please attach Is written resignation attached for voluntary separation?  Yes same. work load.) ______________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 286 . supportiveness.)___________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Company Policies & Practices? (fairness. opportunities. _____________________ 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.

) ________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 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. what? _______________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Do you plan to return to work at the company?  Yes  No If Yes. etc. 287 . working environment.Termination of employment Salary & Employee Benefits? (fairness.  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. 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.

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

Name:______________________________________ Supervisor: __________________________ Date of Separation: ________________________________________________________________ 1. What did you enjoy most about working at {Company Name}? ____________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 3. What is your opinion of your supervisor?_______________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 5. What did you enjoy least about working at {Company Name}? _____________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 4. What is your overall opinion of {Company Name} as a place to work? _______________ __________________________________________________________________________ __________________________________________________________________________ 2. please return in the envelope provided.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}. What suggestions do you have for improving {Company Name} as a place to work? ________________________________________________________________________ ________________________________________________________________________ 7. _______________________________________________________ Other Comments: ________________________________________________________________________ ________________________________________________________________________ Employee Signature Date 289 . Once completed. Rate the following: Work Environment Benefits Compensation Performance Review Good ____ ____ ____ ____ Fair ____ ____ ____ ____ Poor ____ ____ ____ ____ 6.

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

that time should be granted. 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. legally required policies (such as anti-harassment policies). 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. The acknowledgment-of-receipt form should be read and signed by each employee upon receipt of the handbook. of the employer’s policies. when new policies are released or to acknowledge significant changes to certain. 291 .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. such as the policies prohibiting discrimination and harassment. it may be a violation of the National Labor Relations Act (NLRA) to compel an employee to sign the acknowledgment form in such circumstances. New acknowledgment-of-receipt forms should be signed by employees when a new employee handbook is released. typically on the employee’s first day of employment. please consult legal counsel to make sure that the policy and overall handbook complies with the law. WARNING: If the handbook contains a union-free policy. The signed acknowledgement form should be retained in the employee’s personnel file. 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. or should have been aware. If the employee would like additional time to review the written policies and procedures. Some policies should even be separately acknowledged. An employee’s express acknowledgement can be an important piece of evidence in litigation to show that the employee was aware.

A copy will be provided to the Employee upon request. the Human Resources Department. retaliation or harassment to my supervisor. I understand that the Company has adopted the Personnel Policies [use title of handbook] only as a general guide about policies. and with or without advance notice. 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 understand that the Company complies with all applicable laws regarding equal employment opportunity and provides a workplace free from unlawful harassment and discrimination. I will bring any questions or concerns I have regarding equal employment opportunities. I have read this acknowledgement carefully before signing. discrimination. During my employment with the Company. or any trusted manager or supervisor. with or without cause. 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. I also understand that the Personnel Policies [use title of handbook] control over any other contradictory statements. work rules and the work environment. for any or no reason. I acknowledge that no promises have been made to me that are inconsistent with this “at-will” statement. updates and new polices as issued.].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 either the Company or I may terminate my employment relationship at any time. ______________________________________________ Employee Signature _________________ Date The original of this document will be kept in the Employee’s personnel file in the Human Resources Department. and that they are subject to change at any time in the Company’s sole discretion. 292 . I understand that it is my responsibility to remain informed about the policies as revisions.

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

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

Posting requirements 295 .

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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. it applies to an enterprise with an annual dollar volume higher than $500. consult further in the book for an explanation of those other requirements. If the number places your business on the borderline.Appendix B Compliance thresholds The following list does not include all federal and Oregon employment laws. or other entity that pays salary or wages for work performed. 6 305 . that coverage for some of the laws also depends on requirements other than the number of employees. sex. such as whistleblowers. color. Also prohibits Oregon employers from discriminating against other protected classes. association with someone in a protected class. Covers race. and the like. or that has control over employment opportunities. but it does provide a snapshot view of how many employees an employer must have to be covered by these most significant laws. an expunged juvenile record. organization. marital status. religion. age (18 years of age or older). 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. Alternatively. institution.000. sexual orientation. national origin. Remember. however. lawful users of tobacco products during off hours. recipients of unemployment benefits.

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.” 25 25 Oregon Family Leave Act 306 . 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.” Employers with 100 or more employees must annually file EEO1 survey.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. or in the year immediately preceding the year in which the rest periods are to be taken. or in the year immediately preceding the year in which leave is taken. 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. 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. 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.

000 or more. Also requires annual filing of VETS-100 report. 50 Family Medical Leave Act 50 Rehabilitation Act of 1973 50 Vietnam Era Veterans Readjustment Assistance Act of 1974 (Federal) 307 .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. and have contracts worth at least $50. Contractors who employ 50 or more persons. Employers with federal government contracts worth $25. Contractors who employ 50 or more persons.000 or more.000 must implement a written affirmative action plan.000 or more ($100. 2003).Compliance thresholds Minimum employees 50 Law Executive Order 11246 (Federal) Notes Employers with federal government contracts worth $10.000 must implement a written affirmative action plan. and have contracts worth at least $50. Contractors who employ 50 or more persons.000 must implement a written affirmative action plan. Employers with federal government contracts worth $10. 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. and have contracts worth at least $50.

Compliance thresholds 308 .

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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