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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Introduction 6 .

If such information is provided. Finally. 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 . Information about an applicant’s marital status. Finally. applications should include a statement indicating that if the employer discovers any 7 .) Job applications It is important that the application only request information pertinent to the job at hand. screening or interviewing process. (For more information.” Employers may ask applicants about their ability to perform essential functions of a job. essential. 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. A thorough. See 29 CFR § 1630.Chapter 2 Job descriptions and applications Job descriptions Before beginning the employment application and hiring process. with or without a reasonable accommodation. Employers should not to request any information that would provide the employer with the age of the applicant. according to new FMLA regulations that went into effect January 16. family background and the like should not be sought at any point during the advertising. an employer should write a job description for the position needing to be filled.. Employers should consider identifying “attendance” as an “essential job function” for positions where attendance is. 2009.2(n). because the person must be able to perform only the “essential” functions. an employer should carefully consider whether the functions should are “essential” or “marginal. in fact. this description shall be considered evidence of the essential functions of the job. This will allow the employer to pinpoint the exact qualifications required for the position and will assist greatly in the hiring process. The ADA and the EEOC regulations suggest ten reasons or factors to be considered. When listing the functions of the job. it could lead to claims of age discrimination by the applicant if he or she was not chosen for the position. . .” Under the Americans With Disabilities Act and corresponding Oregon law. such as the applicant’s birth date. 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. A template for a job description is included in this chapter.

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

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

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

Job descriptions and applications AT-WILL EMPLOYMENT APPLICATION 11 .

Job descriptions and applications 12 .

Job descriptions and applications 13 .

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

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

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

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

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

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

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

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MEANING THAT EITHER THE EMPLOYER OR EMPLOYEE CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON. THE COMPANY IS AN AT-WILL EMPLOYER. after which the applicant will need to reapply. Position Applied For:_______________________________ Date of Application: ______________ Date You Can Start:_______________________________ Please note that this application will only remain active for six months. 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.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. 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 .

YEARS ACQUAINTED NAME ADDRESS & TELEPHONE RELATIONSHIP Emergency Contact ________________________________________________________________ Name/Street/City/State/Telephone 24 . equipment operation. 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.Job descriptions and applications EDUCATION: NO. date and place where offense occurred: ___________________________ ________________________________________________________________________________ ________________________________________________________________________________ Please provide any additional information such as special skills.) If so. management experience. please state citation. training. or qualifications you feel will be helpful to us in considering your application: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ REFERENCES: Three Individuals Not Related To You.

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

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

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

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pregnancy.Chapter 3 Candidate screening Interviewing applicants The job interview is a process of candidate screening that is necessary. but one that also is filled with many legal pitfalls. 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. the Age Discrimination Act in Employment (ADEA). 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. Laws such as the Americans with Disabilities Act (ADA). 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. 29 . Oregon’s disability law. 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.

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

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

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

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

4. 2. Other information that may be requested (be specific)_____________________________ ________________________________________________________________________ ________________________________________________________________________ Signed: Employee_____________________________ Manager _________________________________ 34 . ___________________________________. 3. 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. agree to the release of the following information concerning my employment with {Company Name}. 5. 6.Candidate screening REFERENCE RELEASE FORM Employee Reference Release I. as may be requested by prospective employers: Job Reference Information 1. 8.

a self-addressed stamped envelope is enclosed. For your convenience in replying./Title) ______________________________________ (Date) 35 . Thank you for your assistance.Candidate screening REFERENCE INQUIRY REPLY TO: Human Resources Manager TELEPHONE:_____________________ TYPE OF REFERENCE: EMPLOYMENT OTHER APPLICANT’S NAME SOCIAL SECURITY NO. 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. We would greatly appreciate your furnishing the information requested on the attached form for the type of reference checked above. ______________________________________ (Company Rep.

5. 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 . 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. 4.Candidate screening EMPLOYMENT REFERENCE Name of applicant:_______________________________________________________________ Stated dates of employment: _______________________________________________________ 1. 2. 6. 3.

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

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

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

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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 .

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 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.

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 .

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

members of the general public. 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. 11. which job functions can not be performed. etc. 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. 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. 7. Signature: Title: Date: Printed Name and Address: 68 . If medical leave is one of the possible accommodations listed above.)? Yes No If yes.General policies 6. Please review the job description and assess whether [EMPLOYEE] can perform all job functions: Yes No If not. or reduce it to an acceptable level: 10. and why not? 8. 7: 9. Attached is a job description for the [POSITION NAME] position.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

thereby decreasing their productivity. 86 . At a minimum. 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. depending on the facts and circumstances of the case. Some employers may also wish to include a policy prohibiting violence in the workplace.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. (4) Employment that directly or indirectly competes with the business interests of the Company. the handbook should contain language that required all employees to treat each other with respect. 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. even minor incidents of workplace bullying can create a hostile and intimidating environment for employees. Further. because even the “equal opportunity offender” can result in liability to a company. Policies prohibiting “bullying” in the workplace Companies often consider whether to include a policy that prohibits workplace bullying in the workplace. A sample policy follows. Authorization to engage in outside employment can be revoked at any time. the Company assumes no responsibility to the outside employment. If the outside employment is authorized.

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

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

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

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

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

the employer may be liable for not only statutory civil rights claims but also for physical torts such as battery. an employer can monitor possible incidents of harassment in the workplace. thoroughly and. The Civil Rights Act of 1991 and Oregon law have exposed employers to punitive and compensatory damages and jury trials for unlawful harassment.EEO policies Whether the employer has a stated anti-harassment policy is relevant to the first element of the defense. to the greatest extent possible. 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. This enables the employer to take action to stop the harassment and thereby accomplish its goal of eliminating workplace harassment. Complaints should be investigated and resolved promptly. 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. confidentially. Obviously. Therefore. 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. 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. employers must consider each claim with the utmost seriousness. With a policy in place that encourages employees to request that any perceived harassment be stopped. confidentiality may be difficult if not impossible to maintain in many situations. If the employer concludes that improper conduct has occurred. conduct internal investigations of such incidents. 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. Additionally. courts have found that when sexual harassment has a physical component. • • When facing specific complaints of sexual harassment. 92 . then the alleged harasser should be disciplined accordingly. and remedy problems before they result in litigation.

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

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

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

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.

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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.

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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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child. 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. or newly fostered child (parental leave) or • to care for a spouse. Under OFLA. 102 . parent-in-law. FMLA and military leave.250 hours during the 12 months preceding the date leave is to begin. newly adopted. 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. same-sex domestic partner. Under FMLA. newly adopted. see page 109. For more information. including an illness. FMLA also provides leave for members of the Armed Services and their guidelines.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. 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. parent. Employers with 25 or more employees in Oregon are covered by the Oregon Family Leave Act (OFLA). an eligible employee may take up to 12 weeks of unpaid leave within a 12-month period (and sometimes more. injury or condition related to pregnancy or child birth that disables the employee or • “call to active duty” or “qualifying exigency” leave (12 weeks). under certain circumstances) for the following purposes: • to care for a newborn. but not seriously ill. or newly fostered child or • to care for a spouse. or to care for an injured servicemember (up to 26 weeks). child. or parent with a serious health condition or • to care for the employee’s own serious health condition. child.

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

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

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

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

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

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

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

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

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

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

a Veterans Affairs health care provider. National Guard or Reserve.Time off and leaves of absence leave shall qualify as an exigency. Regardless of which 12-month calculation period/rule for establishing the leave year that an employer follows.dol. 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. Department of Labor web site: www. including those on the temporary disability retired list (the TDRL).” In addition. an employer may require information from the health care provider and from the employee and/or covered servicemember to support military caregiver leave. and agree to both the timing and duration of such leave. a Department of Defense TRICARE network.” During any single 12-month period.” A “covered servicemember” for MC leave is a current member of the Regular Armed Forces. intermittently. per-injury basis (which may be taken continuously. however. 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.S. WH-385. Military Caregiver Leave is available to an eligible employee who is the spouse. to be used for certification of MC leave situations. parent or next of kin of a “covered servicemember. New Form WH-385 – Certification for Military Caregiver Leave The Department of Labor has developed a prototype form.” 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. or on a reduced schedule basis). or a nonnetwork authorized private health care provider. 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. the covered servicemember must be receiving medical treatment or oversight by a Department of Defense health care provider. daughter. the employee’s total leave entitlement is limited to a combined total of 26 weeks for all qualifying reasons under FMLA and military leave. son. is available for downloading by going to the U. Then. In general. 113 . A copy of WH-385. 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. once a single 12-month period expires.gov/esa/whd/forms/WH-385.pdf. entitled “Certification for Serious Injury or Illness of Covered Servicemember for Military Family 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. 114 . Both certifications must be provided within 15 days. and discuss with legal counsel other provisions included in this policy that may not apply. absent unusual circumstances. consult with your company’s legal counsel to determine which provisions apply to your company. 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. Employers who fall under OFLA only. however. For example. 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. the following sample policy states that health insurance will continue during the course of the leave. SAMPLE OFLA/FMLA POLICY The following sample policy could be used by an employer who is subject to both OFLA and FMLA. Again. need not provide continuing benefits during family medical leave unless the employer has a policy or practice to continue benefits. 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.

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

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

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

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

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

Holiday Pay While on Leave [Optional] Employees receiving short. 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. 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. 120 . Substitution of Paid Leave for Unpaid Leave Employees may use any available paid time off while on approved Family Medical Leave. 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. Additionally: 1.or long-term disability will not qualify for holiday pay. Employees who are on unpaid leave during a holiday will not qualify to receive holiday pay. Company may require a second or third opinion. 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. In some cases (except for leave to care for a sick child). at Company’s expense. prior to returning to work. Employees also must inform the employer if the requested leave is for a reason for which FMLA leave was previously taken or certified. one three-day occurrence or three separate instances) of sick child leave within a oneyear period. the leave will be unpaid.e. Employees using PTO during a portion of approved Family Medical Leave in which a holiday occurs will qualify to receive holiday pay. the employee must furnish. Fitness-for-Duty Certification If Family Medical Leave is for the employee’s own serious health condition. 2.. or circumstances supporting the need for either Call to Active Duty or Servicemember Family Leave. If the employee’s PTO time is exhausted. 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 wishing to maintain health insurance during a period of approved OFLA leave will be responsible for bearing the cost of coverage. If an employee is on approved OFLA Leave. Benefits While on Leave If an employee is on approved Family Medical Leave under FMLA. the employee may qualify for workers’ compensation time-loss benefits. 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. Please see ____ for more information regarding health insurance coverage. With the exception of employees on leave as the result of an on-the-job injury or illness or otherwise required by law. Company will continue the employee’s health coverage under any “group health plan” through the end of the month in which the leave began. 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. even if leave was originally approved for a longer period. Employees are expected to promptly return to work when the circumstances requiring Family Medical Leave have been resolved. Job Protection Employees returning to work from Family Medical Leave will be reinstated to their former position. If the employee’s serious health condition is the result of an on-the-job injury or illness. reinstatement shall not be considered if the leave period exceeds the maximum allowed. 121 . 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. the employee may be reassigned to an available equivalent position. Reinstatement is not guaranteed if the position has been eliminated under circumstances where the law does not require reinstatement. 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 who work for other employers during their leave. may be subject to discipline up to and including termination.Time off and leaves of absence Employees are on leave because they are unable to work. 122 . or who use Family Medical Leave for reasons other than the reason for which leave had been granted.

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 .

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

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

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. DATE: TO: FROM: {Date} PERSONNEL DEPARTMENT {Employee Name} GENERAL INFORMATION 1.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. 145 . Reason for leave of absence:___________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 3.

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

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

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

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

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

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

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

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

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

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

NUMBER: _____________________ DATE OF BIRTH: ______________ If dependent. S. please give address if different from employee’s: ___________________________________________ ___________________________________ ******************************************************************************* COBRA QUALIFYING EVENT:/:VALID CODES FOR QUALIFYING ARE: EX-EMPLOYEE B Company Bankruptcy F Fired (Eligible) G Fired (Gross misconduct) H Hours Reduced L Lay Off M Eligible for Medicare R Retired T Takeover by New Admin.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. V Voluntary Quit X Disabled O Other DEPENDENTS A Over dependent or student age D Divorced I Dependent. no coverage P Death of employee ADDITIONAL INFORMATION: ____________________________________________________ EMPLOYEE SIGNATURE:_________________________________________________________ Date Received:______________________________________ Date Entered: __________________ 156 .

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

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. 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.Employee benefits If you have any questions about this notice or your rights to COBRA continuation coverage. complete this Election Form and return it to us. Under federal law. COBRA Continuation Coverage Election Form Instructions: To elect COBRA continuation coverage. 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. _________________________________________________________________________ [Add if appropriate: Coverage option elected: _______________________________] c. 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 you do not submit a completed Election Form by the due date shown above. _________________________________________________________________________ [Add if appropriate: Coverage option elected: _______________________________] _____________________________________ Signature ______________________________________ Print Name ______________________________________ ______________________________________ ______________________________________ Print Address ______________________________ Telephone number _____________________________ Date _____________________________ Relationship to individual(s) listed above 158 . you will lose your right to elect COBRA continuation coverage. you must have 60 days after the date of this notice to decide whether you want to elect COBRA continuation coverage under the Plan. Read the important information about your rights included in the pages after the Election Form. However. it must be post-marked no later than [enter date]. you should contact [enter name of party responsible for COBRA administration for the Plan. If mailed. with telephone number and address]. _________________________________________________________________________ [Add if appropriate: Coverage option elected: _______________________________] b.

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

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

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

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

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

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

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

COBRA continuation coverage lasts for up to a total of 36 months. and the employee became entitled to Medicare benefits less than 18 months before the qualifying event. 166 . Otherwise. you and your entire family may be entitled to receive up to an additional 11 months of COBRA continuation coverage. 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. for a maximum of 36 months.Employee benefits COBRA continuation coverage is a temporary continuation of coverage. your divorce or legal separation. the name of the appropriate party to whom notice must be sent. or both). Part B. 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. Part B. COBRA continuation coverage for his spouse and children can last up to 36 months after the date of Medicare entitlement. or a dependent child’s losing eligibility as a dependent child. COBRA continuation coverage generally lasts for only up to a total of 18 months. [Add description of any additional Plan procedures for this notice. for a total maximum of 29 months. There are two ways in which this 18-month period of COBRA continuation coverage can be extended. if notice of the second qualifying event is properly given to the Plan. or both). and the time period for giving notice. 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 a covered employee becomes entitled to Medicare 8 months before the date on which his employment terminates. For example. or gets divorced or legally separated.] 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. When the qualifying event is the end of employment or reduction of the employee’s hours of employment. 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. the employee’s becoming entitled to Medicare benefits (under Part A. or if the dependent child stops being eligible under the Plan as a dependent child. becomes entitled to Medicare benefits (under Part A. including a description of any required information or documentation. 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. 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 . contact the nearest Regional or District Office of the U. Plan Contact Information [Enter name of group health plan and name (or position).) Keep Your Plan Informed of Address Changes In order to protect your family’s rights. you should keep the Plan Administrator informed of any changes in the addresses of family members.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.S. the Health Insurance Portability and Accountability Act (HIPAA). You should also keep a copy. For more information about your rights under ERISA.gov/ebsa. and other laws affecting group health plans.dol. Department of Labor’s Employee Benefits Security Administration (EBSA) in your area or visit the EBSA website at www. including COBRA. for your records. of any notices you send to the Plan Administrator. (Addresses and phone numbers of Regional and District EBSA Offices are available through EBSA’s website.

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

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

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

Under federal law. _________________________________________________________________________ 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. complete this form and return it to us.Employee benefits Form for Switching COBRA Continuation Coverage Benefit Options [Only use this model form if the plan permits Assistance Eligible Individuals to elect to enroll in coverage that is different than coverage in which the individual was enrolled at the time the qualifying event occurred.] 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. you have 90 days after the date of this notice to decide whether you want to switch benefit options. *THIS IS NOT YOUR ELECTION NOTICE* YOU MUST SEPARATELY COMPLETE AND RETURN THE ELECTION NOTICE TO SECURE YOUR COBRA CONTINUATION COVERAGE. it must be post-marked no later than [enter date]. If mailed. 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. 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].

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

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

Employee benefits

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

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

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

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

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

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

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

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

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

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

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

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

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

In addition. unpaid meal period where the employee is relieved of all duties would impose an undue hardship on the operation of the employer’s business. In addition.Hours of work and overtime employee may take per shift worked is included. financial resources. minors must receive paid.oregon. Note that this policy does not address the break laws applicable to minors.gov/BOLI/WHD/docs/WH-161S. Effective January 12. to rest. A copy of the notice is included at the end of this chapter and can be downloaded from: www. and to use the restroom and must be paid for this time.” 206 . As used in the revised meal period rule.gov/BOLI/WHD/docs/WH-161. this is in addition to all rest periods required by rule for the number of hours worked on any given shift.pdf (a Spanish version can be found at: www. undue hardship means: “significant difficulty or expense when considered in relation to the size. 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. 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.pdf ). 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. and would need to be modified to specify the meal and break periods unique to minors. Specifically. 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. uninterrupted rest breaks of at least 15 minutes for each four-hour segment worked. 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. nature or structure of the employer’s business. 2009. Under the new rule. employees must still be provided with adequate time to consume a meal.oregon. 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.

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

In addition. effective March 16.gov/BOLI/WHD/docs/WH-161. There are some exceptions to this requirement.pdf (Spanish) or upon request from any BOLI office. 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. 2009.oregon.pdf).Hours of work and overtime “UNDUE HARDSHIP” NOTICE TO EMPLOYEES REGARDING MEAL AND REST PERIODS Pursuant to OAR 839-020-0050 (www.gov/BOLI/LEGAL/docs/Meal_and_Rest_ Periods_Final_Rule_January2009. rest. Employers claiming an undue hardship exception must still provide employees with adequate time to consume a meal.gov/BOLI/WHD/docs/WH-161S. 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. 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.oregon.pdf (English) and www. employers are required to provide their employees with meal periods of at least 30 minutes of uninterrupted time in which the employee is relieved of all duties for work periods of at least six hours. The required notices are available at www.oregon. and employees must be paid for this time. and use the restroom. 208 .

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

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

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

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

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

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

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

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

: Employee 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 .

Hours of work and overtime Payroll advances As a general matter. 219 . Oregon employers are best served by not allowing employees to take payroll advances. 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. it may wish to include the policy. in the employer’s written policies. with an explanation of the conditions and requirements for receiving such advances.

Hours of work and overtime 220 .

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

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

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

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

Performance reviews. Employee’s significant weak points: C. E. Development of future potential: If applicable. 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. 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.*** Comments: (any “Needs Improvement” or “Unacceptable” rating requires comments) ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ IV. Necessary improvements: D. SUMMARY COMMENTS A. Employee’s significant strong points: B. Overall Assessment of employee’s performance 225 . promotion and layoff III.

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

Consider the major responsibilities or objectives for the period being reviewed. and behaviors demonstrating commitment to and an awareness of the regulated aspects of the job (safety.Performance reviews.) COMMENT: 227 . delegating. coaching. cost/profit consciousness. 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. affirmative action. environmental concerns. etc. Complete the comment sections to support your evaluation JOB UNDERSTANDING: How well does the employee demonstrate an understanding of the total duties and tasks required for satisfactory performance and demonstrate technical competence in the job? Consider evidence of short/long term planning. ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ SECTION 2 Outstanding 5 Excellent 4 Effective 3 Needs Improvement Unsatisfactory 1 2 FACTORS AFFECTING PERFORMANCE AND POTENTIAL: Evaluate the effectiveness of the employee’s behaviors in the areas listed below for the period covered by this report.

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

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

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

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

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

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

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

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

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

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

among other things. If possible. and the employee is recalled by the Company and returns to work within 90 calendar days of the date of layoff. When workload increases to the extent that additional employees are needed. 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. promotion and layoff Because of the legal requirements of WARN and the potential for litigation associated with any layoff. benefits and time of service will be fully reinstated on the date of return to work. In determining which employees will be subject to layoff. the terms of which will be governed by the actual group insurance contract in effect at the time the employee returns to work. Information concerning employee rights under COBRA is available from the Human Resources Department. the Company will consider. 238 . productivity. past performance. SAMPLE POLICY Under some circumstances. will remain available under the provisions of COBRA. ABC Company may need to restructure its operations or reduce its workforce. This rule does not apply to the group insurance plan. though not provided.Performance reviews. operational requirements. the skill. the Company may recall individuals according to these same selection criteria. and attendance of those involved. employers should consider consulting with legal counsel prior to any layoff. whether short-term or indefinite. Insurance coverage. All Company benefits will terminate at the time of layoff. employees subject to layoff will be informed of the nature of the layoff and the foreseeable duration of the layoff. If an employee on layoff has fulfilled the orientation period requirements at the time of layoff.

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

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

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

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

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

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

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

Confidentiality and conflicts of interest 246 .

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

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

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

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

or treat you differently in any way for using this fair treatment procedure. 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. The president’s decision on any grievance or complaint will be final. ABC Company is also interested in employees’ constructive ideas and suggestions for improving our business. or if he or she is away from Company premises on business. 251 . Employees are encouraged to express their ideas and suggestions. including the president. No Recrimination Statement No one may criticize you. 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. 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. at any time. and Third Steps of this policy. penalize you. Second.Complaint-reporting procedures The president will give you an answer within 24 hours of the discussion.

Complaint-reporting procedures 252 .

if not used to make employment decisions about the employee. including records relating to leaves of absences. certain records related to the State Board of Higher Education maintained in compliance with ORS 351. arrest or investigation of conduct constituting a violation of the criminal laws of Oregon or another state. workers’ compensation claims and injuries. including timesheets and pay-stubs. This is also true whenever a supervisor or manager keeps his or her own files on particular employees. ORS 652.750(1)(b). and other related documents. disciplinary notices or warnings. Records of an individual relating to the conviction.065.” This includes: • • • • Medical records. Payroll records. promotion. or to be fully aware of where “personnel records” may be within your organization.Chapter 13 Personnel records and recordkeeping requirements Definition of “personnel records” Oregon law defines “personnel records” to include records related to: • • • hiring. confidential references or reports from previous employers. Several types of records should not be maintained in a personnel file containing “personnel records. 253 . demotion or termination decisions pay raises or pay cuts performance evaluations. 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. There are many good reasons to include all “personnel records” in one place. even if the records are identical to those found in the personnel file maintained in the human resources department. Communications from the company’s attorney or in-house counsel regarding a particular employee. and such a note may need to be produced.

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

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

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

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

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

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

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

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

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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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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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

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

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

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

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

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

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

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

Consult with legal counsel or other human resources professionals to find an appropriate translator.Miscellaneous issues Arbitration agreements Some older employee handbooks included arbitration agreements. Because of a new Oregon law. whereby employees and employers agreed to arbitrate any disputes arising out of the employment relationship (in lieu of engaging in costly litigation). 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. 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. but will not be enforced unless entered into at the time of a “bona fide advancement” (promotion. or in what format. etc. This precautionary measure may assist employers who defend against employment lawsuits filed by current or former. some provide one central copy that is accessible to all employees.). • Thus. Some employers choose to distribute paper copies of employee handbooks. In sum. and some make the handbook 276 . 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). 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. do not skimp on the cost. If you decide to translate your handbook. will not be valid unless the following guidelines are met: • All agreements to arbitrate claims or disputes must be presented to a job applicant in a “written employment offer. A poorly translated handbook can be just as ineffective and useless against employment law claims as an out-of-date or haphazardly applied English employee handbook. arbitration agreements entered into between employers and employees after January 1. 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.” Further. however. Agreements to arbitrate claims or disputes may be presented to current employees. 2008. Providing access to employee handbooks in electronic format Neither federal nor state law dictates how an employee handbook should be distributed.

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

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

Miscellaneous issues What to do in Case of an Accident As a Company driver. NEVER plead guilty to any violation of the law in connection with an accident. Complete the proper accident report immediately. Automobile accidents resulting in injury or vehicle damage to any party may be the primary responsibility of the employee driving the vehicle . Report ALL ACCIDENTS TO THE DIRECTOR OF ADMINISTRATION IMMEDIATELY. license number. if at all possible. DO NOT MAKE ANY STATEMENTS TO ANYONE OTHER THAN AN AUTHORIZED REPRESENTATIVE OF THE COMPANY. 279 . Take the necessary precautions to prevent any further accident by placing the proper warning devices. Exchange information with the involved drivers giving them your name. unless advised to do so by the company representative. Render all possible assistance to injured persons. 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. • • • • • • • • • 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. However. take these steps to protect yourself and the interest of the Company: • • Stop immediately. the goal should be to drive without ever having an accident. NEVER offer to settle any claim or damages regardless of the circumstances or apparent smallness of the claim. Call the police if necessary. Take positive action to prevent being involved in the “other drivers” errors. Avoid moving the vehicles until the police arrive. company name and address. and vehicle license number. should you be involved in an accident.

Miscellaneous issues 280 .

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

Oregon law recognizes five categories of lawful payroll deductions: • • • • • deductions required by law (for example. as in the case of discharge. 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. unless the last day falls on a weekend or holiday (in that case. whichever is less. assuming a written agreement is not in place). if the employee has voluntarily signed a loan agreement and as long as the loan was for the employee’s sole benefit. 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. for example. a policy such as the one below notifies the employee that he or she must promptly return all of the employer’s property on or before the employee’s last day of work. 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. the check is due on the next business day) if an employee is discharged. It is required by Oregon law to pay a departing employee’s final paycheck on time. the Company may pursue repayment in a court of law. it is important to not use an employee’s final paycheck to make any unauthorized or unlawful deductions. excluding weekends and holidays. extended a loan to an employee. for example) deductions authorized by a collective bargaining agreement a deduction from a final paycheck for a cash loan to an employee. 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. Under Oregon law. the check is due by the end of the following business day. and the employee has not yet paid the company back by his last day of employment. whichever comes first if an employee quits with notice of at least 48 hours. If the employee refuses to pay. 282 . If your company. 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. • • • Further.Termination of employment • Finally. the final check is due on the final day worked. excluding weekends and holidays. the following “final paycheck” deadlines apply: • if an employee quits with less than 48 hours notice. the paycheck is due within five days. or on the next regular payday.

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

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

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

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

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.  Remind employee to keep company informed about change of address for tax purposes. working environment.Termination of employment Salary & Employee Benefits? (fairness. what? _______________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Do you plan to return to work at the company?  Yes  No If Yes. when? _______________  Explain final pay policy and give (or arrange for) final checks to employee. etc. 287 .) ________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 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.

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

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

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

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

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

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

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

Posting requirements 295 .

Posting requirements 296 .

Posting requirements 297 .

Posting requirements 298 .

Posting requirements 299 .

Posting requirements 300 .

Posting requirements 301 .

Posting requirements 302 .

Posting requirements 303 .

Posting requirements 304 .

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

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

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 . Eligible employees must also be employed at a worksite where 50 or more employees are employed by the employer within 75 miles of that worksite.000 must implement a written affirmative action plan.000 or more for all contracts signed on or after December 1.000 must implement a written affirmative action plan. 2003).Compliance thresholds Minimum employees 50 Law Executive Order 11246 (Federal) Notes Employers with federal government contracts worth $10. Contractors who employ 50 or more persons. and have contracts worth at least $50. 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 $50.000 or more ($100.000 or more. Employers with federal government contracts worth $25. Employers with federal government contracts worth $10. and have contracts worth at least $50.000 must implement a written affirmative action plan. Contractors who employ 50 or more persons. Contractors who employ 50 or more persons.

Compliance thresholds 308 .

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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