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HomeMy Public PortalAbout2024-01-25_Human Resources PROCEDURES FORMS.pdf HUMAN RESOURCES FORMS Contents Form 1-1 Confirmation of Receipt of Human Resources Policies & Procedures Form 2-3 Job Description Review Form Form 3-1 Request for Workplace Accommodation Form 3-5 Corrective Action Form 4-1 Salary Adjustment Form Form 4-4a Flexible Work Arrangement Request Form 4-4b Flexible Work Arrangements Agreement Form 4-4c Remote Work Self Assessment & Safety Checklist Form 5-1a Performance Appraisal Form 5-1b Performance Improvement Action Plan Form 5-2a Individual Development Plan Form 5-2b Training and Development Request Form 6-8 Request for Leave of Absence Form 7-1 Notice of Competition Form 7-2a New Employee Orientation Checklist Form 7-2b Agreement of Confidentiality Form 7-3 Probationary Employee Progress Report Form 7-4a Termination of Employee Checklist Form 7-4b Resignation of Employee Checklist Form 7-4c Exit Interview Form Form 1-1 Confirmation of Receipt of Human Resources Policies & Procedures Form 1-1 Confirmation of Receipt of Human Resources Policies & Procedures This will confirm that I have been provided with the following information: ☐ Personnel Policy & Procedures Manual _______ (Initial) ☐ Internet Policy _______ (Initial) ☐ Cell Phone Policy _______ (Initial) ☐ Location of Occupational Health & Safety Policy & Act _______ (Initial) ☐ A copy of the Joint Occupational Health & Safety Act and Policy are available in each department and the location has been identified to me. _______ (Initial) __________________________________ _________________________________ Signature of Employee Date __________________________________ _________________________________ Signature of Department Head Date __________________________________ _________________________________ Signature of HR Designate Date __________________________________ _________________________________ Signature of CAO Date Form 2-3 Job Description Review Form Form 2-3 Job Description Review Form This form to be completed at the time of an employee’s Annual Review if the procedures and responsibilities outlined in the Employee’s Job Description has changed significantly. Employee Department Job Title Date ☐ Attach current Job Description ☐ Attach any Relevant Previous Job Description Since the existing job description has been prepared are there any changes in the content of the job that necessitate a change in the existing job description? Yes ☐ No ☐ Explanation: Attach an additional sheet as necessary This ☐ will result in a position reclassification request. ☐ will not result in a position reclassification request. Date Employee Signature Date Department Head/Supervisor Signature Date CAO Signature [Grab your reader’s attention with a great quote from the document or use this space to emphasize a key point. To place this text box anywhere on the page, just drag it.] Form 3-1 Request for Workplace Accommodation Form 3-1 Request for Workplace Accommodation The Municipality must not discriminate against employees based on protected characteristics, such as disability or gender. In fact, an employer has what is called a “duty to accommodate." This means they must do what is reasonable to allow a person to get, or keep, a job. Workplace accommodation refers to the Municipality’s obligation under the Nova Scotia Human Rights Act to prevent and remove barriers and provide reasonable accommodation to the point of undue hardship for protected characteristics such as creed/religion, disability, family status and sex (including pregnancy and gender identity). Sometimes, our rules, practices, standards, or policies can create barriers that we didn’t intend. If the accommodation you are requesting is related to one of our rules, practices, standards, or policies, please tell us which one so we can review it. A review will tell us if there is a bona fide requirement (meaning it is necessary to keep it in the document) or if it can be updated. This review is in addition to the expectation that accommodation will be provided for individual needs that remain.” The purpose of this form is to gather the information required to initiate and facilitate the accommodation process in a timely manner under one or more grounds of the Act. Please submit the completed form via email to your immediate supervisor. Your supervisor will then contact Human Resource designate to facilitate the accommodation process. As with all personnel matters, the Municipality will maintain the confidentiality of the information related to an accommodation request. By submitting this form, you consent to disclosing the information provided in this form to the parties that need to be engaged in the accommodation process (i.e., supervisor, Human Resources, etc.). Each accommodation request will be considered on an individual, case-by-case basis in order to determine the most reasonable and appropriate accommodation based on the employee’s individual circumstances. Please refer to the Personnel Policy 3.1 Accommodation for an overview of the workplace accommodation process including the responsibilities of Human Resources, supervisors, and the employee. Should you have any questions or need assistance completing the form, please reach out to your supervisor or the Human Resource designate. Employee Department Job Title Date 1. Which Human Rights ground(s) is your accommodation request related to? ☐ Disability and/or medical condition ☐ Religion ☐ Marital or family status ☐ Not sure ☐ Other (please specify): Form 3-1 Request for Workplace Accommodation 2. What workplace limitations are you currently experiencing? Please provide as much detail as you believe is relevant. 3. Referencing the workplace limitations, you noted above, what specific parts of your assigned job responsibilities are difficult to perform? Please attach a copy of any supporting documentation from your medical provider, if applicable. 4. Please describe as completely and specifically as possible the workplace accommodation(s) that you are requesting. 5. Please provide the duration of the requested workplace accommodation(s). 6. Please describe how the workplace accommodation(s) will assist you in performing your job responsibilities? 7. If the need for accommodation arises from an organizational rule, practice, standard or policy – this should be assessed to make sure that it is a bona fide requirement (BFR). This means that it must be inclusively designed and incorporate the concept of accommodation – this is in addition to the expectation that accommodation will be provided for individual needs that remain. Attach additional pages if necessary. a. Rule or standard to be evaluated Form 3-5 Corrective Action Form 3-5 Corrective Action Employee Department Job Title Date VC = Verbal Counselling WR = Written Reprimand EAP = Request consideration of referral to Employee Assistance Plan S = Suspension T = Termination Z = From verbal warning to dismissal depending on the nature of the offense. 1st Offence 2nd Offence 3rd Offence 4th Offence Intoxicated during working hours EAP/S T Using alcoholic beverages or illegal drugs during working hours Z False/misleading statements on application T Intentional reporting incorrect information or falsifying records Z Stealing - either from fellow employees, or from the Municipality T Refusal to do work assigned without a valid reason Z Carrying or using firearms, fireworks, or any other weapon on Municipal property (except in the course of performing duties) T Willful destruction or defacing property of the Municipality or fellow employees EAP/S T Fighting during working hours Z Abusive or threatening language to a fellow employee or member of the public EAP/S T Failure to report to your supervisor any accident you have while at work Z Horseplay, rowdiness, fooling around in a careless manner, roughhousing in the workplace. Z Insubordination (refusal to obey any reasonable request from management) Z Leaving place of work during working hours without permission EAP/VC WR S T Repeated failure to report to work on time or leaving early EAP/VC WR S T Unreported absence from work EAP/W R S T Vulgar and/or profane language EAP/VC WR S T Interfering with work or fellow employees EAP/VC WR S T Disobeying safety regulations and common-sense safety precautions Z Disorderly conduct Z Immoral conduct or indecency on Municipal property Z Form 3-5 Corrective Action VC = Verbal Counselling WR = Written Reprimand EAP = Request consideration of referral to Employee Assistance Plan S = Suspension T = Termination Z = From verbal warning to dismissal depending on the nature of the offense. 1st Offence 2nd Offence 3rd Offence 4th Offence Sleeping during working hours EAP/VC WR S T Speeding and/or careless driving or use of Municipal vehicles or equipment EAP/S T Willful neglect and/or mishandling of a machine or other equipment EAP/S T Violation of Municipal policies outlined in Sections of the Personnel Policy Manual Z Harassment in the workplace that is in conflict with the Human Rights Act of Nova Scotia (refer to Sexual Harassment Policy) Z Willful and consistent denigration of fellow employees or Department Heads/Managers EAP/VC WR S T Other: Z *The above are to be considered as guidelines for suggested courses of action Description of offense Does the employee have a previous record of disciplinary action? Yes ☐ No ☐ Disciplinary action taken in regard to the above Form 3-5 Corrective Action _______________________________________ _________________________ Signature of Employee (confirming knowledge Date and receipt of a copy of this report) ☐ I am requesting a review of a decision relating to the attached Verbal Warning/ Written Warning/Suspension _______________________________________ _________________________ Signature of Supervisor/Department Head Date _______________________________________ _________________________ Signature of Witness to Discussion and or Date Warning (if applicable) _______________________________________ _________________________ Signature of Chief Administrative Officer Date (for written warning, suspension, or dismissal only) Attach to this report copies of written warnings, notices of suspension, termination slips or any other relevant documents. This record is to be placed in the employee’s personnel file and remain there permanently. The employee will also receive a copy of the report. Action Taken Date Completed Original to Employee File (initial) Copy to Employee (initial) Form 4-1 Salary Adjustment Form Form 4-1 Salary Adjustment Form Employee Department Job Title Date of Hire Current Salary Step Level Recommended Salary Step Level Effective Date Department Head/Supervisor Signature Date CAO Signature Date Approved ☐ Not Approved ☐ Notes: Distribution: Original to Employee File Copy to Employee Scanned to Electronic File OFFICE USE ONLY COMPLETED DATE INITIALS Adjustment forwarded to Morneau Shepell Adjustment made to Group Insurance Premium Clerk - Note evaluation on Master File Form 4-4a Flexible Work Arrangement Request Form 4-4a Flexible Work Arrangement Request Employee Department Job Title Date Confirm the following prior to initiating the request: ☐ I have considered my unit/department’s criteria for flexible work in making this request ☐ I acknowledge and accept the terms of the Flexible Work Policy ☐ I have completed the Remote Work Self Assessment & Safety Checklist (for work from home option) Flexible Work Arrangement Requested ☐ Earned days off (EDO) ☐ Variable hours ☐ Work from Home Current Schedule Proposed Schedule Location Monday Tuesday Wednesday Thursday Friday For EDO indicate day of EDO *Must complete Flexible Work Arrangement Agreement at end of application. Why are you requesting the proposed schedule? Describe your plan for meeting the responsibilities of your position. Form 4-4a Flexible Work Arrangement Request Consider how you will ensure ongoing collaboration with co-workers and your supervisor. How will you ensure regular two-way communication occurs between employee and supervisor? What team norms and agreements have you developed to ensure communication with team members? How will you address team collaboration issues such as scheduling meetings, sharing documents and collaborating on tasks or projects? How will you jointly ensure appropriate work/home boundaries are maintained? How will you create opportunities to participate in the informal interactions of the workplace? What kind of check-ins should we put in place to ensure your health and well-being given we won’t be seeing each other in person every day? How have you ensured that internet connectivity and speed at the remote work location is sufficient for the needs of the role? What contingencies are in place for an unexpected internet outage? What arrangements have been made to create an appropriate and ergonomic workstation? How will this request positively impact unit operations and/or client service aspects of the role? How will on-site tasks be distributed equitably among team members? How will work assignments, goals and priorities be established and work reviewed?