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Forms > 11 Staff Management (186 docs)

11 Staff Management (186 docs)

Free Forms, caregiving nursing forms, policies, Licensing, Training, Management, Elder Care, Assisted Living, Alzheimer's, ALF

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Documents in 11 Staff Management (186 docs) (187)

A free form developed for employees to get to know themselves and others better. About You
Form used to investigate and document details associated with an accidental exposure for employees are residential care facilities. Accident Exposure Investigation Report
A form used in community based care homes and various types of assisted living facilities to report accidents, incidents, and/or injury to an employee. Accident Incident Injury Report Form - Employee
A great list of examples of times you would want to contact the administrator of a care facility after hours. This is great to distribute to employees to clarify necessary after hour contact. Also included is a link to a communication note to be used by employees as an alternative to directly notifying the administrator about minor incidents. 

Excerpt:
It is our policy that the Administrator be notified when a significant event occurs, such as an incident, accident, and/or injury to a resident or staff member after hours or on weekends.

The following are considered significant events:..... Administrator After Hours/Weekends
SAMPLE Assisted Living Employee Handbook containing around 70 employee manual policies for assisted living facility staff, residential care home staff and other types of community based facility staff.  Helpful policies for RCF, ALF, RCFE and even nursing homes. ALF Employee Handbook ebook
Form to report any concerns a staff member may have anonymously. Anonymous Concern Communication
An important form to determine applicants applying for employment in a care facility likes/dislikes and strong/weak points. Applicant Questionnaire
Form used by interviewer to rate the applicants seeking employment in a care facility through questions and observations from the interview to find the most qualified person to fill the available position. Applicant Ranking Form
A form designed to help investigate an auto accident, helpful for a risk management investigation. Useful for all types of care businesses and care facilities. Auto Accident Report
This form is used to request time off due to death in the family. Bereavement Leave Form
Ca Suspect Abuse Report Form for Caregivers - Free Ca Suspect Abuse Report Form for Caregivers - Free
This form covers responsibilities of the safety committee, reviewing accident safety reports, safety reports, employee communication forms, etc.  for all types of community based care homes and residential care facilities. 

Excerpt:
The purpose of the Safety Committee is to assist management in their decision-making process.  Our Safety Committee is responsible for reviewing; making recommendations and seeing that all the policies and procedures of the Illness and Injury Prevention Program are being followed.  The specific duties shall include:... Care Facility Business Safety Committee Duties Form
A complete checklist of policies, procedures and programs that must be completed by new employees and staff that work at a care facility business, including all types of community based residential care homes. Included are links to all related forms and documents.

Excerpt:
The facility may need or want to make changes in this training program because of changes in the facility or the residents, or because review of the plan indicates improvements need to be made Time to complete each section will partially be based upon an individual's own ability to complete the task. Care Facility Employee Orientation Check Off List
This form is used to report exposure to any pathogens, such as blood. Care Facility Exposure Report Form
Care Facility Sample Hepatitis B Vaccination Policy.  Good form for assisted living facilities and residential care homes. Care Facility Sample Hepatitis B Vaccination Policy form
A great form for helping to ensure your care facility business is employing people following the letter of the law.  This two page form contains the basic record standards for a care facility to comply with for care home employees. 

Excerpt:
Is there a current copy of his/her First Aid Training card on file? (see First Aid)

If CPR Training is required is there a current copy of his/her card on file?

Are Licenses and/or Training Certificates on file (i.e. Certified Nurses Aide) for the positions held by the employee? Care Facility Staff Records Review Form
This form is to help keep track of care facility support staff operations during a shift.  Used for Facility Managers, Maintenance Supervisors, Activity Directors, Housekeeping and even laundry support staff. Care Facility Support Staff Shift Report
A great form with information for care facilities and care businesses.  Important basic standards for reducing workers compensation claims and preventing accidents in a care facility. Care Facility Worker's Comp Loss Control Check Form
This good sample Care Service Handbook is addendum number 2 to the admission agreement.  It details the various care services the facility would provide.

Excerpt:
This handbook describes our Care Services.

We want you to fully understand how we provide care services at our Facility.   It is our responsibility to care for all the residents, and provide a safe working environment for the staff.  This manual contains narrative information about the care services we provide and our reasonable care service Care Service Handbook
Form to be used for details of injury, time off, expected return to work date and other information pertaining to workers comp. Certificate for Disability (Form)
This form is used to schedule cleaning tasks, what to clean, when to clean, who will clean, etc. Cleaning Schedule
A great form used to document communication, response and follow up concerning issues within the company. Company Communication Note (Form)
This great form used to convey and post the dress code policies of residential care homes, nursing homes, and assisted living facilities.

Excerpt:
Our company does require a dress code to be followed by all employees.  This is a business and the subtle messages you send with your dress impacts your success in the workplace.  We have created this dress code for business related reasons, keeping in mind social customs and the need for a safe, healthy, orderly and sanitary environment.  This policy have been created to help you better understand your compliance obligations.  We enforce this dress code uniformly to all employees, except in cases where special permission has been.... Company Dress Code Policies
Form used to conduct and in-house investigation of a complaint.  This document is useful for all residential care, assisted living and nursing homes administrators. Complaint Investigation Report - For Care Facility In-House Complaint Investigation
The Complaint Log is a form used to document and track complaints from residents and staff from beginning date to resolution. Complaint Log
This form is used when filing a discrimination or harassment claim. Designed for various types of community based care businesses. Complaint of Discrimination/Harassment Form
Compliance Checklist for OSHA Bloodborne Pathogens Standard - national Compliance Checklist OSHA Bloodborne Pathogens Standard
A confidential fax form used in a Care Facility when sending confidential information which is protected by the Federal Privacy Act. Confidential Fax
This form is used to determine type of service and duration of time when hiring a consultant. Consultant Review/Training Form
This form is for documenting statements from employees, such as resolving conflicts or during investigations. Declaration Statement
A good form used to designate persons authorized to receive any documents and carry out administrative processes at a Nursing Home, Residential Care and Assisted Living Facilities. Designation of Facility Manager Responsibility (Form)
This great form is used by an employee of a care facility to designate their choice of Doctor(s) to be used in case of an accident or injury.  This form should be filled out prior to an accident or injury.

Excerpt:
To All Employees:

If you are hurt on the job you may designate your choice of personal physician or medical clinic, (that has your personal medical records), that you want to provide medical care in case of a work related injury.  Please complete the following:

I understand my right to designate... Designation of Physician Statement
This form is used to document an employee violation, action taken, employee comments, and follow-up. Disciplinary Notice Form
Form used to log information disclosed to a state or federal agency due to a court order for an employee. Disclosure Accounting Record - Employee
Form used to log information disclosed to a state or federal agency due to a court order for a resident. Disclosure Accounting Record - Resident
This form is provided to the doctor when an employee has been exposed to blood or other potentially infectious materials and requires medical evaluation. Doctor's Employee Exposure Information (Form)
As a part of Quality Assurance and Risk Management, an audit of the employee's dress code should be performed. This is a great form to be used to thoroughly assess employee appearance and compliance. Dress Code Audit
A form used to warn, discipline, and/or terminate an employee for violating the dress code of the company. Dress Code Violation Notice
Consent form for Drug and/or Alcohol Testing. Drug and/or Alcohol Testing Consent Form
Test the staff's training and knowledge of what to do in case of an emergency using this emergency service test. Twenty-five questions.

Excerpt:
17. If a resident has taken the wrong medication, what should you do?
18. If a resident has ingested something poisonous what should you do?
25. During the Head to Toe Survey, 15 body areas are checked, name the primary 4...: Emergency Service Test
In any emergency you need to know who you can count on.  FEMA guidelines specify getting your staff to acknowledge their acceptance of emergency duties.  This Emergency Staff Roster form serves both purposes and is good for all types of community care facilities and residential care facilities that have to comply with emergency provisions for their residents.  Good for Assisted Living Communities, Nursing Homes, Hospitals and other types of businesses too. Emergency Staffing Roster Form
This is a check list of items that need to be returned (such as uniforms, keys, cell phones, etc.) when an employee working in a care facility or care business terminates employment. Employee Checkout Record Form
General type form used to document employee performance, comments and follow-up. Employee Evaluation
This form is used when interviewing an employee that is terminating their employment with the company. Employee Exit Interview Form
A great form that requires employee signature that they acknowledge and accept the facility's employment policies and procedures. Employee Handbook Acknowledgement
Sample form - Employee Job Exposure Training Check Off List for Care Facility Staff Training.  Good tool to help ensure employees in all departments' staff get the basic exposure training required by OSHA. Employee Job Exposure Training Form Check Off List for Care Facility Staff Training
This form is signed and dated by the employee acknowledging they have received and read the employee manual. Employee Manual Acknowledgement
This form is designed to be used by the employee to share what awards and recognition methods they favor.  The employee picks five Informal Recognition Awards and five Formal Recognition Award rating them based on interest. Employee Recognition Questionnaire
This complete and detailed form is used for keeping a record on start/termination dates, wages, training received and other necessary information that should be maintained in the employee's record at a care facility. Employee Record
Checklist form for Employee file to be completed with all new hires in the State of California. Employee Record - CA
An employee wishing to inspect his or her personnel records maintained by the care facility, or to authorize another person to inspect the employee's file needs to submit this form for approval. Employee Records Access Release Form
Communication and suggestion form used by employee's regarding unsafe conditions and/or occupational health concerns. Employee Safety Communication and Suggestion Form
A survey which is completed by the employee to let the owner determine how well they are doing and if there are any problems that need to be corrected.  This gives the employee a chance to voice their opinion and share ideas. Employee Satisfaction Survey
Form used for employees to provide suggestions to facility administration. Employee Suggestion Form
A sample letter of disclosure from the employee's that he/she are dating another employee. Employees Sample Letter of Disclosure
This form enables the staff to evaluate his/her employer and company. Employer Evaluation
Application for employment  as a caregiver in a care facility. Employment Application - Caregiver
Application for general employment in a care facility. Employment Application - General
Form used by an employee to assess their ability to lift. 

Excerpt:
In order for the facility to better assign lifting tasks to individuals who are able to perform the job, we require each employee to complete this form.
Employee's Name:	
Date:
Facility Name:
To Whom it May Concern,
I understand one lifting standard does not fit all persons, due to size, weight, height, and physical strength that it is my responsibility to ensure for my self-safety.  I know I can safely lift: Ergonomics Self Verification Form
This document covers how to eliminate or minimize employee occupational exposure to blood or certain other bodily fluids and meet OSHA requirements. 

Excerpt:
The purpose of this exposure control plan is to:
~Eliminate or minimize employee occupational exposure to blood or certain other bodily fluids
~Comply with the OSHA Bloodborne Pathogens Standard, 29 CFR 1910.1030
Exposure Determination
OSHA requires employers to perform an exposure determination concerning which employees may incur occupational exposure to blood or other potentially infectious materials. Exposure Control Plan for Care Facilities
This form is used by the facility to disclose to all employees any potential exposure to contagious or infectious diseases. Facility Disclosure
A form used by a Care Facility to verify the security of a fax number to ensure a residents confidential information is protected. Fax Security Verification (Form)
A helpful form which is used as an agreement for scheduling flexible work-time arrangement week(s), covers an entire month. Flexible Work - Time Arrangement - One Month Agreement
This form is used when an employee is requesting to work a flexible work schedule. Flexible Work - Time Proposal
This form is submitted by the employee when requesting a leave under the Family Medical Leave Act (FMLA). FMLA Leave Form
Take this test for yourself...and send it to your friends, and let them know who you are. 
Don't peek but begin the test as you scroll down and answer. Answers are for who you are now...not who you were in the past. Have pen or pencil and paper ready. 
This is a real test given by the Human Relations Dept at many of the major corporations today. It helps them get a better insight concerning their employees and prospective employees. Free Personnel Personality Test
Check list for potential employees for a free training observation day prior to accepting employment.  

Excerpt:

You have been invited to attend a free orientation-training day at our facility.  We are willing to spend our time teaching you more about company so that you can better see if the job interests you, plus, this will give us more time to get to know you better.  We will be covering the information listed below. Getting to Know Our Company
This form is used by staff to assess hazardous situations and document any corrective action taken. Hazard Assessment and Correction Record
This form is used to report and document any hazardous situation. Hazard Report Form
A quiz for the staff to take dealing with hazardous chemicals to make sure they are properly trained. Hazardous Chemical Staff Quiz
This form is used to train the staff regarding hazardous chemicals that may be found in the workplace. Hazardous Chemical Training
A very helpful form developed by ProvidersWeb listing information needed when running a help wanted ad for a position in your organization. Help Wanted Advertisement Form
This form must be signed by any care facility employee who declines to receive a Hepatitis B vaccination. Hepatitis B Declination Statement for Care Facilities FORM
This form is used to certify that a care facility employee has accepted the Hepatitis B immunization series. Hepatitis B Immunization Form
A form developed for Residential Care, Assisted Living and Nursing Facilities. This exercise can be done by assigning small groups or individuals to answer each question and then sharing the answers with everyone. It can also be used as a work sheet for individuals. Knowing the answers to these questions can help improve ones character and self-esteem. How Can I?
This form is used to document an employees training on safety policies and procedures. IIPP Employee Training Record
This form is used as a risk assessment tool in the Illness and Injury Prevention Program (IIPP).  Many state agencies require care facilities to have an IIPP program. IIPP Survey Services
A form used to advise others of incidents that may be unusual and warrant consideration. For community based care homes. Incident Advisory
A form used to track communication and phone calls regarding incidents that concern the care business or care facility in general. Incident Call and Communication Log - Company
A thorough form covering payment, schedules, services to be performed, contractor tax identification number, etc. when using an Independent Contractor in your organization. Independent Contractor Questionnaire
This form is used by an employer to justify why an employee is nominated for a recognition award.  It covers the reasons, behaviors, and other criteria used to help make a fair determination.  Alzheimer's and Dementia Care facilities, Residential Care Facilities for the Elderly, Mentally Ill, and Developmentally disabled, and Group Homes fro Kids can all benefit by better recognizing their employees.  This form helps get the job done. In-Formal/Formal Recognition Award Nomination
This great form was created by ProvidersWeb to allow administrators to evaluate their in-services with staff feedback. In-Service Evaluation
A form developed by the ProvidersWeb used by the instructor of the in-service to document training on safety, resident care plans, and class attendee's in Nursing Home, Residential Care and Assisted Living Facilities. In-Service Training Report (Form)
A great card to be given to employee's after receiving in-service training as proof that the employee was in attendance and received the necessary training and passed any tests given. In-Service Verification
A thorough list of questions an administrator, supervisor, and/or manager may ask during job interview of personnel seeking employment in a care facility. Great form for assisted living communities, residential care homes and other types of community based care facilities. Interview Questions for Managers to Ask
Description of job duties and responsibilities of an Activity Director in a care facility. This form also includes the purpose, good features, and challenges of this job.

Excerpt:
The Challenges:
~Getting people to volunteer.
~Getting residents to attend activities, getting residents motivated. 
~Managing volunteers
~Supervising volunteer school kids 
~Compliance with all the state rules and regulations, and company policies and procedures at all times. Job Description - Activity Director
Description of the job duties and responsibilities performed by a care attendant in a care facility.  

Excerpt:
The Good Features:
~It is very personally rewarding to help others.
~Working with good people.
~Learning from seniors. Job Description - Care Attendant
Description of the job duties and responsibilities of a Certified Personal Care Aide in a care facility.  

Excerpt:
Not Allowed:
~Take residents money.
~Shop for the residents.
~Fail to report an incident that a resident has reported to you.
~Discuss the residents outside the work place.
~Lift a resident by self.
~Cut toenails.
~Yell at or intimidate residents. Job Description - Certified Personal Care Aide (CPCA)
Description of the job duties and responsibilities of the Dietary Manager and/or Supervisor of a care facility. 

Excerpt:
Purpose of This Position:
~Make the resident happy with their diet. To ensure quality food is delivered to the residents, in a manner that is clean, safe, and healthy.
~Prevent food-borne illness, and cross-contamination.
~Recruit, supervise, train, continually educate, discipline if need be, the dietary staff.... Job Description - Dietary Manager - Supervisor
Description of the job duties and responsibilities of the dishwasher in a care facility.  

Excerpt:
The Positive Features:
~Cleaning can give a person a feeling of accomplishment.
~Helping residents' lives be better.
~Don't have to think much to do the job. Job Description - Dishwasher
Description of job duties and responsibilities of an Administrator in a care facility. 

Excerpt:
Purpose of this Position:
 -To Job Description - Facility Administrator
Description of the job duties and responsibilities typically performed by a facility manager of a care facility.  

Excerpt:
The Challenges:
~Compliance with all the rules and regulations at all times, see attached.
~Legally responsible for carrying out the business established policies and procedures.
~Is legally responsible.
~Duty to care.
~Continuously updating the master care list and med sheets. Job Description - Facility Manager
Description of job duties and responsibilities of a housekeeper in a care facility.  

Excerpt:
The Challenges
~Compliance with all the rules and regulations at all times.
~Legally responsible for carrying out the businesses established policies and procedures pertaining to housekeeping.
~Cleaning toilets.
~Cleaning incontinent residue. Job Description - Housekeeper
Description of the job duties and responsibilities for a facility maintenance supervisor of a care facility.  

Excerpt:
The Responsibilities
~Use universal precautions.
~Must report safety issues.
~Mandated Adult Abuser Reporter.
~Must leave work areas free from hazards.
~Complete repairs and assignments in a timely manor. Job Description - Maintenance Supervisor
Description of job duties and responsibilities of a Medication Aide and/or assistant who is certified in a care facility.

Excerpt:
Not Allowed:
~Leave medications unattended on night stand or table.
~Playing doctor; giving advice on herbs and medicine, etc.
~Discuss residents outside of the facility. Job Description - Medication Aide Certified (MAC)
Description of job duties and responsibilities of the relief cook in a care facility.  

Excerpt:
The Positive Features:
~Cooking is enjoyable for those that like to cook. 
~Appreciation from the residents and staff.
~Able to suggest recipes for menus.
~Learn about special diets and different food cultures. Job Description - Relief Cook
This is a form used to list job tasks that may be encountered which will place care facility staff at risk of occupational exposure to blood or other potentially infectious materials.

Excerpt:
The following is a list of job tasks that the Activity Director & volunteers may encounter, which will place them at risk of occupational exposure.  This list is not conclusive, and new risks should be added as they are identified. Job Exposure Determination - Activity Director & Volunteers
This is a form used to list job tasks that may be encountered which will place care facility staff at risk of occupational exposure to blood or other potentially infectious materials.  

Excerpt:
I understand my occupational exposure risk, and have been trained in the Injury Prevention Methods listed above.  I have asked any questions I may have had pertaining to my job's exposure. Job Exposure Determination - Care Facility Administrator & Facility Manager
This is a form used to list job tasks that may be encountered which will place care facility staff at risk of occupational exposure to blood or other potentially infectious materials. Job Exposure Determination - Care Facility Dietary Aide
This is a form used to list job tasks that may be encountered which will place care facility staff at risk of occupational exposure to blood or other potentially infectious materials. Job Exposure Determination - Care Facility Dietary Manager & Cook
This is a form listing job tasks that may be encountered which will place care facility staff at risk of occupational exposure to blood or other potentially infectious materials. Job Exposure Determination - Care Facility Housekeeping
This is a form used to list job tasks that may be encountered which will care facility place staff at risk of occupational exposure to blood or other potentially infectious materials. Job Exposure Determination - Care Facility Maintenance
This is a form used to list job tasks that may be encountered which will place care facility Medication staff at risk of occupational exposure to blood or other potentially infectious materials. Job Exposure Determination - Care Facility Medication Assistant & Med Manager
This is a form used to list job tasks that may be encountered which will place care facility staff at risk of occupational exposure to blood or other potentially infectious materials. Job Exposure Determination - Care Facility Personal Care Aide
Overview of job duties and responsibilities of an Activity Director of a care facility.

Excerpt:
Personal Abilities: Good Moral Character. Good Assessment and observation skills. Ability to multi-task. Good vision and hearing. Good communication skills. Clean and neat in appearance. Must be energetic, enthusiastic and with out going personality. Job Overview - Activity Director
Overview of job duties and responsibilities of an Administrator of a care facility.  

Excerpt:
Required Training: Employee Orientation Certification. Resident Care Emergency Care Certification. Mandated Adult Abuse Reporter. Resident Rights, Cultures and Beliefs Verification. Accident/Injury Training. Care Service System. Techniques for quality care for Residents. First Aid Training. Medication 101 and Medication Manager Training. Job Overview - Administrator
Overview of job duties and responsibilities of a Care Attendant in a care facility. 

Excerpt:
Required Testing:  Certified Personal Care Aide Exam. Duty Pledge. Emergency Service Test. Testing on above classes. Job Overview - Care Attendant
Overview of the job duties and responsibilities of Certified Personal Care Aide's (CPCA) in a care facility.  

Excerpt:
General Job Duties: Direct care of physical and mental needs of the residents. Good documentation skills. Comprehension and ability to do the job. Comply with all mandated laws. Job Overview - Certified Personal Care Aide (CPCA)
Overview of job duties and responsibilities of the Dietary Manager and/or Supervisor of the Dietary Department in a care facility.  

Excerpt:
General Job Duties: Ensure quality food is delivered to the residents, in a manner that is clean, safe, and healthy and to the residents' satisfaction. Follow proper food handling practices. Comply with mandated laws.  Recruit and oversee dietary staff. Job Overview - Dietary Manager - Supervisor
Overview of the job duties and responsibilities of a Facility Manager in a care facility. 

Excerpt:
Hazards and Exposures: Universal Precautions training, Material Safety Data Sheet (MSDS) training for chemicals or hazardous material. Blood Borne Pathogens training. Job Overview - Facility Manager
Overview of the job duties and responsibilities of a Housekeeper in a care facility. 

Excerpt:
General Job Duties: Keep facility clean, beautiful and free from safety hazards. Comply with all mandated laws. Job Overview - Housekeeper
Overview of the job duties and responsibilities of the Maintenance Supervisor in a care facility.  

Excerpt:
Special Qualifications: Physical ability to handle the job. (Lifting 31 pounds) 18 years of age verification. Free of Communicable Diseases. Fingerprint - clear criminal background. Abilities to multi-task and maintain a good rapport with others. Job Overview - Maintenance Supervisor
Overview of the job duties and responsibilities of the Medication Aide and/or Assistant who is certified in a care facility.  

Excerpt:
Personal Abilities: Good Moral Character. Good Assessment and observation skills. Ability to multitask. Good vision and hearing. Good communication skills. Clean and neat in appearance. Job Overview - Medication Aide Certified (MAC)
Overview of the job duties and responsibilities of the relief cook in a care facility. 

Excerpt:
General Job Duties: Assist the Chef with kitchen duties; keep Dietary Department clean and organized. Ability to follow directions. Follow proper food handling practices. Comply with all mandated laws. Job Overview - Relief Cook
Form used by employee to describe aspects of their jobs.  Likes, dislikes, and things they would change. Job Review - Quality Assurance
This form is used to evaluate the employee while they are performing their normal job duties, checking to make sure safety and procedures are followed at all times. Job Safety Check List
Form used to document employee tardiness, action taken, employee comments and follow-up. Late Report Notice Form
A great form used by employees to evaluate their Administrators, Employers, and/or anyone in a leadership position in the organization.  The form may also be used to evaluate their own leadership abilities. Leadership Evaluation
A good form used to assess a person's leadership skills while working in a care facility or managing a care business. Leadership Self-Evaluation for all Type of care Facility Administrators and Owners
This form is used when an employee has a planned absence. Leave of Absence Request Form
Free FEMA Form for assessing your ability to communicate effectively. Listening Self-Assessment
This form is used to track long distance calls made from the facility phones by staff and residents. Long Distance Telephone Call Log
This form is used to request repairs needed in the facility. Maintenance Repair Request (Form)
Medical authorization Form used when an employee has a work related illness and/or injury that needs medical attention. Medical Authorization Form
This form is used to inventory and audit chemicals used and located at the facility and to make sure there is a Material Safety Data Sheets (MSDS) on file for each chemical kept in a binder for easy reference in case of emergency. MSDS Inventory Safety Log
This form should be completed for all new employees of a care facility for the business office records, which will allow them to complete all required documentation for state and federal regulations, payroll, etc. New Employee Record Form - for Care Businesses
This form is used when termination is due to excessive absences from work. Notice to Terminate Employment - Excessive Absences
This form is used when termination is due to drug use and/or intoxication that compromises a residents care. Notice to Terminate Employment - Intoxication/Drug Use
Notice to give to employee upon termination of employment due to a safety violation. 

Excerpt:
You have violated the below listed company safety policy:
Company Policy:

We cannot tolerate any.... Notice to Terminate Employment - Safety Violation
This form is used in cases where termination was due to a violation of company policy.  

Excerpt:
You have violated the below listed company policy.   Due to the nature of your actions we are... Notice to Terminate Employment - Violation of Company Policy
Agreement used between employee and employer regarding payment for meal time worked. On-Duty Meal Period Agreement
This form documents that the employee understands the OSHA bloodborne requirements, policy and procedures. OSHA Bloodborne Pathogens Training Final Checklist
This form is used when an employee is requesting authorization to work a 2nd job outside their present employment. Outside Employment Request Form
This form is used for approval of overtime. Overtime Consent Form
This form notifies the employee of normal pay days. Pay Day Notice
This form authorizes the employer to take specific deductions from the employees paycheck. Payroll Deduction Form
This form is used by employee and employer to determine goals and document progress. Performance Goals Form
This form is used to designate a responsible supervisor that will ensure the employees use appropriate personal protection equipment. Personal Protective Equipment Responsibilities
This form defines the rights of residents to be treated with diginity, respect and their personal rights upheld.  This form is read and signed by the staff memebers that they understand these rights. Personal Rights - Employee Acknowledgment
The job of managing personnel is one of the hardest of any business.   In the care home industry we have to maintain stricter standards with our staff.   Why? Because when someone does not do their job, or is absent, or shows up late, the care of our residents can be neglected.  This e-handbook was created to assist staff managers in handling their personnel, however it is not conclusive.  We cannot provide a e-handbook which addresses the needs for every personnel manager in every situation, therefore this e-handbook just covers general specific areas.  It is the duty of the personnel manager to review the current state and federal requirements to ascertain the latest laws. Personnel Handbook eBook - ISBN 1-889226-12-2
This form is submitted by an employee when requesting an advance on their paycheck from petty cash. Petty Cash Advance Form
This is a form used to update your exposure plan, employees should review their Job Exposure Determination list, and add any tasks they feel places them at occupational risk. Position Input - Job Exposure Determination
A form used for pre-employment physicals, includes sections for the Administrator, Applicant, and Physician to complete. Pre-Employment Health Screening Report
Form - Pre-Employment Test Consent for Drivers that drive residents from the care business. Pre-Employment Test Consent for Drivers - Drug and Alcohol Test
This document/form covers privacy rights and employees responsibilities about the disclosure of medical information. 

Excerpt:
Denial of access
The facility may decline to grant access to records if the physical or physiological condition of the resident would be jeopardized. In this event, the individual has the right to designate a licensed medical practitioner or psychologist to examine the records. Privacy Notice for Community Based Care Homes
It's important to ensure your staff is proficient enough in his/her ability to read and write in English to properly handle the language requirements of his/her job.  This review is for information purposes only and is not to be considered in anyway a conclusive English test.  Its is a great review to use with other samples of the applicant's writing to help the interviewer determine the applicant's English reading and writing ability.  Please note:  This document was previously named Read and Write English Verification. Read and Write in English Review
This form is designed to help the interviewer review a prospective employees's english skills, if the ability to read, write and speak english is a requirement of the job.  Useful tool for Residential Care Administrators and Facility Managers of ALFs, RCFEs, RCFs, SNFs and CCFs. Read, Write and Speak English Review Part 2 - Answer Sheet For Supervisors
This form is used to request special accommodations for disabled workers and staff. Reasonable Accommodation Request Form
A good form to recap an Recap of At-Will Employment Terms
This form is submitted by an employee for reimbursement cost when using their personal car for facility business. Reimbursement for Mileage Form
This form is used to provide a limited response to a request for an employee's reference.  It is important that information that is released be guarded, to avoid lawsuits.  

www.ProvidersWeb.com supplies management tools for Administrators, Caregivers, Facility Managers and all types of care home staff. Request for Employee Reference - Response
This is a form submitted by the employee for approval of requested vacation days. Request for Vacation Form
A thorough check off list used for training staff of a Care Facility in resident rights.  Included are links to information on all rights.

Excerpt:
Laws and Regulations:
~Architectural Barriers Act
~Patient Self Determination Act (PSDA)
~Americans with Disabilities Act
~Personal Rights - Resident Rights Part 1 Resident Rights - Staff Training Check Off List
This form is completed by the employee's physician to specify any work restrictions, or non-restrictions for the employee to return to work. Return to Work Medical Release - Fit for Duty Medical Release
A great form to determine potential risk to health and or body. Risk Identification Checklist
Form used to document topics discussed at the safety meeting by the Safety Committee. Safety Committee Meetings Minutes
A form used by the Safety Committee for periodic checking and follow-up on safety issues. Safety Committee Report
Sample Employee Exposure Prevention Training Form for Care Businesses Sample Employee Exposure Prevention Training Form for Care Businesses
Overview of facility policy on smoking, prohibited areas and using designated smoking areas.

Excerpt:
Smoking and using tobacco products at this facility is restricted for medical, legal and ethical reasons.  Current research clearly demonstrates that second hand smoke can be very hazardous to others. We have strict smoking guidelines.  The goal of this policy is to protect the air quality and ensure the safety of all persons who come in contact with this facility. Smoking Policy
Handling accidents and worker's compensation cases right in your nursing home, residential care, or assisted living facility is important.  This helpful Staff Management Forms Ebook on Accidents and Worker's Compensation takes you through the essential steps of accident and claim management. Staff Management Forms Ebook on Accidents and Worker's Compensation
A great form to designate a person responsible for selecting, reviewing, modifying, adding to, and updating the polices, procedures and forms contained in the Staff Management Manual of your organization. Staff Management Manual Responsibility Designation (Form)
This form is used to schedule and document work days and time off for staff of the facility. Staff Schedule Form
Blank form to be used to post staff phone numbers in the facility for employees. Staff Telephone Number List
A form used to track the rate of staff turnover. Staff Turnover Report
This form insures the resident know of their rights to medical record privacy.

Excerpt:
The federal law protects the Right to Privacy.  The Medical Records Confidentiality Act of 1995 ensures that all 50 states adopt a uniform policy for protecting the confidentiality of medical records. State's Authority to Review the Resident's Record
This form is used by Care Facility Staff to have the resident authorize a request so that the facility can obtain specially protected information.  This form must be signed by the resident or their responsible party. Super Confidential Information Release Form
This good form is used by the employee(s) to evaluate a supervisor's work performance.  This gives a chance for the employee's opinion to be heard and feedback to be collected. For use in Alzheimer's and Dementia Care Homes, small 6 bed care homes, homes for the mentally ill and developmentally disabled, plus nursing homes and assisted living communities. Supervisor Evaluation (Form)
This form is to notify an employee that they are suspended from their job without pay, the number of days suspended and why the action was taken.  

Excerpt:
This letter is to notify you that you are hereby suspended from your job for the next _____ days. This action has been taken due to the following: Suspended Without Pay Form
A good form used for verifying previous employment history by phone. Telephone Reference Request Form
This form is used to document discharge/resignation of an employee of the company. Termination of Employment Record
A pre-made and clear time card used to document the hours an employee has worked. Time Card (Form)
This form is used to document universal precautions training of care facility staff, with instructor summary. Universal Precautions In-Service Training Record for Care Facilities
Test for care facility or care business employees to determine knowledge about universal precautions policy and procedures.

Excerpt:
1. Explain the main types of personal protection equipment
1.	_________________
2.	_________________
3.	_________________
4.	_________________
5.	_________________

2. What steps do you take if you are accidentally exposed to bloodborne pathogens or potentially infectious body fluids? Universal Precautions Test for care Facility and Care Business Employees
This form is used to determine that the care facility or care business employee understands the regulations, policy and procedures concerning Universal Precautions, Bloodborne Pathogens, and Infectious Diseases. Universal Precautions Training Check Off List for Care Facilities
This form is used to designate the responsible person for one on one training of Universal Precautions for care facility managers or persons in charge of training staff and updating policies and procedures. Universal Precautions Training Responsibility - For Facility Manager or Staff Trainer
Form used to make sure employee complies with policies and procedures when taking residents out on their own time. Voluntary Outings by Employee
Agreement between employee and employer regarding deductions from pay for rent/accommodations and/or meals. Voluntary Rent/Meal Deduction Agreement
This form is used to document and give notice to employee of type, time and date of violation, action taken, employee comments, and follow-up. Warning Notice Form
A great form for organizing meetings, topics, reports, issues to discuss when having a meeting with supervisors, managers and heads of the various departments in your organization, i.e. Nursing Home, Residential Care, Assisted Living Facilities. Weekly Department Head Meeting (Form)
Checklist used to verify that employees used proper safety procedures when loading a resident in a wheelchair.

Excerpt:
~Did the employee introduce self and explain to the resident each step of the way, giving them reassurance?
~Did he/she position the wheelchair at the rear of the van, allowing enough room for the doors to open and for the lift to be lowered? Wheelchair Loading Safety Review
Checklist for instructor to use when training an employee in proper safety techniques when loading wheelchair bound residents. 

Excerpt:
When the lift is down and flat on the ground show the employee how to unbuckle the safety strap on the front of the lift, roll the wheelchair on to the lift and set both wheelchair brakes. Wheelchair Loading Safety Training
A good form for verifying previous employment history of an applicant seeking employment in a care facility. Work Information Verification (Form)
Form used to keep track of staff duties and work performed within the care facility during the day. Work Time Report - Daily
This is a form to be used by administrative personnel when a workers comp claim is filed to document all the details of the claim. Workers Comp Administrative Report
Checklist to help reduce your facility's Worker's Comp liability.  This great form is designed for use in the managing of Residential Care, Assisted Living, and Nursing Home Facilities, however, this plan applies to almost any business. An excellent workman's compensation reduction plan resource. Worker's Compensation - Loss Control Management Plan
This form is used to monitor and document an open workers comp claim. Worker's Compensation Case Monitoring
Form for recording an employees attendance in a care facility during a one year period. Yearly Attendance Record
 
   
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