Forms & Contacts

Forms
Below are various forms.

Employment:

Personnel Action Form (PAF): This form is used to document personnel status changes.
Time Off Request Form: This form is used for all staff to request time away from work; including, Vacation, Sick, Personal Days, Jury Duty, Bereavement Leave, and Unpaid Leave.
Emergency Contact / Electronic Authorization Form: This form is used to update an employee's emergency contact information and to authorize the use of Employee Self Service to dispense various tax and payroll documents via e-mail and online.
Personnel Requisition: This form is used to request a position be posted and actively recruited for by Human Resources Staff. This form is typically used when a vacancy needs to be filled or a new position is created.

Safety & Risk Management:

Workplace Injury Report: This form is used to document a workplace injury for both PD and non-PD staff.
Property Loss or Damage Report: This form is used in any incident where there is property loss or damage.
General Liability Claim Report: This form is used for any general liability claims.
Automobile Accident Report: This form is used when there is an incident involving an automobile accident.
Student Accident Report: This form is used when there is a student accident.

Benefits:

Health Savings Account - Enrollment / Additional Contributions Form: This form is for employees who want to have money withheld from their paychecks by the Town and deposited into their health savings account (HSA) on a pre-tax basis.
Vacation Buyback Form: This form is used to process the annual vacation buyback as outlined in the Employee Handbook, Section X. Vacation.

Performance Management:

Probationary Employee Performance Evaluation: This form is used to evaluate all regular, probationary employees prior to the completion of their probationary period.
Self-Evaluation - Non-Represented Staff: This form is used as part of the annual performance management process for non-represented staff.
Self-Evaluation - Local 808 Staff: This form is used as part of the annual performance management process for members of Local 808.
Self-Evaluation - Police: This form is used as part of the annual performance management process for members of IBPO.
Performance Evaluation - Police: This form is used for supervisory/management staff to evaluate their reports who are in the IBPO union.
Performance Evaluation - Local 808 Staff: This form is used for supervisory/management staff to evaluate their reports who are in the Local 808 union.
Performance Evaluation - Non-represented Staff: This form is used for supervisory/management staff to evaluate their reports who are non-represented.

Wellness:

Annual Physical Exam Verification: This form is used to provide the Town documentation of a completed annual physical exam for staff who choose to participate in the voluntary employee wellness program.
A Healthier You! Gym Enrollment Form: This form is used to sign-up for the Town's gym enrollment program with our wellness partner Luxe Fitness.

Rewards & Recognition:

Employee Reward and Recognition Form: This form is used for staff to submit their documentation to be recognized for their professional development for either the Professional Development Award, or the Gaining Knowledge Award.

Tuition Reimbursement:

Tuition Reimbursement Application Form: This form is used to apply for the Town's Tuition Reimbursement Program.
Tuition Reimbursement Service Agreement: This form is the employee service agreement required for all employees who participate in the Town's Tuition Reimbursement Program.
Tuition Reimbursement Grade Verification Form: This form is to be completed by the employee once final grades are received and submitted to Human Resources to determine reimbursement costs.

Contact Information:
Below HR has provided the various contact/websites for our benefits partners.

Blue Cross Blue Shield of RI: The Town's medical benefits provider.
Coastline - Employee Assistance Program: The Town's employee assistance program provider.
Delta Dental: The Town's dental benefits provider.
London Health: The Town's flexible spending account (FSA) and health savings account (HSA) provider.
Symetra: The Town's life insurance benefits provider.
ICMARC: The Town's 401a and 457 retirement plan provider.