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 Westerly 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.