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Forms & Contacts
Forms
Below are various forms.
Contact Information
Below HR has provided the various contact/websites for our benefits partners.
Below are various forms.
- Personnel Action Form (PAF): This form is used to document personnel status changes.
- Workplace Injury Report: This form is used to document a workplace injury for both PD and non-PD staff.
- 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.
- Probationary Employee Performance Evaluation: This form is used to evaluate all regular, probationary employees prior to the completion of their probationary period.
- 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.
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.