Woodhaven Annual Review of Important HR and Program Reminders

Woodhaven Annual Review of Important HR and Program Reminders

This review is provided to verify that all staff understand the policies and procedures of our organization. Violations to policies may be subjected to disciplinary action up to and including possible termination. If you do not understand a specific policy, please contact Human Resources for clarification.
Employee Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email Address: *
A current email address is required to complete CPR and First Aid training as well as a backup contact for HR purposes.
Emergency Contact Name *
First and Last Name
Emergency Contact Phone Number*

Area CodePhone Number
I am aware that Woodhaven may send out important information that may require a response by a deadline. This information may be sent out through Therap s-comm, personal email message or by voice mail on the phone number and email provided to the Human Resource office. It is my responsibility to check messages on a regular basis to avoid missing a deadline.*

Agree
I have been given access to the most recent revision of the Woodhaven Employee Handbook by going to http://intranet.woodhaventeam.org I understand that I may refer to this book to answer questions regarding employment at Woodhaven, including benefits, grievance policy, personal conduct and history. I further understand that receiving this booklet in no way implies a written or oral contract of employment between myself and Woodhaven, nor does it alter my right or the right of Woodhaven to terminate the employment relationship at any time for any reason with or without cause.*

Agree
All employees in positions requiring a chauffeur’s license are required to maintain a valid chauffeur’s license. Any moving violation obtained must be reported to HR within 48 hours of the incident. Annual Driving Records are completed on all employees. Any violation that is not reported may result in disciplinary action up to and including possible termination. I have access to this procedure by going to http://intranet.woodhaventeam.org*

Agree
Employees arrested for a crime of any kind must immediately report the incident to the Human Resource Director. All reported information will be held in confidence. Should a conviction affect your position with this agency, we will accommodate you whenever possible by a change in position and/or department. However, we reserve the right to take action, up to and including separation from the agency. If you, as our employee, are ever in doubt whether an activity meets our ethical standards or compromises Woodhaven’s reputation, please discuss it with the Human Resource Director. I further understand that some offenses are listed on the DMH Disqualifying list and may prevent me from retaining employment with Woodhaven unless an official exception is filed with the Department of Mental Health. I have access to this procedure by going to http://intranet.woodhaventeam.org*

Agree
I understand that direct support staff may request a transfer to another work location after 3 months, if they are in good standing and meet minimum qualifications for the requested position. Transfer/Promotion request forms may be obtained from the Human Resource Forms Tab on the Intranet Page or by contacting the Human Resource office. I have access to this procedure by going to http://intranet.woodhaventeam.org*

Agree
I have reviewed my job description upon hire and annually during my evaluation appraisal and am aware that I may request a copy at any time through the Human Resource Department. Under no circumstances is sleeping allowed on a regular awake shift. The only time you are allowed to sleep is when you are in a sleep overnight position. If there is any question regarding this matter, please contact your immediate supervisor. If I am, at any time, a Team Support Leader (TSL) I understand that my work assignment is either Sunday through Thursday or Tuesday through Saturday Flex. I understand that I am guaranteed two days off a week (either Fri/Sat or Sun/Mon). I further understand that this position requires that I accept hours (days, evenings and overnights) on my regularly scheduled days. I will not be scheduled to work more than 40 hours unless I agree to accept overtime. I understand that I may be required to cross train and work on other teams based on the needs of the organization. I am aware that I may request a copy of my job description at any time through the Human Resource Department. If I am, at any time, an on call DSP, I understand that I must work a minimum of 40 hours per month.*

Agree
I am knowledgeable of the MITC phone system and clocking in/out. I can access the procedure at any time if I need clarification by going to http://intranet.woodhaventeam.org and reviewing Procedure 3-10-1 of the Policy Manual. I understand that all money is deposited directly into my back account or on an issued pay card. I understand that manual checks will NOT be issued due to employee noncompliance with timesheet deadlines. Instead the pay will be deposited on the following payroll deposit. Pay stubs may be downloaded from columbiaedp.com*

Agree
I am knowledgeable of the overtime procedure 4-10-18 and have access to this procedure at any time if I need clarification by going to http://intranet.woodhaventeam.org. I understand and have received adequate information pertaining to this and agree to follow all guidelines. I understand that it is the responsibility of the non-exempt staff to inform their immediate supervisor prior to working any hours above their regular schedules shift. Violation may be subjected to disciplinary action up to and including possible termination.*

Agree
I understand that non-exempt employees are required to give a minimum two week notice of resignation to Human Resources. Exempt employees and non-exempt managers are required to give a minimum of 30 days written notice in order to be eligible for payment of their ETO balance. This will be paid at the time the final paycheck is received. I understand that if I am terminated as a part of disciplinary action, any ETO balance will be forfeited. You may schedule an exit interview with Human Resources. I have access to this procedure by going to http://intranet.woodhaventeam.org*

Agree
I am aware of the Call in procedure 4-10-49 which states an employee must call in a minimum of two (2) hours for all shifts prior to their scheduled time to report to work in order for a Supervisor to consider assigning an excused absence. You must contact your supervisor to speak with the supervisor to seek approval for the absence. You cannot leave a voice message or send a text message. If you do not obtain authorization for the absence, this time off would be leave without pay and disciplinary action may occur. Employees should make every effort to contact their immediate supervisor as soon as they are aware that they are going to need an unscheduled absence. If you are unable to reach your immediate supervisor, please follow the chain of command to reach the next supervisor in line. (Example: Home Coordinator, Program Manager, Director of Programs I have access to this procedure by going to http://intranet.woodhaventeam.org*

Agree
I am knowledgeable of procedure 4-10-50 regarding social media usage while at work. I understand that Woodhaven computers are not to be used by staff to access Facebook, Twitter, or other forms of social media for personal reasons. I understand that if Woodhaven is tagged as my employer, it can give the perception of my being an unofficial spokesperson for the agency. Any inappropriate statements involving Woodhaven or the individuals supported could result in disciplinary action up to and including termination. I have access to this procedure by going to http://intranet.woodhaventeam.org*

Agree
I am knowledgeable of the procedure regarding Work Related Injuries 4-2-2. I have been informed that if I believe I have an injury or illness that is work related and feel that I need medical attention. I MUST contact the nurse on call (or in the absence a Program Manager) and be referred to a physician or emergency room. If I seek medical attention without the above referral, the bills incurred may be my responsibility. I have access to this procedure by going to http://intranet.woodhaventeam.org*

Agree
I am knowledgeable of procedure 4-10-36 regarding Progressive Employee Counseling and Corrective Guidelines. I understand the purpose of the guidelines is to assist the employee in conforming behavior to expectations of the organizations. I also understand that some consequences are defined by state law, including termination and/or criminal sanctions. I have access to this procedure by going to http://intranet.woodhaventeam.org*

Agree
I am knowledgeable of Procedure 5-10-14 regarding appropriate footwear while working with the individuals. I understand that open-toe shoes, clogs, and shoes with more than a one inch heel are not allowed while performing direct care. Failure to abide by this policy could result in disciplinary action, or in the event off an injury, a reduction in worker compensation benefits. I have access to this procedure by going to http://intranet.woodhaventeam.org*

Agree
I am knowledgeable of the Appropriate Clothing Attire in the Work Place expectation. I have signed this acknowledgement upon hire and have access to this expectation by requesting a copy from the Human Resource office.*

Agree
I am knowledgeable of the Annual Training Requirements and agree to keep in-services current. I understand by not renewing all required in-services PRIOR to expiration, employee will be suspended without pay effective immediately following the expiration date. I have access to this procedure by going to http://intranet.woodhaventeam.org*

Agree
I am knowledgeable of Woodhaven’s Rules of Conduct & Expectations. I understand that Woodhaven is free to modify or amend its policies and practices, rules, procedures and regulations at any time without prior notice. I have access to this procedure by going to http://intranet.woodhaventeam.org*

Agree
I am knowledgeable regarding Telephone and Cellular Phone usage and procedure 1-9-7. I have access to this procedure by going to http://intranet.woodhaventeam.org. I understand that I am never to use a cellular phone while driving an agency vehicle. I also will not use a cellular phone in my personal vehicle if I am transporting individuals supported. I further understand that use of my cellular phone while on duty will subject me to disciplinary action.*

Agree
I am knowledgeable regarding Unpaid Leave and Leaves of Absence procedure 4-10-12. I have access to this procedure by going to http://intranet.woodhaventeam.org. I understand that if I am enrolled in Health Insurance benefits and must take unpaid leave (other than FMLA leave), my benefits will terminate the first pay period when no check is issued. The insurance provider will notify me of COBRA options.*

Agree
Confidentiality: In the interest of confidentiality for our employees and persons Woodhaven serves, all employees are required to initial and date below the following statement upon hire: During the course of my work at Woodhaven, I understand that I will come in contact with confidential information on many persons. I understand that I am committed to an oral and written bond regarding the safeguarding of this confidential information. I agree that I will not release or discuss any confidential information from a record or from any other source to any unauthorized persons including other employees. I understand that any unauthorized discussion or release of knowledge found in any record(s) will be subject to disciplinary action.*

Agree
I acknowledge if it is requested that I use my personal vehicle to transport individuals while on duty (not required), I must follow the guidelines listed below:1. Maintain vehicle in safe operating condition;2. Maintain an acceptable driver status as defined in Woodhaven’s Procedure No 1-8-33. Maintain in good standing, liability insurance of at least the minimum level required by State law.4. Voluntarily copy proof of liability insurance to the Office of Human Resources upon each renewal.5. Understand that any accident and/or injury occurring while transporting a person served or employed by Woodhaven in their private vehicle, shall be their responsibility and that of their insurance carrier.6. Understand that they may be required by their insurance carrier to notify the carrier that they are using their vehicle for business use and any increase in premium rate will be at the employee’s expense.7. (If approved by supervisor to use personal vehicle for business) – submit a mileage reimbursement request signed by employee and supervisor to the Woodhaven Accounting office. Mileage reimbursement will be at the IRS approved rate and can be anticipated ten days following request to the Woodhaven Accounting Office.8. If the person supported causes damage to the private vehicle, Woodhaven may or may not reimburse expenses, depending on the circumstances.*

Agree
Do you have other employment in addition to your job at Woodhaven?*

YesNo
If you answered yes to the above question: What is the name of your other employer
Type of Business
Please list the assigned days and hours you are required to work at your other job
It is my responsibility to keep my immediate supervisor and the Office of Human Resources informed of the days and hours worked at other businesses. If a change occurs in the days and hours worked, I will inform my supervisor and the Human Resource office. Failure to comply with this directive could result in disciplinary action being taken.*Exempt Employees, including non-exempt managers are not authorized to have a second job outside the organization due to the responsibilities assigned to working this exempt status position. Any exception must be authorized by the Director of Human Resources.*

Agree
I am knowledgeable of the abuse/neglect reporting procedure 2-6-8 and have access to this procedure at any time if I need clarification by going to http://intranet.woodhaventeam.org. I understand that all individuals receiving services from Woodhaven are to be free from psychological and physical abuse. I understand that no form of negligence, mistreatment or seclusion of people receiving services will be tolerated. I will be subject to a recommendation for termination as well as possibly prevented from working in the field for even one instance of abuse/neglect or misuse of consumer funds. I further understand that I am a mandated reporter. Failure to report witnessed abuse, neglect, or misuse of consumer funds immediately will result in disciplinary action up to and including termination.*

Agree
I am knowledgeable of the Critical Incident Procedure 2-6-26 and have access to this procedure at any time if I need clarification by going to http://intranet.woodhaventeam.org. I understand that critical events must be completed on an GER as soon as possible after the incident and no later than the end of the shift. My direct supervisor is to be notified any time an GER is completed.*

Agree
I am knowledgeable of the Communication between Shifts Procedure 2-6-29 and have access to this procedure at any time if I need clarification by going to http://intranet.woodhaventeam.org. I understand I am expected to speak with staff that will be relieving me prior to departure from the home at the end of my shift. I am expected to communicate relevant medical or behavioral information between shifts. If applicable for my home I understand that we will need to do a controlled medication count. I understand that if I am being relieved by a live-in staff, I will speak to the live-in prior to leaving and ensure that they are in their apartment prior to leaving. The only exception to this rule is in homes where individuals have documented alone time in their ISP.*

Agree
I am knowledgeable regarding the procedure Daily Note Documentation 2-6-30 and have access to this procedure at any time if I need clarification by going to http://intranet.woodhaventeam.org. I understand that I am expected to complete a daily accounting of each individual’s daily activity in Therap T-logs by the end of my shift. I understand these notes should be written objectively and accurately reflect what occurred during the shift. I understand that each note should be marked High, Medium or Low. I can refer to the procedure if I am unsure how to mark an entry. Failure to provide accurate and complete documentation in a timely manner will result in disciplinary action, up to and including a recommendation for termination. I further understand that I am required to complete ISP objective data on a daily basis. Failure to complete this will result in disciplinary action up to and including termination.*

Agree
I am knowledgeable regarding when to contact an agency nurse, procedure 5-10-8. I have access to this procedure at any time if I need clarification by going to http://intranet.woodhaventeam.org. I understand that when I call the nurse I should be prepared to provide temperature, pulse, blood pressure and respiration. IF vital signs are outside of the parameters listed in this procedure I understand that I must contact an RN or doctor and document their recommendations. Failure to contact a nurse according to prescribed guidelines set forth in the procedure could result in disciplinary action up to and including termination. If I am unable to reach a nurse, I must contact my supervisor.*

Agree
I am knowledgeable regarding procedure 2-6-21 Complaint Procedure for Individuals Supported. I understand that part of my role is to be an advocate for them when they have concerns. I have a responsibility to report their concerns to my supervisor in order for them to be addressed. If I need clarification of this procedure I can refer to http://intranet.woodhaventeam.org.*

Agree
I am knowledgeable regarding the Emergency Preparedness Disaster Plan, procedure 5-8-11. I have access to this procedure at any time if I need clarification by going to http://intranet.woodhaventeam.org. I have also been specifically trained on the home specific Emergency Procedure and Evacuation Plan. I understand that this is located in the Home Reference Book, and I can review it any time I need to.*

Agree
I am knowledgeable regarding Behavioral Support Strategies and Procedure 2-6-14 for Woodhaven Consumers. I have access to this procedure at any time if I need clarification by going to http://intranet.woodhaventeam.org. I understand that consumer rights cannot be restricted, without going through a Due Process Review by the Department of Mental Health. I further understand that when an individual is at imminent risk of physically harming themselves or others, I may use a CPI non-violent physical intervention (restraint) on which I have been trained. I understand that this is only to be used as a last resort. I understand this type of incident will require me to document in Therap, complete a GER and notify a supervisor. Failure to do this will result in disciplinary action.*

Agree
I am knowledgeable regarding procedure 2-6-28, Individuals visiting staff personal residence or family events. I have access to this procedure at any time if I need clarification by going to http://intranet.woodhaventeam.org. I understand that I must have authorization from my Home Coordinator/Program Manager to take an individual supported to my residence or family function. I further understand that this is only to be done with the intent to facilitate community inclusion and develop relationships and not for the convenience of myself. Any incidents of conducting personal business on agency time will result in disciplinary action up to and including termination.*

Agree
I am knowledgeable regarding delegations that have been delegated to me by an RN and those that were taught to me by an RN in the Level 1 Medication Aide class for the Woodhaven consumers I am assigned to work with. I have access to these delegations at any time in the Consumers Home Book or MAR book. Failure to be/remain familiar with all of the delegations in the home, those specific to a Consumer as well as those taught in Level 1 Medication Aide, could result in disciplinary action up to and including termination.*

Agree
I am knowledgeable that it is my responsibility to provide Community Access and Choice to the individuals that I support. I understand that community based activities should be what the individual supported is interested in and wants to do, and not what my interests are. If I need further clarification I can go to procedure 2-6-35 at http://intranet.woodhaventeam.org. Failure to meet this expectation will result in disciplinary action*

Agree
Confidentiality: In accordance with the Health Insurance Portability and Accountability Act, you shall only access, request or disclose the minimum necessary client health information and/or records relating to treatment, payment or operations which reasonably pertain to the performance of your duties. Violation of the above may result in disciplinary action up to and including termination and/or criminal sanctions or penalties. This is to confirm acknowledgement and receipt of Woodhaven’s confidentiality procedure and information on the Privacy Rule, pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). I confirm that I am expected to understand and follow policies and procedures related to privacy completely. If concerns or questions arise, I may contact the Privacy Officer, the Compliance Officer, my supervisor or Human Resources without fear of retaliation.*

Agree
COVID 19 - I understand that we are currently operating in a global pandemic. I am knowledgeable regarding the steps that I need to take on a daily basis to ensure the health, safety and welfare of the individuals supported, my co-workers and myself. I agree to follow the protocols listed below and I have access to procedure 5-10-15 at any time I need clarification by going to http://intranet.woodhaventeam.org*

Agree
COVID-19 PROTOCOLS:

I, {employeeName}, understand that I must wear a mask at all times when working unless I am in an office by myself or working an overnight shift with no consumer interaction.

I,{employeeName}, understand that I am not to come into work, if I have a temperature, am feeling ill or have lost my sense taste or smell.

I,{employeeName}, understand that daily temperature checks are required currently for all the individuals supported and documented in Therap.

I,{employeeName}, understand that enhanced cleaning protocols must be maintained in the home, including wiping down all commonly touched surfaces several times per shift.

I,{employeeName}, understand family members are not allowed within the home unless authorized by Administrative staff. I further understand the Director of Programs must approve all home visits for individuals supported.

I,{employeeName}, understand that whenever possible, I must maintain six feet of social distancing from the individuals and my peers.

I,{employeeName}, understand that Human Resources must be notified of any travel that I am planning out of state. I understand I may have quarantine when I return.
Employee Signature*

Clear
Please verify that you are human*
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