Peter Bishop (2346)

Occur. #

6

Title: Operator

Location: Nicollet

Next Shift: 9 FEB 8PM - 4AM

Manager: Tony Stark

Apply FMLA

Eligibility Date:

Has available FMLA hours?
  FMLA Used: hhh
  Remaining: hhh
  Undesignated: hh : mm
Available FMLA Certificates (click to apply)

FMLA Hub

Absence Management

Absence Hub
Absence: mm/dd/yyyy - mm/dd/yyyy FMLA 020
mm/dd/yyyy - mm/dd/yyyy [insert Pay Code] Hours: 00:00
Source comments go here. Work Days Missed: [insert #]
mm/dd/yyyy - mm/dd/yyyy [insert Pay Code] Hours: 00:00
Source comments go here. Work Days Missed: [insert #]

Chargeable Occurrence (Yes): 5

Chargeable Occurrence:

Reason for changing chargeability:

Change Notes: (required)

Sign-Off Milestone

Signature(s) needed from:

  • [insert employee name/badge #]
  • [insert manager name]

Counseling Milestone

Reason for Counseling: Absenteeism Record

Chargeable Absence Dates:

# DATE(S) PAY CODE
6 07/06/2016 - 07/07/2016 1024 - Sick
5 07/01/2016 1024 - Sick
4 06/28/2016 2029 - Request Off Chargeable
3 06/27/2016 2006 - No Show
2 06/20/2016 2005 - Late for Work
1 06/13/2016 2005 - Late for Work

Describe events or behavior leading to this counseling:

Action Plan:
1. What are the consequences if performance does not improve?

2. Describe the actions employee will take to improve performance.

Employee Assistance Program (EAP) discussed; phone number and website information provided.
Call Sand Creek EAP at 651-430-3383 or visit online at SandCreekEAP.com.

Yes
#unique doc id

  Record of Warning Milestone

Reason for Warning: Absenteeism Record

Chargeable Absence Dates:

# DATE(S) PAY CODE
7 08/01/2016 - 08/03/2016 1024 - Sick
6 07/06/2016 - 07/07/2016 1024 - Sick
5 07/01/2016 1024 - Sick
4 06/28/2016 2029 - Request Off Chargeable
3 06/27/2016 2006 - No Show
2 06/20/2016 2005 - Late for Work
1 06/13/2016 2005 - Late for Work

Describe events or behavior leading to this warning:

Action Plan:
1. What are the consequences if performance does not improve?

2. Describe the actions employee will take to improve performance.

Employee Assistance Program (EAP) discussed; phone number and website information provided.
Call Sand Creek EAP at 651-430-3383 or visit online at SandCreekEAP.com.

Yes

  Final Record of Warning Milestone

Reason for Warning: Absenteeism Record

Chargeable Absence Dates:

# DATE(S) PAY CODE
10 08/30/2016 2006 - No Show
9 08/29/2016 2006 - No Show
8 08/28/2016 2006 - No Show
7 08/01/2016 - 08/03/2016 1024 - Sick
6 07/06/2016 - 07/07/2016 1024 - Sick
5 07/01/2016 1024 - Sick
4 06/28/2016 2029 - Request Off Chargeable
3 06/27/2016 2006 - No Show
2 06/20/2016 2005 - Late for Work
1 06/13/2016 2005 - Late for Work

Describe events or behavior leading to this warning:

Action Plan:
1. What are the consequences if performance does not improve?

2. Describe the actions employee will take to improve performance.

Employee Assistance Program (EAP) discussed; phone number and website information provided.
Call Sand Creek EAP at 651-430-3383 or visit online at SandCreekEAP.com.

Yes

  Evaluate for Discharge

Reason for Discharge: Absenteeism Record

Chargeable Absence Dates:

# DATE(S) PAY CODE WDM
13 09/02/2016 2006 - No Show 1
12 09/01/2016 2006 - No Show 1
11 08/31/2016 2006 - No Show 1
10 08/30/2016 2006 - No Show 1
9 08/29/2016 2006 - No Show 1
8 08/28/2016 2006 - No Show 1
7 08/01/2016 - 08/03/2016 1024 - Sick 3
6 07/06/2016 - 07/07/2016 1024 - Sick 2
5 07/01/2016 1024 - Sick 1
4 06/28/2016 2029 - Request Off Chargeable 1
3 06/27/2016 2006 - No Show 1
2 06/20/2016 2005 - Late for Work 1
1 06/13/2016 2005 - Late for Work 1

Milestone Process:

  1. Print Notice of Hearing
  2. Schedule Loudermill Hearing
  3. Print Notice of Discharge
  4. Leaving Service Form
  5. Exit Survey

Optional:

  Job Abandonment

Start Job Abandonment Process

Chargeable Absence Dates:

# DATE(S) PAY CODE WDM
5 09/02/2016 2006 - No Show 1
4 09/01/2016 2006 - No Show 1
3 08/31/2016 2006 - No Show 1

FMLA Exhausted

Employee requests FMLA leave as covered by the following:

FMLA certification number: [ ]

Certificate start date: [ ]

This certification covers the following condition: [ ]

Condition Descriptions:

  • Employee Illness: Serious Health Condition
    Note: If you visit your health care provider for this reoccurring condition and there is a change in your condition or treatment, the Council requests documentation of your visit.
  • Pregnancy/Prenatal Care
  • Eligible Family Member's Serious Health Condition
    This includes spouse, child, or parent. The employee's child is covered if he/she is a dependent child under 18 years of age, or a dependent child above the age of 18 who is incapable of self-care because of a physical or mental disability.

Employee was contacted by phone.

FMLA Certificate Expired

Employee requests FMLA leave as covered by the following:

FMLA certification number: 001

Certificate start date: 12/01/2015

Certificate end date: 12/01/2016

Remaining FMLA hours available: 170:30

This certification covers the following condition: [ ]

Condition Descriptions:

  • Employee Illness: Serious Health Condition
    Note: If you visit your health care provider for this reoccurring condition and there is a change in your condition or treatment, the Council requests documentation of your visit.
  • Pregnancy/Prenatal Care
  • Eligible Family Member's Serious Health Condition
    This includes spouse, child, or parent. The employee's child is covered if he/she is a dependent child under 18 years of age, or a dependent child above the age of 18 who is incapable of self-care because of a physical or mental disability.

Employee was contacted by phone.

Intermittent FMLA Milestone

Employee requests intermittent FMLA leave as covered by the following:

FMLA certification number: [ ]

Certificate start date: [ ]

This certification covers the following condition: [ ]

Condition Descriptions:

  • Employee Illness: Serious Health Condition
    Note: If you visit your health care provider for this reoccurring condition and there is a change in your condition or treatment, the Council requests documentation of your visit.
  • Pregnancy/Prenatal Care
  • Eligible Family Member's Serious Health Condition
    This includes spouse, child, or parent. The employee's child is covered if he/she is a dependent child under 18 years of age, or a dependent child above the age of 18 who is incapable of self-care because of a physical or mental disability.

Intermittent leave begins on: [ ]

Expected return date: [ ]

Worker's Compensation: Yes/No/Unsure