Probation

Occur:

7

Debits:

0

Title: Operator

Location: Nicollet

Next Shift: 9 FEB8PM - 4AM

Manager: Tony Stark

FMLA

As of today:

	Hire Date:	mm/dd/yyyy
	Hours Worked:	hhhh : mm
	Remaining FMLA Hours:	hhh
	Undesignated:	hh : mm

	Has worked 12 months?
	Hire Date:	mm/dd/yyyy
	Years Employeed:	#
	Has worked 1250 hours?
	Hours Worked:	hhhh : mm
	Has available FMLA hours?
	FMLA Used:	hhh : mm/480

> FMLA Hub

DMC History

Disability Management

Joshua Jackson 00001

Disability: 01/01/2017 – 09/05/2017

process id

DM: Day 240 - 6th DMC

due: 09/05/2017

Medical Leave Status Report

Print MSR

> Days Absent: 246 DMC absences in the last year.

*Is the employee back to work, or coming back to work?

Yes. Return date:

No

*DMC minutes:

DMC comments:

*Schedule next conference (DMC: Day 180)

(suggested date: August 27, 2017) Auto-Fill

*Required

Signature(s) required from:

[insert employee name/badge #]

Add Notes
Upload/Manage Documents

Add Persons Present (no badge)

Print Snapshot Audit Log

#unique doc id

DM: Modified DQ

due: 07/15/2017

Modified Disqualification

> Days Absent: 186 DMC absences in the last year.

*Modified DQ Start Date:

*Required

Print Snapshot Audit Log

#unique doc id

DM: Day 185 - Pre-DQ

due: 07/10/2017

Medical Leave Status Report

Print MSR

> Days Absent: 46 DMC absences in the last year.

*Is the employee back to work, or coming back to work?

Yes. Return date:

No

*DMC minutes:

DMC comments:

*Schedule next conference (DMC: Day 180)

(suggested date: August 27, 2017) Auto-Fill

*Required

Signature(s) required from:

[insert employee name/badge #]

Add Notes
Upload/Manage Documents

Add Persons Present (no badge)

Print Snapshot Audit Log

#unique doc id

DM: Day 165 - DMAC

due: 06/20/2017

Disability Management Advisory Committee

Print MSR

> Days Absent: 165 DMC absences in the last year.

*Is the employee back to work, or coming back to work?

Yes. Return date:

No

*DMC minutes:

DMC comments:

*Schedule next conference (DMC: Day 180)

(suggested date: August 27, 2017) Auto-Fill

*Required

Signature(s) required from:

[insert employee name/badge #]

Add Notes
Upload/Manage Documents

Add Persons Present (no badge)

Print Snapshot Audit Log

#unique doc id

DM: Day 150 - 5th DMC

due: 06/05/2017

Medical Leave Status Report

Print MSR

> Days Absent: 46 DMC absences in the last year.

*Is the employee back to work, or coming back to work?

Yes. Return date:

No

*DMC minutes:

DMC comments:

*Schedule next conference (DMC: Day 165)

(suggested date: August 27, 2017) Auto-Fill

*Required

Signature(s) required from:

[insert employee name/badge #]

Add Notes
Upload/Manage Documents

Add Persons Present (no badge)

Print Snapshot Audit Log

#unique doc id

DM: Day 120 - 4th DMC

due: 05/05/2017

Medical Leave Status Report

Print MSR

> Days Absent: 46 DMC absences in the last year.

*Is the employee back to work, or coming back to work?

Yes. Return date:

No

*DMC minutes:

DMC comments:

*Schedule next conference (DMC: Day 165)

(suggested date: August 27, 2017) Auto-Fill

*Required

Signature(s) required from:

[insert employee name/badge #]

Add Notes
Upload/Manage Documents

Add Persons Present (no badge)

Print Snapshot Audit Log

#unique doc id

DM: Day 90 - 3rd DMC

due: 04/05/2017

Medical Leave Status Report

Print MSR

> Days Absent: 46 DMC absences in the last year.

*Is the employee back to work, or coming back to work?

Yes. Return date:

No

*DMC minutes:

DMC comments:

*Schedule next conference (DMC: Day 165)

(suggested date: August 27, 2017) Auto-Fill

*Required

Signature(s) required from:

[insert employee name/badge #]

Add Notes
Upload/Manage Documents

Add Persons Present (no badge)

Print Snapshot Audit Log

#unique doc id

DM: Day 60 - 2nd DMC

due: 03/05/2017

Medical Leave Status Report

Print MSR

> Days Absent: 46 DMC absences in the last year.

*Is the employee back to work, or coming back to work?

Yes. Return date:

No

*DMC minutes:

DMC comments:

*Schedule next conference (DMC: Day 165)

(suggested date: August 27, 2017) Auto-Fill

*Required

Signature(s) required from:

[insert employee name/badge #]

Add Notes
Upload/Manage Documents

Add Persons Present (no badge)

Print Snapshot Audit Log

#unique doc id

DM: Day 30 - 1st DMC

due: 02/05/2017

Medical Leave Status Report

Print MSR

> Days Absent: 46 DMC absences in the last year.

*Is the employee back to work, or coming back to work?

Yes. Return date:

No

*DMC minutes:

DMC comments:

*Schedule next conference (DMC: Day 165)

(suggested date: August 27, 2017) Auto-Fill

*Required

Signature(s) required from:

[insert employee name/badge #]

Add Notes
Upload/Manage Documents

Add Persons Present (no badge)

Print Snapshot Audit Log

#unique doc id

DM: Day 20

due: 01/25/2017

FMLA Eligibility

Print FMLA Packet

Medical Leave Status Report

Print MSR

Eligible for FMLA

Employee is eligible for FMLA. Please print the FMLA packet.

Not Eligible for FMLA

Employee didn't work for 1250 hours in the past year.

> Days Absent: 46 DMC absences in the last year.

Is the employee back to work, or coming back to work?

Yes. Return date:

No

Schedule 1st conference (DMC: Day 30)

(suggested date: March 27, 2017) Auto-Fill

Print Snapshot Audit Log

#unique doc id

DM: Day 7

due: 01/12/2017

Doctor's Note

Print 7th Day Absent letter

Doctor's Note Required

Please upload doctor's note; otherwise print and mail the 7th Day Absent letter.

> Days Absent: 46 DMC absences in the last year.

Print Snapshot Audit Log

#unique doc id

DM: Day 4

due: 01/05/2017

FMLA Eligibility

Print FMLA Packet

Eligible for FMLA

Employee is eligible for FMLA. Please print the FMLA packet.

Not Eligible for FMLA

Employee didn't work for 1250 hours in the past year.

> Days Absent: 46 DMC absences in the last year.

Did you contact the employee?

Yes.

No; unable to contact employee.

Print Snapshot Audit Log

#unique doc id

First Name:
Last Name:
Description:

First Name:
Last Name:
Description:

First Name:
Last Name:
Description:

First Name:
Last Name:
Description:

7

0

Title: Operator

Location: Nicollet

Next Shift: 9 FEB8PM - 4AM

Manager: Tony Stark

FMLA

Eligibility Date:

DMC History

Disability: 01/01/2017 – 09/05/2017

DM: Day 240 - 6th DMC

Medical Leave Status Report

*Is the employee back to work, or coming back to work?

Yes. Return date:

No

*DMC minutes:

DMC comments:

*Schedule next conference (DMC: Day 180)

Signature(s) required from:

DM: Modified DQ

Modified Disqualification

*Modified DQ Start Date:

DM: Day 185 - Pre-DQ

Medical Leave Status Report

*Is the employee back to work, or coming back to work?

Yes. Return date:

No

*DMC minutes:

DMC comments:

*Schedule next conference (DMC: Day 180)

Signature(s) required from:

DM: Day 165 - DMAC

Disability Management Advisory Committee

*Is the employee back to work, or coming back to work?

Yes. Return date:

No

*DMC minutes:

DMC comments:

*Schedule next conference (DMC: Day 180)

Signature(s) required from:

DM: Day 150 - 5th DMC

Medical Leave Status Report

*Is the employee back to work, or coming back to work?

Yes. Return date:

No

*DMC minutes:

DMC comments:

*Schedule next conference (DMC: Day 165)

Signature(s) required from:

DM: Day 120 - 4th DMC

Medical Leave Status Report

*Is the employee back to work, or coming back to work?

Yes. Return date:

No

*DMC minutes:

DMC comments:

*Schedule next conference (DMC: Day 165)

Signature(s) required from:

DM: Day 90 - 3rd DMC

Medical Leave Status Report

*Is the employee back to work, or coming back to work?

Yes. Return date:

No

*DMC minutes:

DMC comments:

*Schedule next conference (DMC: Day 165)

Signature(s) required from:

DM: Day 60 - 2nd DMC

Medical Leave Status Report

*Is the employee back to work, or coming back to work?

Yes. Return date:

No

*DMC minutes:

DMC comments:

*Schedule next conference (DMC: Day 165)

Signature(s) required from:

DM: Day 30 - 1st DMC

Medical Leave Status Report

*Is the employee back to work, or coming back to work?

Yes. Return date: