Grand Forks County Policy Manual Appendix


Appendix Table of Contents

101 General Introductory Policies
    - Employee Acknowledgement Form
    - Employee Emergency Contact Form
    - Grand Forks County Organizational Chart Coming Soon
    - Notice of Employee Change Form

102 Employee Hiring and Classification Policies

103 Employee Compensation and Timekeeping Policies
    - Direct Deposit Agreement Form
    - Employee Attendance Record Example - County Employees Only
    - Employee Status Change Proccess
    - Employee Status Change Form Department Head Only
    - NDW-R Reciprocity Exemption From Withholding For MN Residents
    - Travel Voucher
    - W-4

Section 4 – Employee Leave Request Forms, Information and FAQs
    - Family Medical Leave
        . FMLA Employee Rights and Responsibilities
        . FMLA Leave FAQ
        . FMLA Leave Request Form
    - Personal Leave of Absence Request Form
    - Shared Leave FAQ
    - Shared Leave Request Form
    - Shared Leave Donation Form

105 Employee Conduct Policies
    - County Emergency Alert System Form
    - Disciplinary Action Report Example Only
    - Employee Warning Notice Example Only
    - Employee Grievance Form Social Services Only
    - Purchasing Card Policy

106 Group Health, Workforce Safety and Other Related Benefits
    - Blue Cross/Blue Shield Group Membership Application Form
    - Risk Management Non-Employee Injury Reporting Form
    - Avesis Vision Brochure
    - Avesis Vision Application
    - MetLife Dental Insurance Brochure
    - MetLife Dental Insurance Application
    - MetLife Dental Certification
    - MetLife Dental Card
    - Life Insurance Enrollment or Change
    - Life Insurance Designation of Beneficiary
    - Workforce Safety Site Phone: 1-800-932-8730
        . Reporting Procedures – Claims
        . Filing an Incident Report When Medical Attention Is Not Being Sought
            Company Name: Grand Forks County
            Company Account Number: 1196351
                Business Name: ND Association Of Counties Inc
        . Filing a First Report of Injury When Medical Attention Is Being Sought
        . Capability Assessment C3
        . Employee Post-Accident Procedure Form C4
        . Designated Medical Provider Form
        . Accident Investigation Root Cause Form
    - Notice of Change ND PERS Only
    - Retirement Membership Application
    - Designation of Beneficiary for Group Retirement Plan
    - Medical Data Release and Waiver
    - Request for Exemption From Mandatory Vaccinations
    - Vaccination Form

Grand Forks County Office Building, 151 South 4th Street, Grand Forks, ND 58201

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