Page 12 - HR Solutions Catalog

Medical Record Folders

Employee Management Forms

Employee medical records must be filed separately — it’s federal law. A number of federal laws, including the Americans
with Disabilities Act (ADA), Family and Medical Leave Act (FMLA), Health Insurance Portability and Accountability Act (HIPAA), Brought to you by ComplyRight™
Genetic Information Nondiscrimination Act (GINA) and Occupational Health and Safety Administration (OSHA), require
employers to maintain the confidentiality of employee medical information. These records must be stored in
dedicated folders and not in employees’ personnel files. ■ What It Is:
Easy-to-use tools to assist businesses in managing employees, addressing
HR challenges and maintaining government compliance — from attendance
tracking to hiring and harassment training.

■ Who It’s For:
Businesses of all sizes can benefit from these expert-developed, fully compliant

tools. From performance evaluations to state-compliant job applications, we serve
as a one-stop shop to make employee management easier.

■ Why Sell It:
Every employer faces HR and employee management challenges. To get ahead

of their day-to-day responsibilities, they need smart tools. You can be a valued
resource for practical, expert-developed solutions.

Bestseller
■ When to Sell:
Confidential Employee Medical Records Folder
Year-round.
Confidential Employee Medical Records Folders are perfect for storing required FMLA forms
and for documenting accident and illness information as required by OSHA
A2211 – Standard Payroll Change Notice
A3325 – Expanded Capacity
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Date ______________ ID # ______________________________ Department _______________________________________
3
Price per pkg/25. Size: 9 3 / 8" x 11/ 4". Expanded: 1½" expansion. Employee Name ________________________________________ Title _____________________________________________
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Social Security # ________________________________________ Date Effective: _________________ Attendance Calendar™
Check Appropriate Box: Absence Codes
A – Additional Hours J – Jury Duty T – Tardy Name: ______________________________________________________
■ Add to Payroll ■ Change Withholding Rate (Complete new W-4 form) – Bereavement K – Termination U – Unexcused Last First Middle
B
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C – Partial Hours Worked L – Leave of Absence V – Vacation Department: _______________________ Hire Date:________________
■ Change Rate Old Rate: _________________ per _________ ■ Change Status to: D – Doctor’s Appointment LE– Left Early X – Illness in the Family
( )
E – Excused
New Rate: _________________ per _________ ■ Full-Time ■ Part-Time ■ Temporary F – FMLA LO– Layoff Y – Floating Holiday Position: ____________________________ Phone #:________________
Z – Last Day Worked
M – Military Leave
■ Remove from Payroll ■ Leave of Absence: Paid? ■ Yes ■ No G – Injury on Job N – No Call/No Show __– _______________________ Employee/Payroll #: ___________________________________________
H – Holiday
P – Personal
__– _______________________
■ FLSA Reclassification Return (Date of return to work) _________________________ S – Suspension = Legal Public Holidays Vacation Time: _____________________ Sick Time:________________
I – Illness - Self
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■ Change Title to: ■ Address/Information Change _______________________ T February March
January
__________________________________________________
M

S
Orthodontic Patient File Folders ■ Transfer to: (Department) __________________________________________________ 1 8 W 2 9 T 10 3 F 11 4 S 12 5 Total S 3 M 4 T 5 W 6 T 7 F 1 8 S 2 9 Total S 3 M 4 T 5 W 6 T 7 F 1 8 S 2 9 Total

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7

__________________________________________________
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Record personal data, case details and insurance ■ Change Shift to: _____________________________________ __________________________________________________ 22 23 24 25 26 17 18 19 20 21 22 23 17 18 19 20 21 22 23

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information on the outside for easy access. New Hire Information 27 28 29 30 31 24 25 26 27 28 24 31 25 26 27 28 29 30
Notes _____________________________________________
Address ___________________________________________________________________________________________________ Notes _____________________________________________ Notes _____________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Item No. A1048 Telephone # _______________________________________________ Date of Birth (For administrative use only) ________________ May __________________________________________________
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April
June
Status: ■ Full-Time ■ Part-Time ■ Full-Time Temporary ■ Part-Time Temporary S M T W T F S Total S M T W T F S Total S M T W T F S Total
Price per pkg/25. Standard: 11¾ x 9½". 1 2 3 4 5 6 1 2 3 4 1
■ Exempt ■ Non-Exempt ■ Hourly ■ Other _______________________________________ 8
7 9 10 11 12 13 5 6 7 8 9 10 11 2 3 4 5 6 7 8
W-4 attached? ■ Yes ■ No 14 15 16 17 18 19 20 12 13 14 15 16 17 18 9 10 11 12 13 14 15
Rate of Pay ___________________ Per __________________ 21 22 23 24 25 26 27 19 20 21 22 23 24 25 16 17 18 19 20 21 22
28 29 30 26 27 28 29 30 31 23 24 25 26 27 28 29
30
Reason for Payroll Change: Notes _____________________________________________ Notes _____________________________________________ Notes _____________________________________________
__________________________________________________ __________________________________________________ __________________________________________________
Merit Increase See Performance Appraisal New Employee __________________________________________________ __________________________________________________ __________________________________________________
July
Promotion Other __________________________________________________________________________________ August September
S M T W T F S Total S M T W T F S Total S M T W T F S Total
1 2 3 4 5 6 1 2 3 1 2 3 4 5 6 7
Reason for Termination:
7 8 9 10 11 12 13 4 5 6 7 8 9 10 8 9 10 11 12 13 14
Voluntary Discharged Laid Off Other 14 15 16 17 18 19 20 11 12 13 14 15 16 17 15 16 17 18 19 20 21
Comments: __________________________________________________________________________________________________ 23 24 25 26 27 18 19 20 21 22 23 24 22 23 24 25 26 27 28
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____________________________________________________________________________________________________________ 30 31 25 26 27 28 29 30 31 29 30
____________________________________________________________________________________________________________
Notes _____________________________________________ Notes _____________________________________________ Notes _____________________________________________
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Submitted By: _________________________________________ Title ______________________________ Date ______________
__________________________________________________
__________________________________________________
__________________________________________________
12 Recordkeeping Folders Approved By: _________________________________________ Title ______________________________ Date ______________ T W T F S Total November T W T F S Total December T W T F S Total 13
Employee Management Forms
October
S
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M
S
M

S
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This product is designed to provide accurate and authoritative information. However, it is not a substitute for legal advice and does not provide
legal opinions on any specific facts or services. The information is provided with the understanding that any person or entity involved in creating, 6 7 8 9 10 11 12 3 4 5 6 7 8 9 8 9 10 11 12 13 14
producing or distributing this product is not liable for any damages arising out of the use or inability to use this product. You are urged to consult
©2016 ComplyRight, Inc. an attorney concerning your particular situation and any specific questions or concerns you may have. 13 14 15 16 17 18 19 10 11 12 13 14 15 16 15 16 17 18 19 20 21
A0394 Important note: This is approved for use by the purchaser only. This form may not be shared publicly or with third parties.
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Notes _____________________________________________ Notes _____________________________________________ Notes _____________________________________________
__________________________________________________ __________________________________________________ __________________________________________________