avenal community health center · achc new employee packet 5 child abuse reporting responsibilities...

ACHC New Employee Packet 1

Avenal Community Health Center Aria Community Health Center

New Employee Package

Name: _____________________________________ Position: _____________________________________

Start Date: _____________________________________

Check list: 1. _____ New Employee Data Record

2. _____ Application

3. _____ W-4 _______DE4 4. _____ I9 INS

_____ ID #1 ____________________ _____ ID #2 ____________________

5. Current License and Certification _____ Profession ________________

_____ CPR _____ ALS/BLS/ ________________

6. Health Examination Scheduled Date of Exam __________________

_____ Medical History (Employee Physical Form)

_____ Hepatitis B series, T.B., and Influenza (Vaccine Form)

7. Position Documents Reviewed and Signed _____ Abuse Reporting

_____ Confidentiality Policy & Statement (HIPPA)

_____ 10 Step Quick Reference HIPAA Guide (HIPPA) _____ Employee HIPAA Compliance Signature Form (HIPPA)

_____ Disaster Plan (Safety) _____ Chain of Infection and Hand Washing Techniques (Infection Control)

_____ Blood Borne Pathogens and Flow chart of “How to Report Exposure”

_____ Policies & Procedures

_____ Attendance & Punctuality Policy Acknowledgment _____ Policy on Gossip, Rumors, and Innuendo _____ Chaperone Policy _____ Non Fraternization Policy _____ Employee Manual (Need signed acknowledgement page) _____ Safety Checklist

8 _____ Notice To Employee Form

_____ Job Description Signed Off Form


Employee Data Record CONFIDENTIAL To Be Filed in Separate Medical File Name Social Security

#

- -

Last First Middle

Please Complete this New Employee Data Record. It will supply us information needed for our payroll and benefits programs.

Present Address City State Zip Phone( )

Previous Address City State Zip Phone( )

How long at present address? How long at previous address?

In Case of Emergency Notify: (Please Print) (Relationship) 1. Name Phone (Day): ( )

Address Phone (Night): ( )

City State Zip (Relationship) 2. Name Phone (Day): ( )

Address Phone (Night): ( )

City State Zip

Personal Data

Date of Birth / / Sex: □ Male □ Female

Have you ever been employed here

before?

□ Yes □ No If yes, give

dates:

From / / To /

/

List any friends or relatives working for us

Have you ever been

bonded?

□ Yes □ No

If yes Please Explain

Voluntary Information

Marital Status □ Single □ Married □ Separated □ Divorced □ Widowed

Name of Spouse Number of Dependents including yourself

Dependent Children:

Name Sex Age Name Sex Age

1. 3.

2. 4.


Physical

Are you requesting reasonable accommodation to assist you to perform the essential functions of the job?

□ Yes □ No

If yes, what reasonable accommodation do you believe will assist you in performing the essential functions of the job?

Military Were you in the U.S. Armed Forces? □ Yes □ No If yes, which branch?

Rank at time of discharge?

List duties and special training

Your Reserve Status? Your Draft Status?

Do you have a military obligation that would affect your work schedule?

□ Yes □ No

General

List any foreign language(s) you know and check the boxes that describe your ability.

Speak Some Speak Fluently Read Write

□ □ □ □

□ □ □ □

□ □ □ □

List any professional, trade, business or civic associations and any offices held. (Exclude memberships which would reveal

sex, race, religion, national origin, age, color, disability or other protected status.)

Organization Offices Held

List special accomplishments, publications, awards and licenses, (Exclude information which would reveal sex, race, religion, national origin, age, color, disability or other protected status.)

List hobbies and interests


Educational and Work Experience Educational: List your last three (3) schools attended, starting with the most recent.

Name and Location Years Completed Did you Graduate? Course of Study

Major Degree

Work Experience: List your last three (3) employers, starting with the most recent.

Company Name Address Phone Supervisor Pay Rate

( ) $_____.__ per __

( ) $_____.__ per __

( ) $_____.__ per __

Signed ____________________________________________________________ Date ___________________


Child Abuse Reporting Responsibilities With concern or the total well being of each patient, all employees of ACHC are directed to report known or suspected incidences of child abuse in accordance with state law and district regulations. Employees shall cooperate with the child protective agencies responsible for reporting, investigating and prosecuting cases of child abuse. All employees are considered Mandated Reporters of abuse or neglect. Employees shall report known or suspected child abuse to a child protective agency by telephone immediately or as soon as practically possible and in writing within thirty-six (36) hours. The reporting duties are individual and cannot be delegated to another individual. Definition 1. Child Abuse, as defined by law, includes the following: a. Physical abuse resulting in a non-accidental physical injury.

b. Physical neglect, including both severe and general neglect, resulting in a negligent treatment or maltreatment of a child. c. Sexual abuse including both sexual assault and sexual exploitation d. Emotional abuse and emotional deprivation including willful cruelty or unjustifiable punishment e. Severe corporal punishment

2. Mandated Reporters are those people defined by law as child custodians, medical practitioners and non-medical practitioners and include virtually all school employees. The following clinic personnel are required to report: doctors, nurses, medical assistants, receptionists, and counselors. 3. Reasonable Suspicion means that it is objectively reasonable for a person to entertain such a suspicion, based upon facts that could cause a reasonable person in a like position, drawing when appropriate on his/her training and experience, to suspect child abuse (Penal Code 11166). Reporting Procedures To report known or suspected child abuse, employee shall report by telephone to the local child protective agency: Child Protective Services 1200 South Drive Hanford, CA 93230 Phone 582-3211 or 582-3241 The telephone report must be made immediately, or as soon as practically possible, upon suspicion. The verbal report will include: a) name of the person making the report, b) name of the child, c) present location of the child, d) nature and extent of any injury, e) any other information requested by the child protective agency, including the information that led the mandated reporter to suspect child abuse.

___________ Initials

At the time the verbal report is made, the mandated reporter shall note the name of the official contracted, the date and time contracted and any instructions or advice received. Within 36 hours of the telephone report, the mandated reporter must complete the mail a written report


to the local child protective agency. The written report shall include completion of the required standard Department of Justice Form (DOJ SS 8572) available in the nurses’ station. Employees reporting child abuse to a child protective agency are encouraged, but not required, to notify the site administrator or designee as soon as possible after the initial verbal report by telephone. If requested by the mandated reporter, the site administrator may assist in the completion and filing of forms necessary for reporting. If the mandated reporter chooses not to disclose his/her identity, s/he shall provide a copy of the written report without his/her signature or name. Legal Responsibility and Liability 1. Mandated Reporters have absolute immunity. Employees required to report are not civilly or criminally liable for filing a required or authorized report of known or suspected child abuse. 2. A mandated reporter who fails to report an instance of child abuse, which he/she knows to exist or reasonable should know to exist, is guilty of a misdemeanor and is punishable by confinement in jail for a term not to exceed six (6) months or by a fine of not more than one thousand dollars ($1,000) or both. The mandated reporter may also be held civil liable for damages for any injury to the child after a failure to report. 3. The duty to report child abuse is an individual duty and no supervisor or administrator may impede or inhibit such reporting duties. Furthermore, no person making such a report shall be subject to any sanction.

_________ Initials



Confidentiality Policy & Statement

Avenal Community Health Center is committed to the principal of fair and ethical business practices and to ensuring confidentiality of records and related information for all patients, employees and other clinic business. Avenal Community Health Center gives full consideration to patients’ rights for privacy concerning all aspects of their health care. All communications regarding their care will be treated as confidential information. Access to any of the information is to be limited only to individuals who have a legitimate purpose for the use of any given information. All employees, volunteers and contracted providers who have access to information about patients, employees or clinic operations which is of a confidential nature, will be prohibited from discussing or revealing such information in any unauthorized manner. Any breach of confidentiality (i.e. the unauthorized discussing or revealing of patient, employee or clinic operating information), represents a failure to meet the professional and ethical standards expected of all employees and constitutes a violation of this policy. If it is determined that a breach of confidentiality has occurred, the employee may be subject to disciplinary action, up to and including termination or employment. This breach need not take the form of a deliberate attempt of breach of confidentiality, but will include an unnecessary or unauthorized informal discussion of a confidential matter (i.e. informal dialogue in the break room or hallways) for which the same rules will apply. This policy and requirement to maintain confidentiality extends beyond the hours of work and beyond the term of your employment at Avenal Community Health Center. I hereby acknowledge receipt of this confidentiality policy, and I agree to be bound by such policy, as stated above. ________________________________________________ ______________________ Signature Date ________________________________________________ ______________________ Witness Date


10 STEP QUICK REFERENCE HIPAA (PRIVACY) GUIDE (post in an accessible and prominent office location)

1. Use lowered voice for all verbal communication that might disclose personal health information.

2. Never “call out” any information that might be considered as personal, e.g. tests

required or taken, test results, medications, devices used, etc. 3. Do not allow computer screens to be viewed, intentionally or unintentionally, by

unauthorized persons. 4. Exit all programs that might contain personal health information when leaving a

computer workstation for a period of time. 5. Be certain that “sign-in” sheets do not require “reason for visit” information. 6. All chart holders must effectively obscure patient information. 7. All email, written and faxed personal health information (PHI) must be clearly marked

“confidential” and contain a privacy warning. 8. Never leave files or folders open or unattended. Filing cabinets etc. containing PHI must

be secured and locked. 9. Do not share computer passwords. Change them regularly. 10. Take every precaution to control personal health information.

________ Initials


EMPLOYEE HIPPA COMPLIANCE SIGNATURE FORM Employee: _____________________________________________ Date: _________________________

My Commitment to Compliance: I have read and understand our office’s Employee HIPAA Compliance manual. I agree to do all I can, within my area of responsibility to maintain up-to-date knowledge about federal and state laws and program requirements. I will comply with these requirements to the best of my ability, and to immediately let the Compliance Officer know if there is any where I feel our office is not in Compliance with these laws and program requirements. Our policy is a simple, yet powerful four-step process: Keep Up-to-date, educate comply, and audit/correct.

a. We seek to maintain up-to-date knowledge about federal and state law pertaining to protection of our patients Protected Health Information.

b. We educate our employees and keep them up-to-date about federal and state

law as it applies to Protected Health Information. c. Our policy is to comply with all federal and state law governing Protected Health

Information. We desire that all our employees are particularly cognizant of the fact that protected health information must be treated with utmost attention, accuracy, honesty, and integrity. We seek to educate and carry out these policies with all our employees, managers, clinicians, and where appropriate contractors and other agents. I agree with our policy and will do all I can to comply with all regulatory laws pertaining to personal health information. In understand that our office has an open door policy and I may discuss any problems I feel may occur with PHI without worry of recourse with my supervisor or other supervisors. __________________________________ __________________________________ Signature of Employee Signature of Compliance Officer



Policy & Procedure

DISASTER PLAN

The Clinic has developed emergency plans to handle casualties in the event of an internal or

local disaster. Every employee within the Clinic must function according to the plan in time of

disaster. All employees are required to know the disaster plans, and to be able to implement it

on a moment’s notice.

For an internal disaster, all patients and employees will evacuate the building, and congregate

in the parking lot in the safest spot near the center island. The receptionist will bring the patient

sign-in/check-out sheet to verify that all patients are accounted for. The Administrator or other

designated person will take roll call of the employees.

All employees will be in serviced on the disaster plans and on appropriate skills needed during a

disaster (i.e., use of a fire extinguisher). Disaster drills will be conducted at least semi-annually.

At least one of those drills should mock an earthquake. Review of the Disaster plan and compliance will occur annually. Evidence of such review shall

be the signed review of these policies and procedures.

_________ Initials


Avenal Community Health Center 1000 Skyline Boulevard • P.O. Box 700 • Avenal, CA 93204-0700 • Phone (559)386-4500 • (559)386-0550

Each of you will play an important part in preventing the spread of infection. Observe the following infection control principles to protect yourself and others from infections. In order to know how to control

or prevent infections, you should first have a basic understanding of how infections are transmitted, or passed from on person to another. The “Chain of Infection” illustrates this process, and your role is to

break the “Chain of Infection”.

In order for an infection to be passed to another al six of the links of the chain must be present.

Microorganism Carrier Way Out Travel Way In Susceptible Person 1. A MICROORGANISM (virus, bacteria, fungus) that causes the infection. 2. A CARRIER is a patient or health-care worker, who carries the microorganism.

3. A WAY OUT of the carrier, such as coughing, sneezing, etc. 4. A METHOD OF TRAVELING such as though the air, through direct physical contact or through

contaminated hands, linens, towels, instruments, bandages, etc.

5. A WAY INTO ANOTHER PERSON, such as breathing, swallowing, or a break in the skin. 6. A SUSCEPTABLE PERSON who doesn’t have resistance and becomes infected.

INFECTION CONTROL MEASURES BREAK THE INFECTION CHAIN by reducing the number of

microorganisms, controlling travel, using barrier precautions to prevent entry into another person, and

immunizing susceptible employees against vaccine preventable illness.

HANDWASHING or USE OF ALCOHOL-BASED HAND RUBS is the single most effective way to stop the spread of infection (break the chain of infection

Wash or gel your hands when:

• You arrive at work

• After using the restroom

• Before eating, drinking or handling food

• After patient contact

• After touching blood, body fluids,

secretions, excretions, and contaminated items, whether or not gloves are worn.

• Immediately after gloves are removed

• Note: Hands must be washed when

they are visibly soiled or exposed to blood or OPIM (other potentially

infectious materials).

How to wash your hands:

• Wet your hands with warm running water.

• Keeping hands lower than elbows, apply hand washing agent.

• Distribute hand washing agent thoroughly

over hands

• Vigorously rub hands together for at least

10-15 seconds covering all surfaces of the

hands and fingers with particular

attention to -----

the fingertips and nails

• Rinse under running water.

• Dry hands with a single use paper towel.

• Use paper towels to turn off the faucet

(this helps keep your hands clean not touching the dirty faucet).

How to gel your hands:

• Apply to palm of one hand. • Rub hand together covering all areas of

hands and fingers until hands are dry. _____________ Initials


Blood Borne Pathogens Question and Answer

What is a Blood borne Pathogen? Name two

1.

2.

Define Universal Precautions

Give at least 3 examples of workers who are at risk of exposure to blood borne pathogens:

1.

2.

3.

List three ways exposure to blood borne pathogens commonly occurs.

1.

2.

3.

Describe at least 5 key aspects of a blood borne pathogen Exposure Control Plan:

1.

2.

3.

4.

5

Name three PPEs: 1.

2.

3.

List three important steps to take if exposed to a blood borne pathogen: 1.

2.

3.

Print Name

Signature and Date



Policy & Procedures

ACKNOWLEDGEMENT

I have reviewed the Policy and Procedures for Avenal Community Health Center, outlining both

my privileges and obligations as an employee. I understand that I am responsible for reading

and familiarizing myself with the material in the Policy and Procedures, which describes the

policies governing my employment. I further understand that the Clinic may, at its sole and

absolute discretion, with or without prior notice, supplement or rescind the rights and

responsibilities identified in the policy and procedure manuals.

No statement(s) in this Policy or in other statement(s) of policy, including statements made

during performance appraisals, are to be construed either as an expressed or implied promise

of continuing employment.

Employee Printed Name Employee Signature Date Within 30 days of hire, and annually thereafter, each employee will review the following: 1. Clinic Policy and Procedures 2. Disaster Plan 3. Infection Control Procedures 4. Safety Manual 5. Employee Handbook This review is a prerequisite for continued employment. By signing below, the employee acknowledges that they have reviewed the documents noted above. Employee Printed Name

Employee Signature Date


Avenal Community Health Center 1000 Skyline Boulevard • P.O. Box 700 • Avenal, CA 93204-0700 • Phone (559)386-4500 • (559)386-0550

Memo: GOSSIP Gossip can occur from misunderstandings or from someone who is intent on being destructive or hurtful. The initiation or perpetuation of gossip is a waste of time and energy, and is completely unacceptable! Recent surveys show that gossip is one of the top three complaints found in the workplace. When people feel betrayed by malicious or unfounded rumors and gossip, the entire clinic can suffer. Low morale and contention can affect patient care. In addition, gossip outside the office can put the practice at risk for unauthorized disclosure of protected health information, and are destructive to the reputation of individuals and the organization. Though the word ‘Gossip’ does not appear in our Employee Policy Manual, it would fall under at least the ‘Harassment’ section on page 12, which starts with sentence ...’Our clinic prohibits any form of harassment.’ Each and every person serving in our organization is required to acknowledge that if you initiate or perpetuate gossip, rumor or innuendo, you may be disciplined, up to and including immediate termination. Due to the nature of gossip, this will apply whether you participate in gossip in the workplace or anywhere else. Please feel free to ask questions or make comments to your supervisor or administrative personnel. I acknowledge I have read this memo, and understand that if I initiate or perpetuate gossip, rumor or innuendo, I may be disciplined, up to and including immediate termination. Signature ____________________________ Date: ____________________ Print Name___________________________


Policy Document – Attendance and Punctuality

Prepared by: Bonnie Ross Approved by: John Blaine

Effective Date: 04/08/2013 Revision date:

Purpose

The purpose of this policy is to establish attendance guidelines for all employees, provide clear expectations and communicate explicit consequences for failure to adhere to this policy.

Scope

This policy applies to all Avenal Community Health Center (including Aria Lemoore, Stratford and

Kettleman City) personnel. ACHC management is responsible for ensuring compliance with this policy.

Policy

It is the policy of Avenal Community Health Center to establish reasonable and necessary controls to

ensure adequate attendance and to meet clinic and patient needs.

Punctual and regular attendance is an essential responsibility of each employee. Any tardiness or

absence causes problems for fellow employees, management and most of all patients. When an employee is absent, others must perform their work, which diminishes the level of quality service we

strive to provide in our clinics.

Employees are expected to report to work as scheduled, on time and prepared to start work. Employees

also are expected to remain at work for their entire work schedule. Late arrival, early departure, or other absences from scheduled hours are disruptive and should be avoided.

Definitions

1. Absence: the failure of an employee to report for work when the employee is scheduled to

work. a. Excused Absence occurs when all four of the following conditions are met: i) the

employee requests scheduled time off or provides sufficient notice to management, ii) the reason is found credible or acceptable by management, iii) such absence request is

approved by management, and iv) the employee has sufficient accrued PTO time to cover such absence. Employees should use earned PTO time for every absence unless otherwise

allowed (e.g. Bereavement, Jury Duty, etc.) or prohibited (accrued PTO not sufficient) by

company policy and management discretion. b. Unexcused Absence occurs when one of the four conditions in “excused absence” is not

met. If it is necessary for you to be absent or late for work because of illness or an emergency, you must notify management as soon as possible but no later than 30 minutes

prior to the employee’s scheduled starting time on that same day.

2. Sufficient Notice: to be considered an excused absence as defined in 1. a, sufficient notices must

be given to management. Sufficient notice is: a. For a scheduled absence of 8 hours or more, employees must give a notice of one week (7

days).


b. For a scheduled absence of less than 8 hours, employees must give a notice of two working days. (No exceptions).

c. For an emergency absence occurring i) at the beginning of the employee’s shift, employees must notify management within 30 minutes prior to the beginning of their shift and ii) during

the employee’s shift, employees must notify management prior to leaving the premises.

3. Tardiness: You are expected to report to work on time and can clock-in up to 5 minutes prior to

the start of your shift. If you can’t report to work as scheduled, you should notify management no later than your regular starting time. This notification does not excuse the tardiness but simply

notifies management that a schedule change may be necessary. a. There is a 5-minute grace period in the morning and when coming back from lunch.

Management will track when this grace period is used in excess, more than 12 times in one year. Once an employee has used 10 grace period allowances, they will forfeit use of a grace period and any tardiness will be counted toward the excessive determination.

Procedure

1. All unexcused absences and excessive tardiness are subject to corrective discipline as follows:

More than two per month Verbal Warning

More than three per month Written Warning

Continued excessive absenteeism, tardiness or

shortened shift after prior written warning.

Subject to Termination

2. General guide to excessive determination:

Unexcused Absences 2 or more instances in a calendar

month or any 10 instances in a

calendar year.

Tardiness 3 or more instance of lateness in a calendar month or any 12 instances of

lateness in a calendar year.

Tardiness - Grace Period 3 or more instance of lateness (up to 5

minutes) in a calendar month or any 12 instances of lateness (up to K

minutes) in a calendar year.

Shortened shift Should not exceed one instance per

month or five instances in a calendar year.

3. Any employee who fails to report to work without notification to management for a period of two or more days will be considered to have voluntarily terminated their employment with ACHC.

4. ACHC reserves the right to require an employee to submit a physician’s certificate in the event of

repeated absences for the medical reasons or in the event of medical absences exceeding three days.

5. PTO must be used in increments of at least two hours, therefore scheduled time off must be

requested for at least two hours. ACHC requires that all full time employees take 40 consecutive

hours each year with a minimum of two weeks advanced written request to management. All other accrued PTO can be used for excused absences.


AVENAL COMMUNITY HEALTH CENTER

Attendance and Punctuality - Policy

Attendance and Punctuality Policy Acknowledgement

I have read and been informed about the content, requirements, and expectations of the attendance

policy for employees at Avenal Community Health Center. I have received a copy of the policy and agree

to abide by the policy guidelines as a condition of my employment and my continuing employment at

Avenal Community Health Center. I understand that if I have questions, at any time, regarding the

attendance policy, I will consult with the appropriate management of the clinics.

Please read the policy carefully to ensure that you understand the policy before signing this document.

Employee Signature: _______________________________________

Employee Printed Name: ____________________________________

Date: _________________________


Avenal Community Health Center

1000 Skyline Blvd. ● PO Box 700 ● Avenal, Ca 93204 ● Phone (559) 386-4500

SECOND MEAL PERIOD WAIVER

FOR NON-EXEMPT EMPLOYEES WORKING A 10 HOUR SCHEDULE

The law allows for two unpaid uninterrupted thirty (30) minute meal periods in a ten-hour work day. Our Health Clinic policy is that that a 60-minute meal period is to be taken no later than 4.59 hours from the beginning of a shift. The law allows my employer and me to agree to waive the second scheduled meal period if I do not work more than twelve (12) hours in a worked day. I voluntarily agree with my employer to waive the second meal period when I work ten (10) hours, however, if I do work more than twelve (12) hours a day I must take both meal periods. By waiving the second meal period, I understand that I am not entitled to a second uninterrupted thirty (30) minute unpaid meal period in the workday. I understand that this agreement will valid until revoked. I also understand that this second meal period waiver is not a guarantee that I will work more than ten (10) hours in any work day. I further understand that I can revoke the second meal period waiver at any time. By signing below, I acknowledge that I have read this agreement and waiver, fully understand it, and voluntarily agree to its provisions. ________________________________ Dated: Employee Signature Dated: Print Employee Name Dated: Witness



1000 Skyline Blvd. • P.O. Box 700 • Avenal, CA 93204 • Ph. 559 386-4500 • Fax 559 386-0999

Policy and Procedure: Chaperones Effective Date: 6/15/2011 Revised Date: 01/05/2013 Approved by: John Blaine, CEO Dennis C. Smith, MD, Medical Director Policy When disrobing or gowning is necessary, a chaperone to both male and female patients will be present; for example, genitalia, rectal or breast examinations. Additionally, anytime a staff member considers it necessary for the protection of the provider, patient or clinic, a chaperone shall be requested and utilized. Purpose Establish procedures that ensure the comfort of patients during physical examinations or patient visits when gowning or disrobing is necessary and to protect against a patient misinterpreting the purpose or method of an examination. Chaperone Defined: A chaperone is a person who witnesses both a patient and a medical practitioner during a medical examination or procedure when gowning or disrobing is necessary. Procedure:

• Communicate the chaperone policy to patients who are asked to disrobe for a medical examination or procedure.

• Provide a gown or appropriate drape to cover exposed areas.

• Instruct the patient the minimum number of garments that must be removed in order to conduct the given examination.

• Leave the patient alone in the examination room to disrobe, unless the patient requires assistance. If a patient requires assistance, ask a co-worker to help you assist the patient.

• When a reasonable time has passed, knock on the examination room door to announce your re-entry into the examination room.

• Educate the patient about the reasons and methods for examination. A conversation between provider and patient before the examination and/or a brochure that explains both will help alleviate patient concerns. Such education can also protect against a patient misinterpreting the purpose or method of an examination.

• At the time of the visit, the chaperone must record their name on the patient record to indicate their role as a chaperone.

• Any variance from acceptable or expected conduct by provider or patient will be immediately reported to the supervising physician and administrator.


_____

Avenal Community Health

Center 1000 Skyline Blvd. • P.O. Box 700 • Avenal, CA 93204 •

Ph. 559 386-4500 • Fax 559 386-0999

SICK LEAVE

Eligibility. The Company will provide paid sick leave to all employees in accordance with the Healthy Work Places/Healthy Families Act of 2014 to eligible employees. All employees who, on or after July 1, 2015, work in California for thirty (30) or more days within a year from the beginning of employment are entitled to begin accruing paid sick leave. Employees are only eligible to use accrued sick leave beginning on their 90th day of employment by the Company.

Use. Sick leave may be taken for personal illness, diagnosis, care or treatment of an existing health condition, or preventive care for the employee or a family member; or for specified purposes for an employee who is a victim of domestic violence, sexual assault, or stalking, as authorized by law. Employees may use a maximum of twenty-four (24) hours paid sick leave per year. Sick leave shall be used in increments of at least two (2) hours. Employees who exhaust their sick leave or use the maximum amount of twenty-four (24) hours per year, may use accrued vacation time in place of sick leave.

Accrual of Sick Leave. Following completion of work in California for thirty (30) days and not earlier than July 1, 2015, whichever date is later, employees will accrue sick leave at the rate of one (1) hour for every thirty (30) hours worked.

Carry Over and Cap On Accruals. Unused accrued sick days shall carry over to the next year and may accrue up to a maximum accrual cap of 48 hours. Once the maximum accrual cap is reached, no further sick time will accrue.

Approval. Whenever possible (e.g., for a scheduled doctor or dentist appointment), employees must seek approval from their immediate supervisor prior to taking their sick leave. Otherwise, employees must notify their immediate supervisor as soon as practicable and in no event later than one half hour prior to their scheduled starting time, if they will not be into work due to illness or a covered absence. Employer may require a doctor’s note for sick leave usage. Compensation for Sick Leave. Eligible employees will receive pay at their normal base rate for any earned sick leave taken; up to twenty-four (24) hours per year. Employees will not be paid for any unused accrued sick leave upon termination of employment.

Initial



1000 Skyline Blvd. • P.O. Box 700 • Avenal, CA 93204 • Ph. 559 386-4500 • Fax 559 386-0999

SICK LEAVE

Acknowledgement Receipt

The undersigned employee acknowledges receipt of a copy of the Avenal Community Health Center (“Company”) Sick Leave. It is understood that the Employee Handbook and all amendments are intended as a reference document summarizing the Company’s personnel policies, guidelines, procedures and benefits. It is understood that the Company may modify or rescind any personnel policies, guidelines, procedures or benefits described in the Employee Handbook at any time without prior notice to any employee.

It is further understood that the language contained in the Company Handbook or any Amendments is not intended to, and does not, create a contract or covenant between employer and employee, express or implied, and that employment and compensation are for no fixed term and may be terminated, with or without cause or notice, at any time at the option of the employer or employee. No person other than the owner of the Company has the authority to enter into any written or oral agreement contrary to the foregoing. Name (Please Printe) Employee Signature Date


Amendment to Avenal Community Health Center Employee Handbook

(July 22, 2016)

Non Fraternization Policy

To promote the efficient operation of Avenal Community Health

Center’s business and to avoid misunderstanding; complaints of

favoritism; other problems of supervision, security, and moral; and

possible claims of sexual harassment, managers and supervisors,

and other employees in supervisory capacities, are forbidden from

dating or pursuing romantic or sexual relationships with

employees whom they supervise, directly or indirectly. Employees

who violate this guideline will be subject to discipline up to and

including termination of employment.

By signing this document, you acknowledge receipt of Employer’s Non-

Fraternization Policy (“Policy”) and agree to comply with the Policy.

__________________________________ _______________

Employee’s Signature Date

___________________________________

Employee’s Printed Name


PLEASE PROVIDE IDENTIFICATION FOR THE USCIS FORM I9


PLEAS


Employee Signature Sheet & ACKNOWLEDGEMENT AGREEMENT

I understand that this policy manual was presented to me as information only and does not represent any legally binding contract. I also understand the following 5 points are an integral part of the Policy manual and my acceptance of employment.

1. The “Handbook and Policy Manual” can be updated and changed from time to time and I will review the manual on a regular basis.

2. The “Employee Handbook and Policy Manual” does not represent an employment agreement,

contract or perpetual guarantee of employment.

3. The employment arrangement between employer and employee is defined as an “at will” arrangement. Either the employee or employer can terminate employment for any reason or no reason.

4. This “at will” status can only be changed by written agreement between employee and

employer.

5. This form covers the entire agreement between employee and employer and there are no promises or understandings that it does not cover.

Signing this form indicates that the employee has received the “Employee Handbook and Policy Manual” and has read the above 5 statements.

Please initial to verify that you have read and understand the following policies; _____ Child Abuse Reporting Responsibilities _____ Confidentiality Policy _____ HIPAA Guidelines _____ Disaster Plan _____ Gossip Policy _____ Non Fraternization Policy _____ Sensitive Services & Minor Rights _____________________________ ____________________________ Employee Employer __________ __________ Date Date