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Resources for employees

Listed below are some of the policies, procedures, forms, and checklists for use by employees at the Polus Center.

Hiring Employees – procedures and forms

New Hire Checklist (Word, 984k)

Pre-offer forms
Application (Word, 284k)
References worksheet (Word, 268k)
CORI Authorization form (Word, 264k)
Employment Eligibility forms (PDF, 380k)
Information for Potential Home Providers (Word, 64k)
Questionnaire for New Providers (Word, 280k)
Summary of Prospective Shared Living Home (Word, 32k)
Home Safety Checklist (Word, 48k)

Making the offer forms
Offer letter (full time) (Word, 468k)
Tax forms (PDF, 164k)
Direct deposit request (Word, 32k)
Change form (Word, 300k)

Orientation and forms to review with new hires
Benefits Summary (full time) (Word, 292k)
Employee Handbook (Word, 846k)
Timecards (Excel, 32k)
Vacation request (Word, 260k)
Check request (Word, 248k)
Petty cash (Word, 276k)
Mileage (Excel, 1.9 Mb)
Purchase order (Word, 404k)
Shared Living Guidelines (Word, 1 Mb)

Part time employees
When hiring a part time employee, all of the same forms and strategies as hiring a full-time employee apply, except for the following:

  • Use the part-time employee offer letter template
  • They receive the part-time employee Personnel policies rather than the full-time policies
  • They do not receive the benefits summary or any related forms such as vacation request

Offer letter (part time) (Word, 468k)
Personnel Policies (Word, 828k)

Hiring and paying a consultant

Procedures for hiring and paying a consultant (Word, 972k)
Consultant vs. employee checklist (Word, 268k)
Statement of Work form (Word, 976k)
Consultant registrar (Word, 276k)
Legal consultant agreement (Word, 40k)

Job descriptions
Care Manager (Word, 48k)
Program Director (Word, 48k)
Community Support Specialist (Word, 36k)
Director of Training and Development (Word, 40k)
Director of Finance and Administration (Word, 40k)
External Trainer & Consultant (Word, 36k)
Office Manager (Word, 36k)
Registered Nurse (Word, 36k)

ADULT FAMILY CARE

ADL / IADL Flowsheet (Excel, 28k)
Agreement to provide service (Word, 1 Mb)
Assessment to stay alone (Word, 1 Mb)
Authorization to disclose health information (Word, 1 Mb)
Caregiver evaluation form (Word, 224k)
Caregiver log (Excel, 36k)
Emergency contact sheet (Word, 1 Mb)
Incident report (Word, 40k)
Intake form (Word, 1 Mb)
Minimum Data Set - Home Care (MDS-HC) (PDF, 112k)
Meal plan (Word, 164k)
Medication list (Word, 1 Mb)
Monthly Expenditure Report (Word, 12k)
Care Manager Monthly Check List (Word, 12k)
Monthly AFC report (PDF, 12k)
Adult Foster Care Semi-Annual Report (Excel, 48k)
Adult Foster Care Monthly Level 2 Report (Excel, 48k)
Nurse Visit Note (Excel, 16k)
Verification of OIG Screening (Word, 1 Mb)
Orientation overview (Word, 1 Mb)
Physician Summary Form (PDF, 24k)
Physician Review Form (Word, 1 Mb)
Request for Services (PDF, 92k)

 

Performance management

Overview (Word, 1 Mb)
Performance review form (general) (Word, 972k)
Support staff review form (Word, 108k)
Performance feedback form (Word, 968k)
Termination checklist (PDF, 659k)

Shared Living forms

Assessment to stay alone (PDF, 92k)
DMR change form (PDF, 128k)
DMR Incident Report (PDF, 68k)
Doctor list (PDF, 52k)
Emergency Evacuation Safety Plan (PDF, 164k)
Emergency fact sheet (PDF, 28k)
Financial Assessment and Agreement (PDF, 76k)
Goal form (PDF, 28k)
Healthcare checklist (PDF, 64k)
Annual ISP health and dental assessments (PDF, 72k)
Health and Dental Summary Tool (PDF, 28k)
Identification sheet (PDF, 40k)
Monthly Rec (PDF, 64k)
Check off List for Notebook (PDF, 28k)
Quarterly report (PDF, 88k)
Reviewed Policies and Procedures (PDF, 24k)
Safety Tool Assessment (PDF, 28k)
Sexual Awareness form (PDF, 60k)
Shared management of funds assessment (PDF, 36k)
Monthly Shared Living Visit Information (Word, 976k)

Evaluations

Shared Living Annual Household Review (Word, 228k)
Cover letter: Guardian (Word, 284k)
Cover letter: Provider (Word, 240k)
Guardian Satisfaction Survey (Word, 1 Mb)
Interviewer’s Comments & Assessment (Word, 32k)
Feedback for shared living households (Word, 972k)
Protocols and Timelines for Evaluations: 2011 (Word, 32k)
Shared Living Home Provider Satisfaction Survey (Word, 220k)
Satisfaction Survey For People Supported in Shared Living (Word, 32k)

Training

An Overview of Social Role Valorization (PDF, 140k)
Person Centered Planning (PDF, 36k)
Massachusetts Community Gateway
Metro Region Training and Development Catalogue - Winter 2012 (Word, 1 Mb)

OTHER Polus forms

Media Consent and Release (PDF, 100k)