Staff Forms
Workers Compensation
Description
Accident Reporting June 2015
RCCDC's procedure for Employee Injury Reporting
Employer Report of Injury/Illness (DO NOT SEND)
The following form provides information when you CALL
Human Resources regarding an incident or Injury
OMNET Providers
List of LWCC OMNET providers - If employee is in need
of non-emergency medical attention.
Modified Duty Work - Agreement
Agreement of duties within Emloyee's abilities and
medical Restrictions (send copy to HR)
Staff Health Forms
Description
Physical Examination Form
Physical Examination Form to be completed by
Employees own Health Care Provider every three (3)
years
Human Resources
Description
2015 Policy & Procedures (updated 11/18/2015)
RCCDC's 2015 Policy & Procedures
Employee Job Change Request Form
Request for Promotion/Lateral Transfer or Other within
a center or to a different Center
Career Development Plan
 
SCR-1 Disclosure Form Rev 08/15
Department of Education Central Registry Disclosure
Form
(Revised August 2015)
Corrective Action Form
Please contact HR prior to completing this form to
discuss any corrective action needed.
  Online Request to fund training/coursework for
employees wishing to attend a training program,
seminar or pursue a degree/certification.  
Payroll
Description
W-4 (Federal Tax Withholding Form)
Complete W-4 so payroll can withhold the correct
Federal income tax from your pay (2014)
L-4 (State Tax Withholding Form)
Complete L-4 so payroll can withhold the correct State
income tax from your pay
Time Edit Form
Time Edit sheet for both salaried and hourly employees
Leave Buy Back Form
Complete
Leave of Absence
Description
FMLA Procedure
FMLA procedure with steps for Employee, HR, and
Supervisor to take.  
Leave of Absence Form (updated 7/2014)
Complete LOA Form to request Vacation, Sick, Personal
Bereavement, Jury Duty, FMLA Leave of Absence
Certificate of Health Care Provider
FMLA  - Own Serious Illness to be completed by own
Health Care Provider
Certificate of Health Care Provider - Family
Member
FMLA - Serious Illness to be completed by family
member's Health Care Provider
Certificate of Health Care Provider - Extingsy
Leave
FMLA - Certification of Qualifying Exigency for Military
Family Leave
Other Staff Forms
Description
Substitute List
Current list of active and eligible subs *updated 2/4
30 Day Training Videos
Current list of 30 Day Training Videos
Non Employee Accident Forms
Description
Parent Visitor Accident Procedure and Forms
RCCDC's procedure for Parent/Visitor Injury Reporting
Student Accident Procedure and Forms
RCCDC's procedure for Student Injury Reporting
401K - The Standard Forms
Description
Retirement Plan Guide (June 2015)
The Standard Guide to Enrolling in Your Retirement
Plan
Beneficiary Form
The Standard Beneficiary Designation for Death
Benefits
Investing Form
To be completed if enrolling in the Guided or
Independent Plan (Savings Form must accompany)
Managed Savings Form
To be completed if enrolling in The Standards Managed
Plan
Rollover Application Form
Authorization Form to request outside 401K or IRA to
rollover into The Standard 401K account
Savings Form
Pre-Tax Payroll Deduction Form (Investing Form must
accompany)
Supplemental Information Form
Information Form to provide more detailed Savings &
Investment Plan
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