POLICY#: A-031
MEAL REIMBURSEMENT
PAGE2
4. Refreshments such as doughnuts, fruit and juice may be purchased for non-routine special activities, such as training sessions, committee meetings, etc.
5. The City Manager or Department Director may authorize the purchase of food for City sponsored community activities.
6. The City Manager or Department Director may authorize the purchase of food when reasonably necessary to support a public safety operation or incident involving City employees and/or personnel from other agencies.
7. Meals shall not qualify for reimbursement if an employee is attending a conference or training outside the City, which does not involve overnight travel, and the employee obtains the meal outside of the conference or training session unless it is necessary to conduct City business. Under IRS rules, reimbursement for any such meal not necessary to conduct City business would qualify as taxable income.
8. City funds shall not be used to purchase meals for employee activities unless approved by the City Manager for special circumstances related to employee recognition activities.
9. This policy is not intended to supplant California Commission on Peace Officer Standards and Training (POST) regarding POST sponsored training.
10. Policy A-12 - Travel shall be referred to for provisions regarding reimbursement of meal expenses associated with overnight travel.
City Manager
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY#: A-032 SUBJECT: SMOKING AND TOBACCO USE --------- 1 SS U ED: 10/1/09 --------- EFFECTIVE: 10/1/09 CANCELLATION DATE: _______ NI'"'"""~-----
SUPERSEDES: New -------
POLICY:
Smoking of cigarettes,. cigars, pipes or any tobacco product and use of chewing tobacco by City employees shall be restricted to designated times and locations in order to ensure that such activities:
1. Are consistent with Federal, State and~ocal laws;
2. Are respectf1;1I of the rights, health and considerations of other employees and the public;
3. Ensure safe and sanitary practices;
4. Protect and maintain public property; and
5. Do not present- a negative image of the City, its employees and operations to the public.
PROCEDURE:
1. Smoking and use of chewing tobacco by employees during work hours while on duty shall be. allowed only during designated break times. Smoking and use of chewing tobacco by employees shall not be allowed during the performance of work duties.
2. Smoking and use of chewing tobacco by employees shall not be allowed in or within 20 feet of any City building.
3. Smoking and use of chewing tobacco by employees shall not be allowed in any City vehicle (See Policy A-10 Use of City Vehicles).
4. Smoking and use of chewing tobacco by employees shall not be allowed in any City park or open space area.
POLICY#: A-oat031-
SMOKING AND USE OF TOBACCO PRODUCTS
PAGE2
5. Ashes, buttes, chewing tobacco juice, and any other waste product that is derived from smoking or use of tobacco products by employees during work hours while on duty shall be disposed of in an appropriate waste container and only after ensuring that all lit items have been extinguished.
... ~· .
Steven Adams
City Manager
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURE POLICY#: A-033 SUBJECT: SOCIAL MEDIA
ISSUED: 7/1/12 -------
EFFECTIVE: 7/1/12 ------
CANCELLATION DATE: N/A
SUPERSEDES:~N_/A~~-
POLICY:
The City of Arroyo Grande shall establish sites and participate in social media networks, including, but not limited to Facebook and Twitter, to disseminate public information and solicit public input. City information shall be posted only by authorized employees.
Information may be accessed and/or posted only for the purpose of educating the public or obtaining information regarding public opinion.
PROCEDURE:
1. Ownership of Data
All social media communications composed, sent or received on behalf of the City or on City equipment are the property of the City.
2. Creation of Social Media Sites
A. Social media networks used shall be limited to those authorized by the City Manager only.
B. Preparation of City social media sites shall be limited to Information Technology staff or department staff designated by the Information Technology Manager. Any preparation of City social media sites shall be coordinated with the Information Technology Division.
3. Administration and Maintenance of Authorized Social Media Sites A. The City Manager or Director of Legislative and Information Services may designate employees to maintain, administer and/or post information on an authorized social media site on behalf of the City for specified purposes.
8. Only employees authorized by the City Manager or Director of Legislative and Information Services are permitted to maintain, administer and/or post information on an authorized social media site on behalf of the City.
POLICY#: A-033
SOCIAL MEDIA
PAGE2
C. Authorized employees shall post only information within the scope and purpose specified. Posting of any information other than for the specified · purposes shall require prior approval of the City Manager or Director of Legislative and Information Services.
D. Any employees authorized to post information to a social media site shall become familiar with, and comply with, all policies, terms, conditions of use, and legal restrictions established by the social media network.
E. Authorized employees shall conduct themselves, and ensure information posted, is in accordance with all City policies.
F. Any and all information posted by authorized employees on social media sites created on behalf of the City shall:
1. Directly pertain to the City of Arroyo Grande;
2. Contain factual information that is freely available to the public and is not made confidential by any policy of the City or by local, state or federal law; and
3. Promote the City and/or City objective or purpose.
G. Authorized employees are prohibited from posting the following content on any authorized social media site:
1. Pictures or video of individuals that are identifiable without their prior written consent or the consent of a legal guardian if they are minors;
2. Language that is sexually explicit, lewd or obscene, racial, promotes religious beliefs, political, illegal, or expresses a personal opinion;
3. Actual or perceived threats to public health, safety or property;
4. Actual or potential legal claims, lawsuits or other legal issues, unless approved by the City Attorney;
5. Personnel or medical matters;
6. Criminal investigations or other confidential public safety matters; or
7. Solicitation for, engaging in, or endorsing any commercial products or activities.
H. Authorized social media sites shall utilize account names or user names that are clearly identifiable as City of Arroyo Grande social media sites.
POLICY#: A-033
SOCIAL MEDIA
PAGE3
I. All content must be managed, stored and retrieved to comply with the California Public Records Act, California's civil discovery statutes, other applicable laws requiring the disclosure of public records, and the City's records retention policy.
J. Employees shall not maintain, administer or post information to social media sites on behalf of the City during off-work hours unless authorized by the City Manager or Director of Information Services.
4. Employee Access to Social Media Networks
A. Employees shall access only authorized social media networks for City related business only.
8. Employees shall not access personal social media sites or access any information on social media networks for personal use.
C. In order to maintain the security of the City's network, employees shall use different passwords for authorized social media networks than are used for logging into the City's internal network. Employees shall follow guidelines provided by the Information Technology Manager for selecting passwords.
D. Employees accessing any authorized social media network shall comply with all applicable City policies, including, but not limited to, use of internet, e-mail and computers.
5. Comments and Posts by the Public
A. Features on an authorized social media site that allow members of the public to post content or comment shall be disabled unless activation is authorized by the City Manager. Social media sites shall not be used unless features exist to disable posting of public content and comment.
8. Authorization to activate posting of public content and comment shall be requested from the City Manager when necessary to obtain desired public input on an issue, project or program.
C. When activation of posting of public content and comment features is authorized, staff shall be designated by the City Manager or Director of Legislative Services to monitor comments and posts from the public on a daily basis and collect data from the responses for use in evaluating the public feedbaqk.
D. Every social media site that allows comments or posts from the public must include the following disclaimer:
POLICY#: A-033
SOCIAL MEDIA
PAGE4
Comments posted on this page will be monitored and inappropriate content will be removed as soon as possible. Under the City of Arroyo Grande's Social Media Policy, the City reserves the right to remove inappropriate content, including, but not limited to:
1. Profane language or content;
2. Content that promotes, fosters or perpetuates discrimination on the basis of race, creed, color, age, religion, gender, marital status, status with regard to public assistance, national origin, physical or mental disability, sexual orientation, or any other basis protected by state or federal law;
3. Comments that are abusive, hateful, or intended to defame anyone or any organization;
4. Sexual content or links to sexual content;
5. Solicitation or advertisement, including promotion or endorsement of any financial, commercial or non-government agency;
6. ConductorencouragementofHlegalacuvity;
7. Comments not topically related to the content being commented upon;
8. Comments in support of or in opposition to political campaigns or ballot measures;
9. Information that may compromise the safety of security of the public or public systems or employees; or
10. Content that violates a legal ownership interest of any other party; Please be aware that, under certain circumstances, content appearing on this page may be subject to California's public records laws and subject to disclosure by the agency if requested. This may include information about you that you make available through your privacy settings.
A comment posted by a member of the public on any City of Arroyo Grande social media site is the opinion of the commentator or poster only, and the publication of a comment does not imply endorsement of, or agreement by, the City of Arroyo Grande, nor do such comments necessarily reflect the opinions or policies of the City of Arroyo Grande.
The City reserves the right to restrict or remove any content that is deemed in violation of this policy or any applicable law. Notwithstanding the foregoing, the City of Arroyo Grande is not obligated to take such actions, and disclaims any and all responsibility and liability for any materials posted by a member of the public.
POLICY#: A-033
SOCIAL MEDIA
PAGE5
By posting a comment, users agree to indemnify the City of Arroyo Grande, its officers and employees from and against al/ liabilities, judgments, damages, and costs (including attorney's fees) incurred by any of them which arise out of or are related to content posted by users. If a user does not agree to these terms, the individual should not use the City of Arroyo Grande's social media sites as a violation of these terms may lead to legal liability.
CITY OF ARROYO GRANDE
POLICY#: A-034
--------
ISSUED: 5/13/16
EFFECTIVE: 5/13/16
CANCELLATION DATE: N/A
SUPERSEDES:_,_N=-=/A'-'--------1
POLICY:
ADMINISTRATIVE POLICIES AND PROCEDURES
SUBJECT: WIRELESS ACCESS
The purpose of this policy is to establish guidelines for access to the City of Arroyo Grande (City) wireless (WiFi) network.· This policy also ensures that wireless access to the Internet is handled in accordance with workplace rules and does not result in an unacceptable level of security risks.
This policy applies to anyone connecting to the City of Arroyo Grande WiFi network.
It is the policy of the City to ensure that access to the City WiFi network is provided to users in a secure and effective manner. This set of requirements defines a framework of standards intended to protect City networks and servers from the risks inherent in wireless access, without significantly impairing the City's mission or the quality of network to the wireless user. Documents received or created while connected to the City WiFi network are public documents subject to disclosure, unless they are deemed to be exempt pursuant to State law.
PROCEDURE:
The City WiFi network is primarily intended for use by City of Arroyo Grande employees, temporary workers, and elected and appointed officials. Access to the WiFi network must be approved by the Department Director or, in the case of elected and appointed officials, the City Manager. A "Guest" network will be made available for temporary access by outside agencies conducting City business. Access to the "Guest" network must be approved by the Department Director by submitting a written request to the Information Technology Manager. Following approval, the Information Technology Division will provide the appropriate access password. On occasion, the WiFi network may be made available to the public for specific events or meetings. Public access to the WiFi network must be approved by the City Manager prior to the event.
Restrictions on Use
Users may only use the WiFi network provided by the City for the sole purpose of accessing the Internet while at work at a City facility. The City WiFi network might not be available at all City facilities. The City Information Technology Division will provide
POLICY#: A-034
WIRELESS ACCESS
PAGE2
Users with a password to access the City WiFi network, and it may change or be time restricted without notice. Users may not use the City WiFi network contrary to these terms or any rule or policy of the City of Arroyo Grande.
Changes in these Terms and Conditions: Termination
The City reserves the right to modify the City WiFi network and these Terms and Conditions, and any accompanying policies, for any reason, and without notice, including the right to terminate the service with or without notice. The City reserves the right to terminate User access to the City WiFi network immediately and without notice at the City's sole discretion. Upon any such termination, any and all rights granted by the City of Arroyo Grande to a user hereunder shall terminate.
WiFi Privacy Policy
The City has the right, but not the obligation, to monitor, intercept and disclose any transmissions utilizing the City WiFi network, and to access, provide, and disclose User demographic account information and related information under certain circumstances (for example, in response to lawful process, orders, subpoenas, or warrants, or to protect the City's rights, users or property).
User Responsibilities
Users agree to abide by all of the terms of the City of Arroyo Grande Information Services policies as they relate to Internet usage. The City WiFi network, which utilizes wireless technologies, is not inherently secure and wireless communications can be intercepted by technology designed and intended for that purpose. The City will not be liable to Users or any other party for any lack of security that may result from a User's use of the City WiFi network. Initiating, activating or using the City's WiFi network will be deemed to have accepted the current version of this Policy.
VIOLATIONS AND- PENAL TIES
Violations include, but are not limited to the following:
• Sharing WiFi access sign-on credentials with unauthorized users; • Failure to conform with the terms of the City's Wireless Access User Agreement; • Failure to notify the City when WiFi access sign-on credentials have been compromised;
• Inappropriate online behavior while using the City's WiFi network. • Failure to comply with City security and computer use policies and best practices. • Streaming music and/or video content not specifically related to a business need.
POLICY#: A-034
WIRELESS ACCESS
PAGE3
Penalties for violation of the Wireless Access Policy will vary depending on the nature and severity of the specific violation. Any employee who viotates the Wireless Access Policy will be subject to:
1. Restriction of wireless access rights and privileges.
2. Termination of wireless access privileges.
3. Disciplinary action including but not limited to reprimand, suspension, and/or termination of employment pursuant to the City's Personnel Regulations.
4. Civil or criminal prosecution under federal and/or state law as applicable.
Procedures for obtaining wireless access privileges
1. Read the City's Information Services and Wireless Access Policies.
2. Complete the Wireless Access User Agreement (Exhibit A).
3. Submit approved Agreement to the Information Technology Manager. A copy will be forwarded to Human Resources for placement in the employee's Personnel File.
Dianne Thompson
City Manager
EXHIBIT A
CITY OF
Wireless Access Agreement
I acknowledge that I have read, understand, and agree to, each of the provisions in the City of Arroyo Grande Wireless Access Policy. The policy applies to me and to anyone who uses the City of Arroyo Grande WiFi network from my computer or other device. By initiating, activating or using the City of Arroyo Grande WiFi network from my computer or other device, I will have been deemed to have accepted the current version of the City of Arroyo Grande Wireless Access Policy. If I do not agree to the terms of the policy, I may not use the City of Arroyo Grande WiFi network from my computer or other device.
I have reviewed the Wireless Access Policy, and agree to comply with all regulations stipulated in this Agreement.
Employee Name (printed):
Employee Signature:--------------
Approved by:
Department Director Signature: _________ _
or
City Manager Signature: ____________ _
Original: Information Technology
Copy: Employee
Date: -------~
Date: -------
Date: -------
CITY OF ARROYO GRANDE
POLICY#: A-035
ISSUED: 7/17/17
EFFECTIVE: 7 /17 /17
CANCELLATION DATE: N/A
SUPERSEDES:~N~/~A:........~-
POLICY:
ADMINISTRATIVE POLICIES AND PROCEDURES
SUBJECT: REMOTE EMAIL ACCESS
The purpose of this policy is to establish guidelines for remote access to the City email system. This policy also ensures that remote access to the City email system is handled in accordance with workplace rules and does not result in an unacceptable level of security risks.
This policy applies to all employees of the City, temporary workers, elected and appointed officials and all other individuals authorized to access the City email system.
To the extent that there is any inconsistency between this Policy and Information Systems Policy A-016, the provisions of this Policy shall prevail. All provisions of Policy A-016 relating to improper use shall apply to remote email access.
It is the policy of the City of Arroyo Grande to ensure that access to the City em a i I system from remote locations is provided to users in a secure and effective manner.
This set of requirements defines a framework of standards intended to protect City networks and servers from the risks inherent in remote access, without significantly impairing the City's mission or the quality of service to the remote user. Documents and email messages received or created while accessing the City email system from a remote location are public documents subject to disclosure, pursuant to the California Public Records Ad, unless they are deemed to be exempt pursuant to State law.
PROCEDURE:
"Remote Email Access" is a generic term used to describe accessing the City's email system (e.g. web and/or smartphone access to electronic mail and calendar) from a location other than the assigned City workstation. From time to time, the City may alter the functions that can be accessed remotely. Users will only be allowed to access those functions authorized by a Department Director and subject to this policy.
Authorization for allowing remote email access is limited to job classifications that have been designated as "Exempt" from overtime, provided authorization is approved by the Department Director.
Approval may also be designated with authorization from the City Manager or his/her designee, for elected and appointed officials or other staff on a case by case basis.
POLICY #: A-035
REMOTE EMAIL ACCESS
PAGE2
Requests must be submitted in writing, on a form developed by the Legislative and Information Services Department. Remote email access will be implemented by the City's Information Technology staff only after approval by the user's Department Director and/or City Manager.
Remote email access is intended to be an alternative and not the primary method for users to connect to the City email system. The City Manager or his I her designee shall have the sole discretion to refuse to extend remote email access privileges to any user or to direct the termination of a remote email access arrangement at any time.
Remote email access is a privilege and may be terminated by the employee's supervisor, Department Director or City Manager at any time. It is also voluntary and may be terminated at any time by the employee.
User Responsibilities
All authorized remote e m a i I a ccess users must comply with the City's Information Systems Policy. All information obtained through remote email access is the property of the City, should be used for the purpose of conducting City business and is not intended for personal use.
Users are responsible for actively protecting City information and information systems when using remote email access services. Users must connect through a designated remote email access service in accordance with specific Remote Email Access User Instructions issued by the Legislative and Information Services Department and as they may be amended from time to time.
Users participating in the Remote Email Access Program remain obligated to comply with all City rules, policies, practices and instructions.
Users must adhere to the City's standard data security procedures. Data and information used by employees provided remote email access must be treated with ·the same caution and respect given confidential material in the office. The City retains ownership of all data and files. Information related to remote email access shall not be shared with family members or any unauthorized personnel.
Users participating in the Remote Email Access Program are responsible for securing any City-owned equipment, including but not limited to mobile data devices and tablets, from unauthorized access. Users are required to return all equipment when it is no longer being used for remote email access, upon separation from employment with the City, or upon the request of the City. Remote access user names and passwords shall be kept confidential and not shared with others.
POLICY #: A-035
REMOTE EMAIL ACCESS
PAGE3
City Responsibilities
All City-owned equipment (hardware, software, and other equipment) to be used by employees in the Remote Email Access Program shall be inventoried by Information Technology.
Department Directors are responsible for notifying Information Technology staff when remote email a~cess privileges are to be terminated or suspended for any employee.
Minimum Standards of Personally-Owned Electronic Equipment It is recognized that a Remote Em a i I Access User may own personal equipment suitable for accessing the City email system under this policy. The City does not take any responsibility for non-City owned equipment. Users shall ensure that antivirus software on personal devices used to access the City's email system is up to date prior to connecting to the City's system.
Information Technology (IT) staff will ·provide instructions related to how users can connect to Remote Em a i I Access. IT assistance shall be limited to assuring City network components are operational and will not extend to support maintenance of user owned hardware or software.
PROCEDURES FOR OBTAINING REMOTE ACCESS PRIVILEGES
1. Read the City's Information Systems and Remote Email Access Policies.
2. Complete the Remote Email Access User Agreement form (Attachment A) and obtain Department Director approval.
3. If required, forward for approval by City Manager or his I her designee.
4. Submit approved Agreement to the Information Technology Manager. A copy will be forwarded to Human Resources for placement in the employee's Personnel File.
VIOLATIONS AND PENAL TIES
Violations include, but are not limited to the following:
• Sharing Remote Email Access sign-on credentials with unauthorized users; • Non work-related use of Remote Email Access;
• Failure to conform with the terms of the City's Remote Email Access User Agreement;
• Failure to notify the City when Remote Email Access sign-on credentials have been compromised;
• Improper use of the City email system, as set forth in Policy A-016; • Failure to comply with City security and computer use policies and best practices.
POLICY#: A-035
REMOTE EMAIL ACCESS
PAGE4
Penalties for violation of the Remote Email Access Policy will vary depending on the nature and severity of the specific violation. Any employee who violates the Remote Email Access Policy will be subject to:
1. Restriction of remote email access rights and privileges.
2. Termination of remote email access privileges.
3. Disciplinary action including but not limited to reprimand, suspension, and/or termination of employment pursuant to the City's Personnel Regulations.
4. Civil or criminal prosecution under federal and/or state law as applicable . . Bergman
ager
EXHIBIT A
CITY OF
Remote Email Access Agreement
I acknowledge that I have read, understand, and agree to, each of the provisions in the City of Arroyo Grande Remote Email Access Policy. The policy applies to me and any other authorized person who uses the City of Arroyo Grande Remote Email Access from my computer or other device. By initiating, activating or using the City of Arroyo Grande Remote Email Access from my computer or other device, I will have been deemed to have accepted .the current version of the City of Arroyo Grande Remote Email Access Policy. If I do not agree to the terms of the policy, I nay not use the City of Arroyo Grande Remote Email Access from my computer or other device.
I have reviewed the Remote Email Access Policy, and agree to comply with all regulations stipulated in this Agreement.
Employee Name: _______________ _
Employee Signature: ________________ Date: _______ _
Approved by:
Department Director Signature: _____________ Date: ______ _ Original: Information Technology
Copy: Employee (Personnel File)
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICIES AND PROCEDURES POLICY#: A-036 SUBJECT: OMV PULL PROGRAM
ISSUED: 11/15/17
EFFECTIVE: 11 /15/17
CANCELLATION DATE: N/A
SUPERSEDES: 11 /15/06
POLICY:
The City shall verify and monitor the driving records of all City employees authorized to drive on City business. The City has implemented the Department of Motor Vehicles' Employer Pull Notice Program. This program promotes driver safety by monitoring the driving records of all employees who are required to drive a City vehicle or their personal vehicle on City business.
PROCEDURE:
1. The city must automatically enroll any driver employed for the operation of any vehicle, if the driver is required to have any of the following licenses: Class A; Class B; or Class C with Hazardous Materials Endorsement, in accordance with Vehicle Code Section 1808.1.
2. All employees or volunteers with the City who drive frequently on City business are required to enroll in the Department of Motor Vehicles' Employer Pull Notice Program (EPN). Driving frequently is defined as driving two or more times per week.
3. Employees/volunteers shall complete the Department of Motor Vehicles' "Authorization for Release of Driver Record Information" form.
4. Prospective employees/volunteers shall provide the City with their current public driver's record prior to an offer of employment. The report is current if it was issued less than thirty days prior to the date of employment.
5. The Department of Motor Vehicles (OMV) sends a copy of employee's/volunteer's driving record to the program coordinator when an employee/volunteer is initially enrolled in the program, and then on an annual basis from the date of enrollment. The OMV also sends out reports if there is negative driving activity on the employee's/volunteer's record.
POLICY#: A-036
DMV PULL PROGRAM
PAGE2
6. The program coordinator shall verify that each employee's/volunteer's driver's license has not been suspended or revoked, the employee's traffic violation point count, and whether the employee has been convicted of a violation of Section 23152 or 23153. The reports shall be signed, dated and maintained by the program coordinator.
7. An employee/volunteer who has a disqualifying action regarding his or her driving privilege or required driver's certificate will not be allowed to drive City or personal vehicles for City business.
8. Upon termination of a driver's employment, the city shall notify the department to discontinue the driver's enrollment in the pull-notice program.
9. When driving City vehicles, employees are authorized to carry non-employee passengers only for the conduct and facilitation of City business as provided in this Policy. All other non-employee passengers must be approved by the City Manager.
10. Employees utilizing City vehicles must possess a valid California Drivers License.
The City, through the Department of Motor Vehicle Pull Program, will monitor the status of the employee's driver's license. The Chief of Police will be the Pull Program coordinator.
., .:a.aw···.········ •.... DEPNmlBIFIJF f/I010R
A Public Service Agency
EMPLOYER PULL NOTICE PROGRAM
AUTHORIZATION FOR
RELEASE OF DRIVER RECORD INFORMATION
I, , California Driver License Number, ,
hereby authorize the California Department of Motor Vehicles (OMV) to disclose or otherwise make available, my driving record, to my employer, _____________ --==,,..,,,.,,.,.,,.,.,.==------------------ coMPANY NAME
I understand that my employer may enroll me in the Employer Pull Notice (EPN) program to receive a driver record report at least once every twelve (12) months or when any subsequent conviction, failure to appear, accident, driver's license suspension, revocation, or any other action is taken against my driving privilege during my employment.
I am not driving in a capacity that requires mandatory enrollment in the EPN program pursuant to California Vehicle Code (CVC) Section 1808.1 (k). I understand that enrollment in the EPN program is in an effort to promote driver safety; and that my driver license report will be released to my employer to determine my eligibility as a licensed driver for my employment.
EXECUTED Al: CITY COUNTY STATE
DATE I ~NATURE OF EMPLOYEE
do hereby certify under penalty of perjury under the laws in the State of California, that I am an authorized representative of this company, that the information entered on this document is true and correct, to the best of my knowledge and that I am requ.esting driver record information on the above individual to verify the information as provided by said individual. This record is to be used by this employer in the normal course of business and as a legitimate business need to verify information relating to a driving position not mandated pursuant to CVC Section 1808.1. The information received will not be used for any unlawful purpose. I understand that if I have provided false information, l may be subject to prosecution tor perjury (Penal Code Section 118) and false representation (CVC Section 1808.45). These are punishable by a fine not exceeding five thousand dollars ($5,000) or by imprisonment in the county jail not exceeding one year, or both fine and imprisonment. I understand and acknowledge that any failure to maintain confidentiality is both civilly and criminally punishable pursuant to CVC Sections 1808.45 and 1808.46.
EXECUTED Al: CITY COUNTY STATE
DATE SIGNATURE AND TITLE OF AUTHORIZED REPRESENTATNE
x
To obtain a driver record on a prospective employee you may submit an INF 1119 form. To add this driver to the EPN Program you must submit the applicable forms: INF 1100, INF 1102, INF 1103, INF 1103A form. You may obtain forms at our website atwww.dmv.ca.gov/otherservices, or by calling 916-657-6346.
THIS FORM MUST BE COMPLETED AND RETAINED AT THE EMPLOYER'S PRINCIPAL PLACE OF BUSINESS AND MADE AVAILABLE UPON REQUEST TO OMV STAFF.
DO NOT RETURN THIS FORM TO OMV.
INF 11.01 ENGLISH (REV. 9/2004) WWW
CITY OF ARROYO,GRANDE
POLICY #.: A-037
ISSUED: 02/01/2018
EFFECTIVE: 02/01/2018
CANCELLATION DATE: N/A
SUPERSEDES:_---'N-=/"--'A'------1
ADMINISTRATIVE POLICIES AND PROCEDURES
SUBJECT: PASSWORDS .
POLICY: ~
The purpose of this policy is to establish a standard for creation of strong passwords, the protection of those passwords, and the frequency of password change. Passwords are an essential aspect of computer security, providing important front-line protection for electronic resources by preventing unauthorized access. Passwords help limit unauthorized or inappropriate access to various network resources at the City of Arroyo Grande. A poorly chosen password may result in the compromise of City systems, data, or the network.
This policy applies to all employees of the City, temporary workers, elected and appointed officials and all other individuals authorized to access the City's computer network resources. To the extent that there is any inconsistency between this Policy and Information Systems Policy A-016, the provisions of this Policy shall prevail.
PROCEDURE:
Creation of Passwords , -
Passwords created by authorized users of City systems shall conform to the following standards:
Your password must be a minimum of nine (9) characters long and must contain:
• At least one special character ( I , $ , # , % )
• At least one uppercase letter
• At least one lowercase letter
• At least one digit (0-9)
Personal information such as your user name, first or last name, organization name, phone number, birth date, or address should not be used.
For new accounts, or when updating passwords for existing accounts, the Information Technology Division will create temporary passwords such that the user will be prompted to change the initial password in order to login to the network.
These provisions shall be enforced electronically whenever possible.
POLICY #: A-037
PASSWORDS
PAGE2
Changing Passwords
• Passwords expire after 90 days and must be changed to be significantly different than previous passwords
• Passwords are not allowed to be repeated within one year Protecting a Password
• Passwords must be treated as confidential information • Passwords shall not to be stored in readable form in locations where unauthorized persons might discover them, and shall not be shared with other individuals
• Passwords must not be included in email messages or other forms of electronic communication
Sharing a Password
• City User IDs are issued to individuals for their exclusive use, and passwords may not be shared
• Departmental account passwords must be shared only with appropriately designated departmental personnel
• Users need to beware of "phishing" or other social engineering scams where a user may have a password requested over the phone. City Information Technology personnel, as a best practice, do not request a user's password over the phone and will reset forgotten passwords
Reporting a Password Compromise
• Suspected compromises of passwords must be reported immediately to the City's Information Technology Division
• The password in question must be changed immediately
VIOLATIONS AND PENALTIES:
Failure to create a password that meets the strong password criteria will result in the inability to log in to the network, email or other applicable computer network resource.
Those experiencing difficulty with password creation are directed to contact the Information Technology Division. Additionally, an individual who circumvents the security provisions of this policy may be subject to disciplinary action including but not limited to reprimand, suspension, and/or termination of employment pursuant to the City's Personnel Regulations, or subject to the termination of specified information technology access and services.
CITY OF ARROYO GRANDE
POLICY#: --------A-038
ISSUED: 8/30/19
EFFECTIVE: 8/30/19
CANCELLATION DATE: N/A
SUPERSEDES: ___ N ___ /A""'--_
POLICY:
ADMINISTRATIVE POLICIES AND PROCEDURES
SUBJECT: REMOTE COMPUTER ACCESS
POLICY
The purpose of this policy is to establish guidelines for remote access to City computer systems. This policy also ensures that remote access to City computer systems is handled in accordance with workplace rules and does not result in an unacceptable level of security risks.
This policy applies to all employees of the City, temporary workers, elected and appointed officials and all other individuals authorized to access City computer systems.
It is the policy of the City of Arroyo Grande to ensure that access to City computer systems from remote locations is provided to users in a secure and effective manner. This set of requirements defines a framework of standards intended to protect City networks and servers from the risks inherent in remote access, without significantly impairing the City's mission or the quality of service to the remote user. Documents received or created while accessing City computer systems from a remote location are City-owned documents; which are subject to disclosure, unless they are deemed to be exempt pursuant to State law.
PROCEDURE:
"Remote Computer Access" is a generic term used to describe, accessing the City's computer network from a location other than the assigned City workstation. From time to time the City may alter the functions that can be accessed remotely. Users will only be allowed to access those functions authorized by a Department Director and subject to this policy.
Remote Computer Access is generally limited to job classifications that have been designated as "Exempt" from overtime, provided authorization is approved by the Department Director.
Approval may also be designated with authorization from the City Manager or his/her designee, for other staff on a case by case basis.
Requests must be submitted in writing on the Remote Computer Access User Agreement
POLICY #: A-038
REMOTE COMPUTER ACCESS
PAGE2
form. Remote Computer Access will be implemented by the City's Information Technology Division only after approval by the user's Department Director and/or City Manager.
Remote Computer Access is intended to be an alternative and not the primary method for employees to connect to City computer systems. The City Manager or his / her designee, shall have the sole discretion to refuse to extend remote computer access privileges to any employee or to direct the termination of a remote computer access arrangement at any time.
Remote computer access is voluntary and may be terminated by the employee, employee's supervisor, Department Director or City Manager at any time.
User Responsibilities
All authorized Remote Computer Access users must comply with the City's Administrative Policies pertaining to e-mail and internet use. All information obtained through remote computer access is the property .of the City, should be used for the purpose of conducting City business only and is not intended for personal use.
Users are responsible for actively protecting City information and information systems when using Remote Computer Access services. Employees must connect through a designated remote computer access service in accordance with specific Remote Computer Access User Instructions issued by the Information Technology Division which may be amended from time to time.
Employees participating in the Remote Computer Access Program remain obligated to comply with all City rules, policies, practices and instructions. Non-exempt employees must record on the employee's timecard all hours worked, whether on-site or through Remote Computer Access, consistent with the City's Personnel Regulations and any applicable MOU.
Users must adhere to the City's standard data security procedures. Data and information used by employees provided Remote Computer Access must be treated with the same caution and respect given confidential material in the office. The City retains ownership of all data and files. Information related to Remote Computer Access and/or access to City systems via Remote Computer Access may not be shared with family members or any unauthorized personnel.
Users are responsible for securing any City-owned equipment used by employees participating in the Remote Computer Access Program, such as laptops, and are required to return all equipment when it is no longer being used for Remote Computer Access, upon separation from employment with the City or upon the request of the City.
POLICY #: A-038
REMOTE COMPUTER ACCESS
PAGE3
City Responsibilities
All City-owned equipment (hardware, software, and other equipment) to be used by employees in the Remote Computer Access Program shall be inventoried by Information Technology.
Department Directors are responsible for notifying the Information Technology Division when Remote Computer Access privileges are to be terminated or suspended for any employee.
Minimum Standards of Personally-Owned Electronic Equipment It is recognized that a Remote Computer Access User may own personal equipment and software suitable for accessing the City network under this policy. The City does not take any responsibility for non-City owned equipment.
The Information Technology Division will provide instructions related to how Users can connect to the Remote Computer Access system. IT assistance shall be limited to assuring City network components are operational and will not extend to support maintenance of user owned hardware or software.
PROCEDURES FOR OBTAINING REMOTE ACCESS PRIVILEGES
1. Read the City's Information Technology Use and Remote Computer Access Policies.
2. Complete the Remote Computer Access User Agreement form (Exhibit A) and obtain Department Director approval,
3. If required, forward for approval by City Manager or his/ her designee.
4. Submit approved Agreement to the Information Technology Manager. A copy will be forwarded to Human Resources for placement in the employee's Personnel File.
VIOLATIONS AND PENAL TIES
Violations include, but are not limited to the following:
• Sharing Remote Computer Access sign-on credentials with unauthorized users; • Non work-related use of Remote Computer Access to City resources; • Failure to conform with the terms of the City's Remote Computer Access User Agreement;
POLICY #: A-038
REMOTE COMPUTER ACCESS
PAGE4
• Failure to notify the City when Remote Computer Access sign-on credentials have been compromised;
• Failure to comply with the City's Administrative Policies pertaining to e-mail and internet use, including inappropriate on-line behavior while remotely accessing City resources such as e-mail;
• Failure to comply with City security and computer use policies and best practices.
Penalties for violation of the Remote Computer Access Policy will vary depending on the nature and severity of the specific violation. Violations to the Remote Computer Access Policy may result in any of the following:
1. Restriction of Remote Computer Access rights and privileges.
2. Termination of remote access privileges.
3. Disciplinary action including but not limited to reprimand, suspension, and/or termination of employment pursuant to the City's Personnel Regulations.
4. Civil or criminal prosecution under federal and/or state law as applicable.
EXHIBIT A
Remote Computer Access Agreement
I acknowledge that I have read, understand, and agree to, each of the provisions in the City of Arroyo Grande Remote Computer Access Policy. In addition, by initiating, activating or using the City of Arroyo Grande Remote Computer Access from my computer or other device, I will have been deemed to have accepted the current version of the City of Arroyo Grande Remote Computer Access Policy. If I do not agree to the terms of the policy, I may not use the City of Arroyo Grande Remote Computer Access from my computer or other device.
I have reviewed the Remote Computer Access Policy, and agree to comply with all regulations stipulated in this Agreement.
Employee Name: _______________ _
Employee Status: Exempt
If Non-Exempt:
Reason for remote access:
Non-Exempt __
-------------------------
Date!Time access is requested: From ______ _ To ------------ Employee Signature: ________________ Date: __________ _ Approved by:
Department Director Signature: ____________ _ Date: ----------- City Manager Signature: Date:
(if required) ---------------- -----------
Original: Information Technology Manager
Copy: Employee, HR Manager
CITY OF ARROYO GRANDE
POLICY#: A-039
ISSUED: 01/26/22
EFFECTIVE: 01/11/22
CANCELLATION DATE: N/A
SUPERSEDES: N/A -----
POLICY:
ADMINISTRATIVE POLICIES AND PROCEDURES
SUBJECT: DIVERSITY, EQUITY, INCLUSION
AND JUSTICE POLICY
The City is committed to supporting diversity, equity, inclusion, and justice (DEIJ) in all facets of society, the principles of which include fairness of treatment, recognition of rights, acceptance of responsibilities, commitment to equity and justice, and dedication to expanding opportunities for all. The mission of the City is to make Arroyo Grande the best place possible for everyone who lives, works , and visits here. Valuing diversity is a core City principle that will be practiced and communicated at all levels of the organization.
Members of our community face challenges and opportunities related to their race, religion , gender, ethnicity, language, age, sexual orientation and gender identity, socioeconomic background, and diverse abilities. It is important for members of our community and the City as a whole to assume the responsibility of facing the challenges and seizing the opportunities created by diversity, and to identify opportunities in policies , regulations , and guidance to address systemic inequities.
Inclusion and equity do not seek to 'treat everyone the same,' but recognize that everyone is different, that there are strengths inherent in those differences, and that people's needs are met in different ways . This can be as a resident, visitor, City Council Member, City Advisory Body Member, or employee. Diversity awareness recognizes that each individual is unique, engendering recognition , respect, and celebration of the added value that differences bring.
DEFINITIONS:
Diversity
Diversity refers to the variety of similarities and differences between people based on which they experience advantages or encounter barriers to opportunities, including but not limited to: gender, gender identity, ethnicity, race, native or indigenous origin , age, generation, sexual orientation, culture, religion/belief system, marital status, parental status, socio-economic status, appearance, language and accent, physical and mental ability, mental health, education, geography, and nationality.
POLICY #: A-039
DIVERSITY, EQUITY, INCLUSION, AND JUSTICE
PAGE 2
Equity
Equity refers to the consistent and systematic, fair, just, and impartial treatment of all individuals, seeking to ensure that all people have access to the same opportunities and resources while recognizing that people do not all start from the same place due to systemic and individual advantages and barriers.
Inclusion
Inclusion seeks to support people with different identities to feel valued and welcomed within a given setting, including fostering a sense of belonging by centering and amplifying the voices, perspectives, and styles of those who experience more barriers based on their identities.
Justice
Justice refers to the practice of directly dismantling barriers to resources and opportunities in society so that all individuals and communities can live a full and dignified life.
IMPLEMENTATION:
The City is committed to modeling and implementing diversity, equity, inclusion, and justice within the community and the City organization, and will do so through measures that include but are not limited to the following :
A. Provide informed, authentic leadership supporting diversity, equity, inclusion, and justice by:
1. Connecting diversity, equity, inclusion, and justice to the City's mission as critical principles to ensure the well-being of the City's employees and the community;
2. Acknowledging and dismantling inequities within the City's policies, systems , programs , and services, including continual review and updates to support ongoing progress;
3. Embedding language in the City's plans, policies, and goals consistent with the intent of this Policy to promote diversity, equity, inclusivity, and justice;
4. Exploring potential underlying, unquestioned assumptions that interfere with diversity, equity, inclusivity, and justice;
5. Advocating for and supporting executive team-level thinking about how systemic inequities impact the City's work, and how best to address these inequities in a way that is consistent with the City's mission and this Policy;
6. Challenging assumptions about what it takes to be a strong leader within the City organization and who is well-positioned to provide leadership;
POLICY#: A-039
DIVERSITY, EQUITY, INCLUSION, AND JUSTICE
PAGE 3
7. Practicing and encouraging transparent and inclusive communication in all interactions, including focus on and commitment to reducing and preventing incidents of prejudice;
8. Committing time and resources to expand diverse leadership opportunities within the City Council, employees, committees, and advisory bodies, including outreach to diverse social and professional organizations and publications;
9. Championing diversity, equity, inclusivity, and justice by leading with respect, awareness, and acceptance;
10. Committing to keeping current on "best practices" that take place in other cities and government jurisdictions, and partnering with other cities in sharing information and efforts;
11. Expecting all employees to exemplify this Policy in all workplace interactions and through everyday practices.
B. Abide by the following to help promote diversity and inclusion in the workplace:
1. Pursue cultural competency throughout the organization by creating substantive learning opportunities and formal, transparent policies;
2. Pursue and evaluate quantitative and qualitative research related to justice, equity, diversity, and inclusion initiatives and barriers to guide the implementation of effective measures;
3. Make incremental, measurable progress toward the visibility of the City's diversity, equity, inclusion, and justice efforts;
4. Improve the City's cultural leadership pipeline by creating and supporting programs and policies fostering leadership that reflects the full diversity of American society;
5. Identify and incorporate DEIJ efforts and components in the City's recruitment, retention , and training efforts ;
6. Pool resources and expand offerings for underrepresented communities by connecting with other organizations committed to DEIJ efforts;
7. Develop and present sessions internally on DEIJ to provide education and resources and to support full implementation of this Policy;
8. Promote opportunities for organizations, businesses , and advocacy groups to share information with the City and with each other regarding the changing realties of the workforce and workplace;
9. Be intentional in bringing awareness and consciousness of bias during the hiring, promoting , and/or evaluating process and institute practices to increase DEIJ in all aspects of recruitment and retention ;
10. Advocate for public and private-sector policies that DEIJ and challenge systems and policies that create inequity, oppression, and disparity.
C. Promote inclusive outreach to diverse communities by:
POLICY#: A-039
DIVERSITY, EQUITY, INCLUSION, AND JUSTICE
PAGE4
1. Identifying traditionally underrepresented or marginalized communities within the City and developing and implementing strategies to increase effective communication and engagement;
2. Regularly conferring with representatives of diversity groups to better understand and support the community and to ensure ongoing application and review of this Policy;
3. Work with community partners . to support opportunities for professional leadership and DEIJ training for small businesses within the City;
4. Intentionally incorporate DEIJ initiatives into the City's economic development efforts, including support for small and diverse businesses;
5. Evaluating barriers to participation in decision-making processes by traditionally underrepresented or marginalized communities and developing mechanisms to reduce identified barriers;
6. Fostering an environment of inclusivity in internal and public-facing events, meetings, and processes through intentional application of this Policy. ~ City Manager
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY #: -=B_-..._00 ..... 1 _____ _ SUBJECT: PERSONNEL ACTION FORM ISSUED: -=6.._/=1 .... / 9"'6,.__ ___ _
EFFECTIVE: 6/1/96
CANCELLATION DATE: N/A
SUPERSEDES: 2/12/95
POLICY:
The policy of the City is to document all transactions involving a City employee.
PROCEDURE:
A. A "Personnel Action Form" (Exhibit "A") will be utilized to document all personnel transactions/actions involving City employees.
1. The form is to be used for all City employees, either full-time or part-time, as defined in the City's
Personnel Regulations.
2. No applicant for a City position may be hired and
commence work until the Personnel Action Form is
completed and signed by both the appropriate
Department Director and the City Manager.
B. A Personnel Action Form shall not be utilized for contract employees budgeted in a Contractual Services Account and subject to receiving an IRS Form·#1099.
1. In situations involving temporary contact employees, a Temporary Employment Memorandum of Agreement
between the contract employee and the City will be
prepared (see Exhibit "B"). Any such Agreement must
be signed by the City Manager.
The direction for completion of the Personnel Action Form is as follows:
1 . EMPLOYEE NAME :
2 . DEPARTMENT:
3. EFFECTIVE DATE:
Name of employee.
Department in which the employee is to be
employed.
Self-explanatory.
;
POLICY #: B-001
PAGE 2
4. FROM:
5. TO:
6. POSITION:
7. STATUS:
8 . REASON FOR CHANGE :
To be completed only for existing
employee. Leave blank for new employee.
To be completed for a new employee or a
change in status of an existing employee.
Affected employee's position/personnel
classification.
Enter appropriate status:
- Permanent Full-time
- Permanent Part-time
- Temporary Full-time
- Temporary Part-time
1. 2.
Mark appropriate reason
Mark appropriate incentive, special
assignment pay, COLA (indicate
percentage), range adjustment, or
other (complete reason and indicate
amount or percentage) when
applicable.
9. EMPLOYEE'S SERVICES: (SEPARATIONS ONLY) _
10. RECOMMENDED FOR
REHIRE:
1. Marks appropriate classification
based upon most recent/ or separation
evaluation.
2. In addition to the above, mark
"Unsatisfactory" when:
a. Termination for Unsatisfactory
Probation.
b. Termination for Disciplinary
and/or Performance reasons.
{SEPARATIONS ONLY)
1. Mark 11 yes 11 when there is a voluntary
resignation with a minimum of a two
(2) week notice or where separation
is due to layoff.
2. Mark "no" when:
a. There is less than a two(2) week
notice by the employee (may be
excused in extenuating
circumstances with the approval
of the City Manager) ; or
b. The termination is for
disciplinary purposes; or
c. The termination if due to
unsatisfactory performance; or
POLICY #: B-001
PAGE 3
d. The termination is due to a
voluntary resignation in lieu of
termination for disciplinary
reasons/unsatisfa9tory
performance.
11. EXIT STEPS COMPLETED: Self-explanatory.
12 . REMARKS: Enter remarks as appropriate. Nonprobationary involuntary separations should contain a brief explanation of the
reason for the separation.
13. DEPARTMENT DIRECTOR: Signature of the Department Director.
14. CITY MANAGER: Signature of the City Manager.
CROSS REFERENCE:
CITY PERSONNEL REGULATIONS
ROBERT L. HUNT
CITY MANAGER
Employee Name: CD
Department: @
Position: @
From: Status: (J)
© Department
Salary: Range:
®
_ Appointment
- Merit Increase
_Promotion
- Reclassification
_Transfer
_ Completion of
Probation
- Additional
Assignment
_ Acting Assignment
EmIBIT A
POUCY #B-001
CITY OF ARROYO GRANDE
PERSONNEL ACTION FORM
Effective Date: ®
Position:
To: Status: CJ)
® Department:
I Step: Salary:
REASON FOR CHANGE
®
I Range:
- Completion of - Educational Incentive
Assignment
- 2.5%
- Resignation 5% - _ Termination _ FTO Pay (5%)
- Retirement
- COLA %
-· - Unsatisfactory Probation
Range Adjustment - _ Suspension - Other
_Layoff
_Deceased
I Step:
%orAmount
Employee's Services Recommend for Rehire: Exit Steps Completed were: _Yes - Vacation Computed - Outstanding -No _ Exit Interview - Above Average - Retirement forms - Satisfactory
_ Unsatisfactory - Equipment\Keys Returned
® @)
REMARKS
@
·AUTHORIZATION
Department Director Date City Manager Date
@) ®
CM-68
®
EXHIBIT B
TEMPORARY EMPLOYMENT
MEMORANDUM OF AGREEMENT BETWEEN JANE DOE
AND THE CITY OF ARROYO GRANDE FOR
TEMPORARY EMPLOYMENT AS ~~~~~~~~~~~~~~~~~~-
This is a Memorandum of Agreement for the temporary employment of ("Temporary Employee") as a_
~~~~~~~~~~~~~~~~~~- with the ~~~~~~~-
Temporary Employee shall work from a.m. to ~~~~p.m. on each (specify days) , beginning In addition, Temporary Employee shall work extra hours in addition to those described above as necessary, upon reasonable notice. Temporary Employee shall perform those services assigned by the ~~~~~~~~
Compensation for this temporary employment
shall be $ per hour. Benefits, including, but not
limited to, time off with pay (vacation), sick leave,
participation in health or life insurance programs, or extra hourly compensation for additional work hours, will not be provided.
By executing this Memorandum of Agreement, you accept,
understand, and agree that this position is temporary in nature and you relinquish all claims for compensation beyond the hourly wage specified above, unless specifically agreed to by the City of Arroyo Grande in writing.
This Memorandum of Agreement may be terminated by either party for any reason, wit~out cause, upon fifteen (15) days' notice in writing.
ROBERT L. HONT
CITY MANAGER
EMPLOYEE SIGNATURE
Executed on ~~~~~~~~~~~~' 199_
c: City Manager
Department Director (Affected Department)
Finance Director
Personnel File
Policy#: B-001
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY #:
ISSUED:
EFFECTIVE:
B-002
6/1/96
6/1/96
SUBJECT: REQUEST FOR OR REPORT OF
LEAVE OF ABSENCE
CANCELLATION DATE: N/A
SUPERSEDES: NEW
POLICY:
It shall be the policy of the City to document a leave of absence by a City employee.
PROCEDUR.E:
A. A Request for or Report of Leave of Absence form (Exhibit "A") is required any time an employee is absent f rem the workplace due to a reportable leave of absence as defined by the City's Personnel Regulations and/or Memorandum of Understanding (MOU) .
B. The form must be completed as follows:
1. Name of employee
2 • Department
a. The Department to which the employee is assigned.
3. Position title
4 . Type of leave requested
a. Check type of leave, or combinations/types of, involved. 5 . Total working hours
a. Total working hours missed.
b. In cases involving combinations of leave, list hours for each type of leave utilized as well as the total leave time used.
6. Reason for leave
List reason for leave ~ when utilizing Family Leave,
Bereavement Leave, Medical Leave, Emergency Leave, and/ or Leave Wi'thout Pay.
7. Signature of employee and date
8. Signature of Department Director and date
The signature of the City Manager is required ~ for
Directors' absences or when utilizing Family Leave, Workers' Compensation Leave, Medical Leave, Emergency Leave, and/or Leave Without Pay.
Revised: April 09, 1997
POLICY #: B-002
PAGE 2
9. Remarks
Any applicable remarks necessary to further explain the reaso.u. for the leave, any restrictions placed on the requested leave, or denial of a requested leave.
ROBERT L. HUNT
CITY MANAGER
• Cit\f of An-0\io GrNtbe?
EXHIBIT "A"
POLICY#: B-002
a • u
~ ~ ~
.. &f'•Lllll ..
41.0011•'·
P. 0. BOX550
Arroyo Grande, California 93421
REQUEST FOR OR REPORT OF LEAVE OF ABSENCE
NAME OF EMPLOYEE CD DEPARTMENT® POSITION TITLE ®
TYPE LEAVE REQUESTED FIRST DATE ABSENT LAST DATE ABSENT
D VACATION
D REGULAR SICK LEAVE
D WORKERS' COMP LEAVE 0 TOTAL NO WORKING HOURS
D FAMILYDEATI-1 LEAVE ®
D MILITARY LEAVE
D ANNUAL LEAVE REASON FOR LEAVE
D JURY DUTY
D WITHOUT PAY © DATE SIGNATURE OF EMPLOYEE
0 DATE SIGNATURE OF DEPT DIRECTOR DATE SIGNATURE OF CITY MANAGER ® ® , .~MARKS -
®
Revised: January 01, 1997
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY #: _B=--0~0~3......_ ________ _ SUBJECT: OBSERVANCE OF WORK HOURS ISSUED: _6=-/ ...... 1~/_,,9_6 ____ _
EFFECTIVE: 6/1/96
CANCELLATION DATE: NIA
SUPERSEDES: NEW
POLICY:
A. It is the policy of the City that all non-management employees shall be required to observe the assigned times for starting workshifts, starting meal breaks, ending meal breaks, and ending work shifts.
B. It is the policy of the City that non-management employees shall not start work prior to the assigned time for the start of a workshift nor shall employees work past the assigned time for the end of a workshift.
C. It is the policy of the City that non-management employees shall not work during assigned, non-paid breaks.
1. Non-management employees shall be notified by their immediate Supervisor of the assigned time for the start of the workshift, the end of the workshift; and the starting and ending times of any non-paid meal breaks.
2. Non-management employees who arrive at the work site prior to the assigned start work time shall not engage in work-related activities unless specifically directed by their immediate Supervisor.
3. Non-management employees shall end all J.ork-related activities at the assigned time for the end of the workshif t unless
specifically directed by the immediate Supervisor. Nonmanagement employees shall not remain at their work site after the assigned time for the end of their workshift unless specifically directed by the immediate Supervisor.
4. Non-management employees shall not perform any work-related activities during an assigned non-paid meal break unless specifically directed by the immediate Supervisor or required by an emergency.
POLICY #: B-003
PAGE 2
5. With the exception of employees of the Police Department and Fire Department, non-management employees shall not be required to remain at a specific work site during a non-paid break. /nL(Jll. ltuJSl'
ROBERT L. HUNT
CITY MANAGER
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY #: --=B_-~0~04...._ ____ _ SUBJECT: WORK BREAKS
ISSUED: -=6,,_/=1._./ 9..._6,.__ ___ _
EFFECTIVE: 6/1/96
CANCELLATION DATE: NIA
SUPERSEDES: NEW
POLICY:
It is the policy of the City to provide work breaks to all employees working for a period greater than four hours per day. Such work breaks are granted by the Department Director for a period not greater than 15 minutes in duration. Scheduling of work breaks shall be determined by the Department Director or Supervisor and shall not interfere with the conducting of City business or public safety. Two work breaks may be taken during a regular work shift; one work break should be taken between the start of the work shift and the lunch break; and the other should be taken after the lunch break and prior to the end of the shift.
PROCIIDUim:
1. Work breaks for work crews, field inspection employees, and field police personnel shall be taken in the field, preferably at the assigned worksite. Employees who take work breaks in the field should not take breaks in groups of three or more.
2. Office employees shall not leave the building during work breaks except to use outside break areas that are provided. Office employees may take breaks at their work locations providing they do not interfere with adjacent employees who are not on a work break and it does not interfere with service to the public. Work breaks shall not be taken within the public view.
3. Work breaks cannot be accumulated nor can work breaks be used to extend the lunch break, leave work early, or report late for work. The Supervisor must schedule and approve all work breaks.
Backup should be provided where necessary to cover counter work or telephone coverage.
ROBERT L. HUNT
CITY MANAGER
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY # : -=B_-0..._0...,5..___ ___ _ SUBJECT: ACCEPTABLE APPAREL/GROOMING ISSUED: _6...,./._.1 ..... 1 ..... 9 ...... 6___ _
EFFECTIVE: 6/1/96
CANCELLATION DATE: NIA
SUPERSEDES: NEW
POLICY:
It shall be the policy of the City that apparel, dress, and grooming shall reflect a businesslike appearance. Staff should make sure their personal appearance does not adversely impact the City's relations and effectiveness in dealing with the public and other City personnel. This is a minimal standard. Specific Departments may have more stringent rules if appropriate.
1. Employees working within City offices should appear at work each day dressed in a manner such that they may attend meetings, connnissions, boards, etc., as needs may dictate.
2 . Employees working at outside jobs shall dress in a manner appropriate to their jobs including uniforms, if assigned, or shirts and ~ies if directed by the Department Director.
3. Casual attire such as jeans or T-shirts are not appropriate for any staff member except where specifically permitted by the Department Director.
4. Exposed midriffs including off-shoulder, spaghetti strap, and halter-type tops are not acceptable.
5. During hours of work, employees shall be neat, clean, presentable, well-groomed, and inoffensive i:p. appearance and odor to others working nearby and to the general public who may come in contact with them.
6. Hair, moustaches, and beards shall be neatly trinnned, groomed, and clean.
7. Hairstyles and/or wigs and hairpieces shall not interfere with the normal wearing of any regulation or required headgear.
8. Partisan political emblems, symbols of fraternal or service organizations, badges and/ or emblems or any kind other than Department issue or military awards shall not be worn if it causes disruption or public connnent.
POLICY #: B-005
PAGE 2
See-through fashions, without appropriate undergarments, and other fashions wherein the absence of appropriate undergarments is distracting are unacceptable.
It shall be the responsibility of Department Directors to ensure employees are properly dressed and groomed and to maintain an image reflecting the responsibility of each individual as a representative of the City.
~Ltl~ ROBERT L. HUNT
CITY MANAGER
CITY OF ARROYO GRANDE
POLICY # : -=B_-=-0=-06=-------
ISSUED: _..,,_6""""/1=/._.9....,6..__ ___ _
EFFECTIVE: 6/1/96
CANCELLATION DATE: NIA
SUPERSEDES: NEW
POLICY:
ADMINISTRATIVE POLICY AND PROCEDURES
SUBJECT: USE OF INTOXICATING
SUBSTANCES
A. Consumption of intoxicating substances, other than legallyprescribed medication, by an employee is prohibited on City premises.
B. Employees or persons conducting business with the City who are intoxicated or under the influence shall not be allowed on City premises.
C. Employees shall not consume intoxicating substances during their work day. The exception to this policy is Police Department personnel who are performing an undercover assignment and who have been given specific permission to consume alcoholic beverages.
PROCEDURE:
1. It is the responsibility of an employee's Supervisor to make an employee aware of the above policies.
2. If, in the judgement of an employee's Supervisor, the employee is intoxicated or under the influence, it is the responsibility of the Supervisor to take appropriate action.
3. The Department Director and the City Manager shall be notified as soon as possible after an employee has been found to be intoxicated or under the influence.
4. An employee who first contacts an intoxicated employee shall immediately notify his or her Supervisor. The Supervisor will notify the Police. Department (Watch Commander) or the
circumstances. The Police Department will take the appropriate action.
ROBERT L. HUNT
CITY MANAGER
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY#: B-007 SUBJECT: EMPLOYEE RECOGNITION
ISSUED: 11/1/12
EFFECTIVE: 11/1/12
CANCELLATION DATE: N/A
SUPERSEDES: 11/1/11
POLICY:
It is the policy of the City of Arroyo Grande to recognize those employees who have made a significant contribution to his/her Department, the overall organization, and/or have gained recognition for the City through positive non-work related activities.
Recognition is provided through annual employee awards, annual employee service recognition, Platinum Service Awards, and retirement or completion of service with the City. Department Directors and Supervisors are also encouraged to utilize creative methods of recognizing employees for exemplary service on an ongoing basis.
PROCEDURE:
1. Annual Employee Service Awards
A. Recognition of significant contribution(s) will be achieved by designating an "Employee of the Year'' for each of the four primary City work locations:
City Hall, Recreation Services Department, Public Works Department, and the Police Department.
B. Employees eligible shall be any employee of the City of Arroyo Grande (full-time or part-time) excluding the City Manager, City Attorney, and Department Directors.
C. Any full-time or part-time employee may submit a written nomination for any eligible candidate. Written nominations shall be submitted to the City Manager on an official nomination form (attached). The nominator will supply the following information on the form provided:
1. Indicate the candidate's work location.
2. Name and title of candidate.
POLICY #: B-007
EMPLOYEE RECOGNITION
PAGE2
3. Background information on the candidate including:
a. Outstanding activities related to the City of Arroyo Grande. b. Involvement in non-work related activities that merit consideration for the Employee of the Year Award.
c. Name and title of employee making the nomination.
4. Nominees will be ruled ineligible if they received significant discipline during the previous calendar year.
D. All eligible nominations in each category will be placed on a ballot to be voted upon by all City employees (full-time and part-time) from each work location.
1. The candidate from each work location receiving the most votes will be designated the award winner. A runoff vote will be held in case of a tie.
2. No write-in candidates shall be eligible.
3. Appropriate procedures and controls will be used to ensure accuracy in the selection process.
2. Annual Employee Service Recognition
Recognition for years of service will be presented to employees each year that have reached an additional 5 years of service from their original anniversary date.
3. Platinum Service Award
A. Platinum Service Awards can be presented at any time to employees for special accomplishments and service above and beyond the expectations for the employee's classification.
B. Any full-time or part-time employee is eligible for a Platinum Service Award, which shall require a recommendation of the Department Director and approval by the City Manager.
C. Platinum Service Awards are presented at a City Council meeting.
0 0
POLICY#: B-007
EMPLOYEE RECOGNITION
PAGE3
4. Completion of Service
A. A City plaque is presented to any employee retiring from the City.
B. A City plaque may be presented to any full-time employee leaving employment with the City who has worked for the City for a minimum of five (5) years if recommended by the Department Director and approved by the City Manager.
5. Other Recognition
Other forms of recognition may be presented to employees if recommended by the Department Director and approved by the City Manager.
Steven Adams
City Manager
EMPLOYEE OF THE YEAR NOMINATION FORM
(Submit to City Manager's office by _____ _,
PLEASE CHECK WORK LOCATION:
{ } CITY HALL
{ } POLICE DEPARTMENT
{ } PUBLIC WORKS DEPARTMENT
{ } RECREATION SERVICES DEPARTMENT
NOMINEE'S NAME _____________________ _
LAST FIRST
NOMINEE'S TITLE----------------------
STATEMENT WHY CANDIDATE IS BEING NOMINATED -TO BE PRINTED ON BALLOT (LIMIT TO A MAXIMUM OF 100 WORDS):
NOMINATOR'S NAME DATE
NOMINATOR'S TITLE Page 1037 of 1799
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY #: -=B_-..... oo=s _____ _ SUBJECT: EMPLOYEE SUGGESTION
AWARD PROGRAM
ISSUED: _6~/ ....... 1 ..... /-=9-=6 ____ _
EFFECTIVE: 6/1/96
CANCELLATION DATE: N/A
SUPERSEDES: 11/1/93
POLICY:
The policy of the City is to establish an Employee Suggestion Award Program in order to promote efforts to improve the City's operation and ·service to its citizens, to improve the working conditions of the City's employees, and to better recognize the invaluable contributions of the employees to the City and the community as a whole.
PROCEDURE:
A. ELIGIBILITY
Any employee, whether regular, part-time, temporary, or under contract, is eligible to submit suggestions for
consideration. City Council Members, the City Manager,
and City Attorney are not eligible to participate in the Program.
B. ELIGIBLE SUGGESTIONS
Any suggestion that accomplishes one or more of the
following objectives is eligible for consideration:
1. Measurable savings of time, money, labor, materials, or supplies.
2. An improvement in the quality of a specific public
service.
3. An improvement in methods and procedures that results in increased efficiency.
4. The elimination of unnecessary and costly procedures that result in time, labor, or material savings.
5. An increase in revenue to the City.
6. An improvement in health and safety or working
conditions.
7. An improvement in employee morale and/ or public
relations.
POLICY #: B-008
PAGE 2
C. INELIGIBLE SUGGESTIONS
Some suggestions are not appropriate for review by the
Suggestion Review Connnittee and are not eligible for
awards. Examples of such ineligible suggestions are:
1. Suggestions dealing with "housekeeping" matters such as routine repair and maintenance.
2. Suggestions that point out problems without offering feasible solutions.
3. Proposals in the nature of grievances, salary
adjustments, or matters within the scope of
employee/employer relations.
4. Proposals for minor improvements in working
conditions that the employee or immediate supervisor
can correct through normal or customary action.
5. Suggestions that are within the employee's job
scope/responsibility.
6. A duplicate of a suggestion currently under
consideration.
7. Anonymous suggestions.
8 . Suggestions that are vague, incomplete, deal with
generalities or opinions, are not factual, or do not
include projected costs or savings.
D. SUGGESTION REVIEW COMMITTEE
The Suggestion Review Committee shall consist of one
representative from each City department and the Program Coordinator. All appointments to the Committee shall be made by the City Manager. The Committee shall be
representative of all levels of employees in the
organization.
The Committee will meet as necessary to act as a screening and review body for all properly-submitted suggestions.
The Committee shall receive input and advice from all
departments affected by a given suggestion and shall
review and assess possible and actual cost savings.
It shall be the duty of the Program Coordinator to
receive, acknowledge, and process suggestions; to assist the Suggestion Review Committee in obtaining needed
information for departments; to maintain program files and records; to record actions by the Suggestion Review
Committee; to notify employees of the Committee's
recommendations; and to prepare all necessary Committee communications to the City Manager, City Council, and City employees. ·
POLICY #: B-008
PAGE 3
E. SELECTION PROCESS
Suggestions are to be submitted to the City Manager's
office on an approved form. The City Manager's office
will request the appropriate department{s) to investigate the suggestion and make a report of findings to the
Suggestion Review Committee. The department will forward its report to the Committee within 30 days. However, some suggestions may take longer than 3 O days to properly
analyze. The Suggestion Review Committee will examine
these findings and determine if the suggestion is
acceptable. The Suggestion Review Committee will then
make a recommendation to the City Manager.
Submitted suggestions
information:
must contain the following
1. A brief description of the present method, operation, or problem;
2. What the suggestion aims to accomplish;
3. How the suggestion will affect City operations;
4. Who or what department is affected and who will gain or benefit from the suggestion's implementation;
5. How the suggestion could be implemented, including
descriptive materials, drawings, photographs, or any other information that will clarify the suggestion; and
6. The estimated cost of implementing the suggestion and the probable savings to the City.
The employee's name, department, title, and signature must be included on the form. ALL SUGGESTIONS WILL REMAIN CONFIDENTIAL UNTIL A DETERMINATION IS MADE BY THE COMMITTEE.
F. AWARDS
All adopted suggestions will receive awards. The awards will be presented by the City Council at a regular Council meeting. Awards shall be as follows:
1. Cash awards will be made for suggestions that result in a measurable savings of $500 or more per year. The award
shall consist of 10% of the first year's estimated net
savings, with a maximum award of $750. A Certificate of Commendation shall also be presented and a copy placed in the employee's personnel file.
POLICY #: B-008
PAGE 4
2. For suggestions that result in a one-time savings, a cash award of 5% of the savings, with a maximum award of $750, will be presented together with a Certificate of
Commendation.
3. A cash award of $25 and a Certificate of Commendation will be given. to an employee for suggestions that result in City savings of $500 or less.
4. For suggestions in which the monetary value cannot be established, the Committee may make a recommendation to the City Manager for a specific cash award not to exceed $750.
5. An additional award will be made to an employee whose suggestion is found after one year to be of substantial savings to the City, with the employee' s Department
Director monitoring the savings.
ROBERT L. HUNT
CITY MANAGER
CITY OF ARROYO GRANDE
POLICY # : -=B_-=-00....,9..__ ____ _
ISSUED: __ 6/~1 .... 1_9_6 ____ _
EFFECTIVE: 6/1/96
CANCELLATION DATE: N/A
SUPERSEDES: 3/1/96
I. PURPOSE
ADMINISTRATIVE POLICY AND PROCEDURES
SUBJECT: DRUG AND ALCOHOL TESTING
UNDER DOT REGULATIONS
The City of Arroyo Grande ("City") recognizes that its employees are its most important resource. The purpose of this document is to outline the City's policy regarding drug and alcohol use and the testing of employees who are required to have commercial drivers' licenses ("CDL"), thereby accomplishing the following goals:
A. To provide a safe working environment for City employees; B. To protect the safety of persons and property;
C. To provide the highest quality of public service;
D. To promote efficiency and productivity;
E. To prevent loss of public confidence and damage to the City's reputation;
F. To encourage etqployees who are concerned about their alcohol and/or drug use to voluntarily seek assistance;
G. To provide reasonable accommodations to those employees whose drug and/or alcohol problem classifies them as
disabled under Federal and/or State law;
H. To comply with the Federal Omnibus Transportation Employee Testing Act of 1991.
II. SCOPE
This procedure is applicable to all "covered" full-time, permanent part-time, temporary part-time City employees, and Fire volunteers as subsequently defined. Where any section,
subsection, sentence, clause, or phrase of this procedure is found inconsistent with either a properly negotiated ratified memorandum of understanding enacted between the City and a recognized employee organization, or with any Federal or State law, the terms of such agreement or laws shall prevail.
POLICY #: B-009
PAGE 2
Exceptions to this procedure shall only be allowed when approved by the City Manager.
A covered employee will be subject to the provisions of Section XII. D. Drug-Free Workplace of the Personnel Regulations Manual that provides for other reasonable suspicious causes, such as work performance.
III • AMENDMENTS
This procedure may be amended by the City Manager when approved by the City Council.
IV. DEFINITIONS
Pursuant to the maintenance of a safe and drug/alcohol-free workplace, the following definitions shall apply in support of enforcing the City of Arroyo Grande 1 s policy:
A. .Administrative Leave - Paid or unpaid leave that is imposed pending determination/ investigation of possible disciplinary action or other issues. If paid administrative is imposed, employees are subject to restrictions such as assignment to their residence during their nonnal working hours, except for normal lunch periods. Employees must be available by telephone at all times during these hours. Absences from the residence during duty hours must be approved in advance by the Department Director/Division Manager.
B. Alcohol - Any beverage containing alcohol. The possession, transportation, distribution, receipt, sale, purchase or arranging for the sale, purchase or distribution of alcohol, including medicines containing alcohol "(prescription or over-the-counter) , is prohibited while on duty, unless, with respect to medicines, the packaging seal is unbroken.
C. Commercial Drivers' License (•CDL•) - Refers to Class A or Class B licenses, including Provisional Licenses held by Fire Department equipment operators.
D. Commercial Motor Vehicle - Vehicles with a gross vehicle weight of at least 26, 001 pounds; vehicles with a gross combination weight of at least 26,001 pounds inclusive of a towed unit with a gross vehicle weight rating ( 11GVWR11 ) of more .than 10,000 pounds; DOT placarded vehicles under
hazardous material regulations or vehicle designed to
transport 16 or more passengers, i~cluding drivers.
E. Covered Employees - Any full-time, permanent part-time, temporary part-time, and Fire volunteer of the City who operates a commercial motor vehicle ("CMV") and has a CDL.
Positions included are listed on .Attachment E.
POLICY #: B-009
PAGE 3
F. Dru.gs/Controlled Substances
cocaine, marijuana, opiates,
Hallucinogenics.
Defined as amphetamines, phencyclidine ("PCP"} , and
G. Fitness for Duty - An individual's ability to perform his/her assigned job free from impairment due to the use of prohibited substances.
H. Five Panel Drug Test - There are five categories of drugs · established by the Federal. government that fall under
"controlled substances . n They are cocaine, amphetamines, opiates, marijuana, and phencyclidine ("PCP"}. Use, sale, dispensing, possession, distribution, and/or manufacture of these substances is against the law and a direct violation of the City's policy.
I. Medical Review Officer {•MR.on) - A licensed physician certified to review and interpret all drug results before they are reported to the employer.
J. Premises - Building, property, work areas, vehicles, parking lots, and any place the employee happens to be during the course and scope of City employment during regular working hours, breaks, or any pay status.
K. Pre-employment - Conducted before applicants are hired or after an off er to hire, but before actually perf arming safety-sensitive functions for the first time. Also
required when employees transfer to a safety-sensitive
position.
L. Prescription Dru.gs - Any drug or medication prescribed by a licensed physician for a medical condition. Use of
prescribed drugs are not in direct violation of the City's policy; however, inappropriate use of prescribed use that may cause significant impairment, thus creating a safety hazard on the job, is in direct violation of the City's policy.
M. Program Administrator - The organization or agency with which the City contracts for drug/alcohol testing and
associated services.
N. Safety-/Sensitive Personnel/Job Functions Employees holding Connnercial Drivers' License and driving a commercial vehicle on a full-time, part-time, or intermittent basis.
0. Substance Abuse Professional (•SAP•) - A licensed physician, licensed or certified psychologist, social worker, employee assistance professional, or an alcohol and drug abuse counselor certified by the National Association of Alcohol and Drug Abuse Counselors ( "NAADAC"} Certification
POLICY #: B-009
PAGE 4
Commission. All persons listed in the definition must have specific knowledge of and clinical experience in the
diagnosis and treatment of alcohol and drug-related
disorders to qualify.
V. APPLICABILITY
Effective January 1, 1996, the Department of Transportation alcohol and drug testing rules require drivers to be tested if they:
A. Hold a Connn.ercial Drivers' License (Class A or Class B) and drive one of the vehicles described below, including
Provisional Licenses held as Fire Department equipment
operators.
B. Drive a vehicle with a gross combination weight of at least 26,001 pounds inclusive of a towed unit with a gross vehicle weight rating ("GVWR") of more than 10,000 pounds.
C. Drive a vehicle with a gross combination weight of at least 26,001 pounds.
D. Drive DOT placarded vehicles under hazardous material regulations.
E. Drive vehicles designed to transport 16 or more passengers, including drivers.
VI. CLASSES OF TESTING
A. Drug Testing - All urine specimens are analyzed for the following drugs:
1. Marijuana Cannabinoids as Carboxy - ("THC")
2. Cocaine Metabolites as Benzoylecgonine
3. Amphetamines (amphetamine, methamphetamine)
4. Opiates (codeine/morphine)
5 . Phencycl idine ( "PCP" )
The testing is a two-stage process. First, a screening test is performed. If it is positive for one or more of the
drugs, then a confirmation test is performed for each
identified drug using state-of-the-art gas
chromatography /mass spectrometry ( 11GC/MS") analysis. GC/MS confirmation ensures that over-the-counter medications or preparations are not reported as positive results. Drug testing will be conducted pursuant to the procedures set forth in Attachment A.
POLICY #: B-009
PAGE 5
B. Alcohol Testing - The rules require breath testing using evidential breath-testing devices ("EBT") approved by the National Highway Traffic Safety Administration ( "NHTSA").
Two breath tests are required to determine if a person has a·prohibited alcohol concentration. A screening test is conducted first. Any result less than 0 . 02 alcohol
concentration is considered a "negative" test.
If the alcohol concentration is 0.02 or greater, a second confirmation test must be conducted. The employee and the breath alcohol technician {"BAT") conducting the test
complete the alcohol testing from to ensure that the results are properly recorded. The confirmation test, if required, must be conducted using the EBT that prints out the results, date and time, a sequential test number, and the name and serial number of the EBT to ensure the reliability of the results. 'l;'he confirmation test result determines any actions taken. The procedures that will be utilized by the lab for collection and testing of the specimen are set forth in Attachment A.
VII. PROHIBITED ACTS
The following conduct is p"rohibited and may result in discipline, up to and including termination:
A. Reporting for duty or remaining on duty requiring the performance of a safety-sensitive function while having an alcohol concentration of 0.04 or greater as indicated by an alcohol breath test;
B. Performing a safety-sensitive function within four hours of using alcohol;
C. Being on duty or operating a covered commercial vehicle while possessing alcohol or controlled substances;
D. Using alcohol or controlled substances while performing a safety-sensitive function;
E. Reporting for duty or remaining on duty requiring
performance of safety-sensitive functions when the employee used .any controlled substances, except if the use is
pursuant to the instructions of a physician who has advised the employee that the substance does not adversely affect the employee's ability to safely operate a vehicle. If an employee is .called back to work by his/her Supervisor and such employee has been using alcohol off-duty, he/she is obligated to disclose any consumption to his/her Supervisor so a violation of the DOT regulations does not occur. This disclosure should occur when contacted by telephone to avoid delays _in assigning call-out work;
POLICY #: B-009
PAGE 6
VIII.
F. Reporting for duty or remaining on duty requiring the performance of safety-sensitiye functions if the employee tests positive for controlled substances;
G. Refusing to submit to any alcohol or controlled-substances test required by this Policy. A covered employee who
refuses to submit to a required drug/alcohol test will be treated in the same manner as an employee who tested 0.04 or greater on an alcohol test or tested positively on a
controlled-substances test;
H. Using alcohol within eight ( 8) hours after an accident, except when 1) you have already completed a post-accident alcohol test or 2) you have been notified by a
Supervisor/Department Director of the City that it has been determined your operation of the vehicle did not contribute to the accident.
TYPES OF TESTING
A. Job Applicant/Pre-employment
1. All pre-employment health screens will include a urine drug screen for marijuana, cocaine, phencyclidine,
opiates, amphetamines .
. a. The provisions of this section shall apply to
promotions where such promotions involve moving
from a position not subject to this Policy to a
position that is covered by this Policy.
2. All job announcement or other promotional material for covered positions shall specify that drug screening
shall be a part of the physical examination.
3 . Only applicants who have been given a job off er
conditioned upon passing a physical examination shall
be given a drug-screening test.
4. All applicants for said positions shall be given a copy of this Policy at the time of their conditional offer
of employment and shall, as a prerequisite to
employment, sign a consent form (Attachment B) and
submit to pre-employment drug testing. Any. applicants
who do not consent to such testing will not be
considered for employment.
5. If the consent form or forms are signed, the preemployment heal th screen is conducted and the urine specimen collected.
6. Any applicant whose drug test does -not indicate a
verified negative result shall be given an opportunity
by the MRO to withdraw his/her application for
POLICY #: B-009
PAGE 7
employment. If, under such circumstances, the
applicant does not withdraw his/her application for
employment, he/she shall be determined by the physician to be physically unfit for employment, and said
determination shall be forwarded to the City Manager or other designees. Such applicants shall be disqualified
for employment.
7. Results of any laboratory test will be sent to the City Manager or other designees designated to receive this
information.
8. If the test results are negative, the individual will be contacted and be given a date to report to work.
9. If the test results are reported by the MRO as
positive, the City will inform the individual that
he/ she has not passed the pre-employment physical. No
other elaboration will be made, even if requested.
10. No perspective employee may begin work prior to
employee health approval and will not be allowed to
begin work at all if illicit drugs are identified
during the employment health screening process.
11. Any applicant disqualified for employment pursuant to this Policy shall be permitted an opportunity to
reapply after one (1) year.
12. Testing is required when employees transfer, promote, or are advanced to a safety-sensitive position.
B. Random Selection and Testing
1. Random Testing Requirements: Employees subject to
random selection for the purpose of alcohol and drug
te$ting for controlled substances will include covered
employees.
The following items regarding the random selection and
testing procedure will apply:
a. The number of urine drug tests conducted annually
shall equal or exceed 50% of the average number
of employees for which testing is required.
Random alcohol tests shall equal 25% of
employees . Some employees may be tested more
than once in a year, while others are not tested
at all, depending on the random selection.
b. The City. shall use random· selection process to
select and request an employee to be tested for
the use of controlled substances.
POLICY #: B-009
PAGE 8
c. An employee shall submit to controlled substance
testing when selected by · a random selection
process used by the City.
To assure that the process is in fact random, all
covered employees, whether or not they have been chosen for testing in the past, will remain in the pool of
employees for each subsequent period. This procedure
assures that the probability of any individual being
selected each period is always the same, whether or not the individual was selected in a previous period.
When an employee is selected for random testing,
his/her Supervisor will ensure ~is/her duties are
covered. The employee will be notified of the location
and time he/she is to report for testing.
2. Selecting Employees for Random Testing: Covered
employees shall be assigned numbers. Selection of
employees shall be by either a computerized or manual
selection process. Under a computerized system, a
random number generating program is loaded into a
computer along with the names or identification numbers .for the covered employees. This list of names will be
checked regularly by a third party, who is not a City
employee, for additions or deletions. The computer
then generates a list of employees to be tested during
the current testing period. Should a manual system be
used, selection will be by a simple drawing of the
required number of employees for testing during the
current testing period.
The selection process is repeated until the required . number of employees is selected. Once the list of test subjects is generated, employees should not be informed that they have been selected until they must report for testing. Advance notice of testing shall not be given.
As in all types of tests, accurate records of the
details of testing must be safely kept and
confidentially maintained at all times.
C. Reasonable Suspicion: The City shall require an employee to be tested, upon reasonable cause/suspicion, for the use of drugs, alcohol, or other controlled substances.
An employee shall submit to testing, upon reasonable
cause/suspicion, for the use of alcohol or controlled
substances when requested to do so by his/her Supervisor.
The conduct must be witnessed by a Supervisor or City
official and a witness. The Supervisor and witness must have received a minimum of four (4) hours of training in the identification of action, appearance, or conduct of an
POLICY #: B-009
PAGE 9
employee that are indicative of thE; use of alcohol. or controlled substances. Supervisors will receive periodic ref re sher retraining. Department Directors will arrange f.or new Supervisors to receive training as soon as feasible.
The employee may have an individual of his/her choosing serve as an additional witness.
The documentation of the employee's conduct shall be
prepared and signed by the Supervisor and witness, utilizing the Observed Behavior - Reasonable Suspicion Record Form {Attachment C) , within 24 hours of the observed behavior or before the results of the test are released, whichever is earlier.
"Reasonable Cause/Suspicion" means that the
Employer/Supervisor believes the actions, appearance,
speech, body odors, or conduct of an on-duty employee are indicative of the use of controlled substances or alcohol.
The witness{es) must directly observe the behavior or other evidence. Hearsay or second-hand. information is not
sufficient cause to require an employee to submit to a drug test. The determination that a reasonable suspicion exists to require an employee to undergo an alcohol test must be based on a short-term, specific, objective, contemporaneous, articulable facts concerning the behavior, appearance,
speech, or body odors of the employee. It must be based upon observations of the Supervisor making the determination and may not be based upon heresay. The Supervisor may not rely on long-term signs, such as absenteeism or tardiness, to support the need for a reasonable suspicion test. The Supervisors witnessing the impairment must document {on Attachment C) the specific observations upon which the
reasonable suspicion is based.
Alcohol testing may be performed only if the observations upon which reasonable suspicion are based are made during, just preceding, or just after the period of work day with which the employee is required to be in compliance.
If an alcohol test is not administered within two (2) hours following a reasonable suspicion determination, the
Supervisor shall document the reasons· for the delay. If an alcohol test is not administered within eight (8) hours, the test shall not be administered, and the Supervisor shall document the.reasons.
Once a reasonable suspicion determination is made, it is the responsibility of the Employer/Supervisor to assure that the employee under suspicion is evaluated and, when necessary, transported to a specimen collection site to provide a
urine/breath sample.
The driver/employee to be tested for reasonable suspicion
POLICY #: B-009
PAGE 10
must be removed from the job. The Manager or Supervisor should require the driver/employee to remain on the premises for a reasonable period of time until he/she can arrange for transportation of the employee for testing and/or to home.
Any time spent remaining on the premises at the request of the supervisor or Manager, or time spent for drug/alcohol testing, will be considered City time and will be paid by the City. If the test results return positive, the employee will be condsidered not fit for duty. Sick leave may be authorized for time off the job until released to return to duty following drug/alcohol testing when SAP verifies the employee is actively participating in a drug/alcohol
assessment and rehabil~tation program.
D. Post-accident: As soon as practicable f cl lowing an accident involving a commercial motor vehicle, the City shall test for alcohol and controlled substances each surviving driver when either: (1) the accident involved a fatality; (2) the driver subject to receiving a citation under State or local law for a moving traffic violation arising from the
accident, or (3) the driver has been determined to be the primary cause of the collision.
The following criteria will be applied in conducting a
drug/alcohol test due to accidents, incidents, or related occurrences:
1. Post-accident breath alcohol and/or drug test must be given as soon as practicable during the eight hours
following an accident/incident.
2 . The employee must be readily available for the test or they will be deemed to have refused the test.
3. The post-alcohol test should be administered as soon as possible. If not within two (2) hours, the
Employer/Supervisor must prepare and maintain records
stating why. If eight (8) hours have passed, the
attempts should be discontinued. Again, the
Employer I Supervisor must record why the City was unable to administer the test.
4. If a controlled substance test is not administered
within 32 hours following the accident, the test may
not be administered and the Supervisor shall document
the reasons.
5. Following an accident, the employee shall remain
available for such testing or may be deemed to have
refused to submit to testing. This rule does not
require the delay of necessary medical attention for
injured people following an accident nor prohibit the
employee from leaving the scene to obtain assistance or
POLICY #: B-009
PAGE 11
necessary emergency medical care ..
6. An employee subject to post-accident testing may not use alcohol within eight (8) hours following the
accident or before an alcohol test, whichever comes
first.
7.. Post-accident information, procedures, and instruction shall be provided to every employee for the first time
prior to operating a CMV and shall be posted in every City CMV. .
8. Any time spent remaining on the premises at the request of the Supervisor or Manager, or time spent on
drug/alcohol testing, will be considered City time and
will be paid for by the City. If the test results
return positive, the employee will be considered not_
fit for duty. Sick leave may be authorized for time
off the job until released to return to duty following
drug/alcohol testing when the SAP verifies the employee is actively participating in a drug/alcohol assessment
and rehabilitation program.
E. Return-to-duty: Employees who violate this drug/alcohol policy standards arid are accepted into Return-to-Duty andFollow-up status will comply with the following guidelines:
1. Employees who violate the City's drug/alcohol policies must have a return-to-duty test that would require the
employee to test negative for drugs or indicate an
alcohol concentration of less than 0.02.
2 . Such employees will meet with the Substance Abuse
Professional ("SAP") for further assessment.
F. Follow-up Testiri.g: All employees identified by the Substance Abuse Professional ("SAP"} as needing assistance will be subject to follow-up testing upon returning to duty.
They will be subject to a minimum of six unannounced tests over the fallowing 12 months . The SAP can direct additional testing during this period or for an additional period up to a maximum of 60 months from the date the employee returns to duty. The SAP can terminate the requirement for the followup testing in excess of the minimum at any time if the SAP. determines the testing is no longer necessary and the City Manager supports such determination.
Follow-up testing may include tests for other substances beyond the employee's :tnitial positive test of alcohol and/or drugs when the SAP has reason to suspect other drug or alcohol involvement during the follow-up period.
POLICY #: B-009
PAGE 12
IX. ACKNOWLEDGMENT AND CONSENT
Employees will be asked to sign an Acknowledgement and
Consent form (Attachment D) authorizing the drug/alcohol testing and permitting release of test results to those City officials on a strictly need-to-know basis. The
Acknowledgment and Consent farm shall include language that employees acknowledge they have read the City's drug/alcohol testing policy.
X. REFUSAL TO SUBMIT TO DRUG/ALCOHOL TESTING
A job applicant who refuses to consent to a drug/alcohol test will be denied employment with the City of Arroyo Grande.
An employee's failure to submit to drug testing required by the City for any reason will be treated in the same manner as an employee who tested 0.04 or greater on an alcohol test and tested positively on a drug test. The employee is subject to
disciplinary action up to and including termination.
Any Supervisor or Manager encountering an employee who refuses an order to submit to a drug and/or alcohol test shall review with the employee the requirements and disciplinary consequences of which he/ she has previously agreed to per Section IX of this Policy.
Where there is reasonable suspicion that the employee is then under the influence of alcohol or drugs, the Manager or Supervisor shall arrange for the employee to be safely
transported home. (The employee shall not be permitted to transport him/herself.)
A refusal to submit to an alcohol or drug test required by this Policy includes, but is not limited to:
A. A refusal to provide a urine sample for a drug test; B. An inability to provide a urine sample without a valid medical determination;
C. A refusal to complete and sign the breath alcohol testing form or otherwise to cooperate with the testing process in a way that prevents the completion of the test;
D. An inability to provide breath or to provide an adequate amount of breath without a valid medical determination; E. Tampering with or. attempting to adulterate the urine specimen or collection procedures;
POLICY #: B-009
PAGE 13
F. Not proceeding immediately to the test site (Federal FHWA law as indicated in 49 CFR, Section 382. 305 (h) requires that: "Employees notified that they have been selected for random testing shall ·proceed immediately to the test site, provided however, if the employee is notified while
performing safety-sensitive functions, the employee shall cease performing such function and proceed to the testing site as soon as possible, as directed by the Supervisor."); G.· Leaving the scene of an accident without a valid reason or authorization from a Supervisor or Manager;
H. Consuming alcohol during the eight (8) hours immediately following an accident where the employee's actions may not have been discounted as a contributing factor;
I. Engaging in any conduct that clearly obstructs the testing process.
XI • CONSEQUENCES OF FAILING AN ALCOHOL AND/OR DRUG TEST A. A positive result from a drug or alcohol test will
constitute the employee being deemed unfit for duty and employee will be put· on an emergency suspension until such time as the employee is fit to return to duty, and the
results of tests and related relevant materials are reviewed by the City Manager or his/her designee.
B. A positive result from a drug or alcohol test may result in disciplinary action, up to and including termination. Such discipline will be administered pursuant to Section VIII of the City's Personnel Regulations Manual. The following
guidelines should be used in determining the appropriate discipline:
POLICY#: B-009
PAGE 14
Alcohol
.02 or less than .04
Drug and Alcohol
.04 or greater
alcohol or positive
drug or refusal to test.
1st offense
2nd offense
3rd offense
4th offense
1st offense
2nd offense
Suspension (24
hours or one work
day minimum) ;
Retesting is
required in order
to return to duty;
No referral to
SAP.
Suspension (72
hours or three
w o r k d a y s
minimum) ; Referral
to SAP; Retesting
is required in
order to return to
duty.
Suspension (120
hours or five work
days minimum) ;
Referral to SAP;
Retesting is
required in order
to return to duty-
-Minimum 6 times
retesting in next
12 months.
Discharge.
Suspension until
clean test (72
hours or three
w o r k d a y s
minimum}; Referral
to SAP; Retesting.
Discharge.
POLICY #: B-009
PAGE 15
Employee Conies Forward
Admits to Supervisor
of his/her use of a
drug and/or alcohol
(not in conjunction
with notification of
random testing or
investigation of
drug/alcohol
reasonable suspicion
testing or accident)
Accident
.04 or greater
alcohol or positive drug.
1st time
2nd time
3rd time
No suspension;
Referral to SAP;
Use of eligible
leave, subject
to proof of
approved
enrollment in a
rehabilitation
program; testing
required in order to
return to duty.
No suspension;
Referral to SAP;
Use of eligible
leave, subject t o
proof of approved
enrollment in a
rehabilitation
program; testing
required in order
to return to duty.
Based on the facts·
and circumstances,
appropriate
discipline may be
imposed, up to and
i n c l u d i n g
discharge.
Discharge
In addition to possible disciplinary action, Federal law requires that the employee:
A. Must be removed from performing safety-sensitive functions; B. Must submit to an examination by a Substance Abuse
Professional. Upon·a determination by the Substance Abuse Professional, the employee may be required to undergo
treatment to cure his/her alcohol or drug abuse. The City is not required to pay for this treatment; C. May not return to his/her former safety-sensitive position until the employee submits to a return-to-duty drug and/or alcohol test (depending upon which test the employee failed} that indicated an alcohol concentration level of less than
0.02 or a negative result on a drug test;
POLICY #: B-009
PAGE 16
D. Will be required to submit to unannounced follow-up testing after he/she has returned to his/her safety-sensitive function; E. Be removed from his/her safety-sensitive position for at least 24 hours if his/her alcohol test indicates an alcohol concentration level between 0.02 and 0.04.
Sick leave may be authorized for time off the job until released to return to duty following drug/alcohol testing when the SAP verifies the employee is actively participating in a drug/alcohol assessment and rehabilitation plan.
Employees must use sick leave for drug/alcohol counseling and/or treatment programs. An adjustment of paid sick leave to unpaid suspended days off will be made once disciplina:r:y action is imposed. Offenses will be cumulative only if they have occurre~ within three (3) years of a previous offense.
If extended time off is required for inpatient
rehabilitation treatment and counseling services, exhaustion of paid benefits must occur prior to taking an unpaid
medical leave of absence, pursuant to Section XII. A. of the Personnel Regulations Manual . In all cases of extended unpaid medical leaves for said treatment, provisions of Section XII, A. 9. of the Personnel Regulations Manual will prevail, except that no leave shall exceed six (6) months.
Further, a leave may not be approved or may be discontinued within the six-month limit if City management determines the employee is uncooperative, malingering, or otherwise is unable to complete his/her treatment.
XII. DISCIPLINE FOR WORK-RELATED PROBLEMS
XIII.
The City of Arroyo Grande may, in its sole discretion, impose administrative/disciplinary measures, ~p to and including termination, upon employees for rule violations and work-related problems, separate and apart from violations of this substance abuse policy and even if such rule violations or work-related problems result from alcohol or substance abuse. Additionally, this policy and procedure does not preclude the City from imposing progressive discipline based on a combination of violations of this policy and a history of other work-relqted problems/violations.
CONFIDENTIALITY
· A. Confidentiality is an essential element of this substance abuse policy. Any employee violating this confidentiality shall be subject to discipline and, if the breach is
intentional, may also be civilly or criminally liable.
POLICY #: B-009
PAGE 17
B. The results of any testing done pursuant to this policy shall be used for employment purposes only and shall not be released for use in the criminal justice system, unless compelled by court order.
1 C. All records pertaining to drug and alcohol testing of. an employee shall be contained in a confidential medical file that will be securely kept under the control of and held at the Program Administrator's facilities.
D. Absent the employee' s consent, test results may be disclosed only to City management on a strictly need-to-know basis and at the employee's request.
E. The City may disclose test results without the employee's consent only when:
1. The information is compelled by law or judicial or
administrative process;
2 . The information has been placed at issue by the
employee in a formal dispute between the employee and
the City;
3 . The information is necessary to administer an employee benefit plan; or
4. The information is needed by med.l.cal pers·onnel for the diagnosis or treatment of the patient who is unable to . authorize disclosure.
F. Any positive results that are later refuted shall be removed from the employee's file and not used for any purpose.
XIV. ·RECORD-KEEPING
The City Manager of the City of Arroyo Grande maintains ultimate responsibility for the following records for the periods specified. The records, however, will be under the control of and held at the Program Administrator's facilities in a secure location with controlled access:
A. Results of an employee' s alcohol test that indicates an alcohol concentration level of .02 or higher; results of an employee's controlled substance test that is positive;
documentation of any employee who refused to submit to a required alcohol/drug test; calibration documentation;
employee assessments and referrals by substance abuse · professionals. Retention period: 5 years.
B. Records documenting the collection process for the alcohol and controlled substances test. Retention period: 3 years_
POLICY #: B-009
PAGE 1.8
c.
.. D.
Records of training of supervisors and employees . Retention period: 2 years (Supervisor'$ certificates maintained in Personnel files) .
Results of any alcohol test that is less than .02;
documentation of any negative or cancelled drug test . Retention period: 1 year or until documentation of DOT random testing requirements finalized.
XV. SUBSTANCE ABUSE PRO~SSIONAL SERVICES { n SAP•)
The City of Arroyo Grande observes the U.S. Department of Transportation ( 11DOT11 } and the Federal Highway Administration ( 11 FHWA11 ) drug and alcohol testing rules published in the Federal Register on February 1.5, 1.994, and subsequently amended.
The City supports an opportunity for treatment to be made available to covered employees. The City will advise a covered employee who engages in conduct prohibited under this policy of the available resources for evaluation and treatment of drug/alcohol problems, including the names, addresses, and telephone numbers of Substance Abuse Professionals ( "SAPs 11 ) , counseling, treatment programs, or other available services . The City will provide for a SAP evaluation to assess employees with drug and/or alcohol misuse problems.
Each covered employee who violates these rules must be evaluated to determine whether the employee needs assistance resolving problems associated with drug and/or alcohol misuse and, if nec.essary, a referral for further treatment.
Before returning to duty, each employee identified as needing assistance must: (1.) be evaluated again by a SAP to determine whether the employee has successfully complied with the treatment program prescribed following the initial evaluation; (2) undergo a d_rug and/or alcohol test to satisfy established acceptable results for return to duty; and (3) be subject to a minimum of six {6} unannounced follow~up drug and/or alcohol tests over the following 1.2 months.
The City will only provide for the cost of an assessment by a Substance Abuse Professional {"SAP") . The City has ·no obligation to provide or pay for further treatment; this is the
responsibility of the employee.
XVI. EMPLOYEE ASSISTANCE PROGRAMS
Until such time as the City establishes an Employee Assistance Program {EAP}, employees needing counseling/tre~~~ent are encouraged to utilize the services that may be availa.Q.~~ through their City-provided Health Care Plan. · v
POLICY #: B-009
PAGE 19
XVII. DISTRIBUTION OF POLICY
XVIII.
All covered employees shall be given a copy of this policy at the time they commence employment with the City. Covered employees currently employed by the City at the time this policy is adopted shall be given a copy thereof within ten (10) days of its adoption.
INTERPRETATION
Any questions relative to the event and/or application of this policy should be directed to the Office of the City Manager.
XIX. DEPARTMENTAL RESPONSIBILITY
It will be the responsibility of each Department Director to inform all concerned departmental staff of these personnel procedures as they are hired or transferred to his/her department and to issue any further instructions to ensure their
implementation.
ROBERT L. HUNT
CITY MANAGER
A'ITACBMBNT A
REASONABLE SUSPICION DRUG/ALCOHOL TESTING PROCEDURES
UNDER DOT/FHWA REQUIREMENTS
FOR THE EMPLOYER.
There may be instances when Supervisors have reasonable cause to believe that (1) an employee has consumed drugs and/or alcohol on City premises; or (2) reported to work under the influence of drugs and/or alcohol.
1. After consulting with the Division or Department Director, the Supervisor should personally escort the employee to an off ice or other private area. Have another Supervisor present as a _witness.
2. Confront the employee with reasons for suspecting drug and/or alcohol policy violations. Use the Reasonable Suspicion Record to question and document information from the employee.
Complet:e the form and in conversation with the employee, determine whether or not the employee has consumed drugs and/or alcohol and is under the influence.
3. If the employee does not appear to be under the ·influence of drugs, including prescription drugs, and the employee is able to perform regular work duties, have him/her return to the work unit and resume work.
4. If it is believed the employee is under the influence of, or has consumed drugs and/or alcohol, advise the employee that the City rules have been violated and that he/she is being requested to provide a urine sample for drug testing, plus the test for alcohol. Personally escort the employee (with
another Supervisor, when possible) to the City-approved drug/alcohol testing site. (The employee shall not be
permitted to drive him/herself to the testing facility.)
5. Require the employee to read and sign a chain of custody form available at the testing location. Advise the employee that refusal to give a specimen will be treated as a refusal to obey a direct request and will constitute an admission that the suspicion is reasonable and will be grounds for
discipline, up to and including termination. Once the
specimen is taken and initialed by the employee, the employee will be transported home. If the test results return
positive, the employee will be considered not fit for duty.
Leave benefits will be charged and disciplinary action imposed in accordance with other provisions of this policy
6. Whenever an employee is required to provide specimens for testing, two (2) specimens shall be collected at the same time in order to facilitate the testing procedures described herein.
7 . In testing for the presence of illegal drugs, the testing facility shall submit the first specimen for testing, using an immunochemical assay or radioimmunoassay test on the employee's urine. If the initial test is· positive for an illegal drug, the same specimen shall be subjected to a confirmatory test using the gas chromatography, thin layer chromatography, or gas chromatography /mass spectrometry method ("GC/MS") for verification.
8. The MR.O will report results to the City via a signed, written communication, within three business days of completion of the MR.O's review. The MR.0 shall also report to the City that he/she has made all reasonable efforts to contact the
employee. The City shall, as soon as possible, request that the employee contact the MR.O prior to dispatching the
employee, or within 24 hours, whichever is earlier. At the time the employee contacts the MR.0, he/she may request that a se~ond specimen be tested at another laboratory.
9. If the employee fails to contact the MR.O, or the employee does not request the testing of the second specimen, or if the employee does request the testing of the second specimen and it : also tests positive for an illegal drug,
·rehabilitative/corrective action shall be taken as specified in this policy.
10. At any time within 24 hours of being notified of a positive test result, the employee may present bona-fide verifi.cation of a current valid prescription in the employee' s name for any potentially impairing drug or medication identified in the positive drug screen.
11. If it is believed the employee is impaired, make arrangements to have the ·employee taken home. Do not permit him/her to leave the premises or drive alone. If the employee refuses any assistance, make sure the witnessing Supervisor can verify that the employee refused such assistance. If the employee cannot control his/her actions and departs without assistance, immediately call the local police or law enforcement agency to inform them of the employee's condition and refusal for assistance. Tell the law enforcement officials the employee's name and a description of the automobile including the license number.
12. Each employee who has engaged in conduct prohibited under this policy will be advised by the City of resources available in evaluating and resolving problems associated with the misuse of alcohol and use of drugs.
13. Before an employee returns to duty requiring the performance of a safety-sensitive function, the employee shall undergo a return-to-duty alcohol test or a drug test. In addition, the ATI'ACBMBNT A - 2
employee shall be evaluated by a Substance Abuse Professional to determine that he/she has properly followed any prescribed rehabilitation program.
14. The employee shall be subject to unannounced follow-up alcohol and drug tests following the employee•s return to duty
consisting of at least six (6) tests in the first 12 months following the employee's return to duty.
NOTE: Employees involved in a fatal accident or who receive a citation for moving violation are required to submit
to a urinalysis test and the alcohol test.
Consequently, steps 2 through 4, above, do not apply.
ATI'ACBMBNT A - 3
GENERAL INFORMATION: DRUG TESTING PROCEDURES
1. The test must be conducted by analyzing an employee's urine;
2. The urinalysis must be done at a laboratory certified by the Department of Health and Human Services;
3. The urine specimen must be split into two bottles labeled as "primary0 and "split" specimen;
-4. ·If the urinalysis of the primary specimen tests positive for the presence of illegal, controlled substances, the employee has .72 hours to request that the split specimen be analyzed by a different certified lab; ·
5. The urine sample must be tested for the following: marijuana, cocaine, opiates, amphetamine, and phencyclidine;
6. If the test is positive for one or more of the drugs, a confirmation test must be performed using gas
chromatography/mass spectrometry analysis;
7. All drug test results must be reviewed and interpreted by the Medical Review Officer ( "MRO") before they are reported to the employer;
8. With all positive drug tests, the MRO must contact the employee to detennine if there is an alternative medical explanation for the positive test result. If documentation is provided and the MRO detennines there was a legitimate medical use for the prohibited drug, the test result may be reported to the employer as "negative."
A'lTACBMENT A - 4
ALCOHOL TESTING PROCEDURES
FOR SPECIMEN COLLECTION
1. The employee reports to collection site for drug and alcohol screen.
2 . The employee must present acceptable picture ID to the collector.
3. Should the collector have reason to believe the employee may become disorderly before administering the initial screen, or at any time during the completion of this protocol, the collector shall contact the City.and request the presence of supervisory personnel of the City.
4. The drug screen shall be accomplished first in accordance with DOT protocols (see pages 6 and 7 of this Attachment) .
5 . The collector shall request that the employee provide an initial alcohol screen sample following the drug screen. The screening device shall be an EBT device listed on the current conforming products list published by the NHSTA.
6. If the initial screen is negative using the EBT, record the result on the alcohol test requisition form per instructions.
7. If the initial screen is positive, the collector shall perform a second screen. The collector shall instruct the donor to be seated for 15 minutes and not to drink or eat anything .. The collector shall contact the City and request the presence of the employee's Supervisor before performing a second EBT screen. After 15 minutes, the collector shall administer a second screen test using the same me.thod as the first sc~een.
8. If the second screen is negative, the collector shall record the test as negative. No further testing is required.
9. If the employee 1 s confirmatory test is positive, the collector shall advise the City Supervisor present at the collection site to escort the employee back to his or·her worksite or to his/her home. The collector shall record the results on the alcohol test requisition.form per instructions.
10. The collector shall notify the City that it will fax the Breath Alcohol Test Requisition form to the Program Administrator and the City Manager or his/her designee.
ATTACHMENT A - 5
DRUG TESTING PROCEDURES FOR THE SPECIMEN
COLLECTION PERSONNEL AT THE COLLECTION SITE
1. Verify the identity of the employee through the use of an official picture identification or verification by a City of·ficial. Notify the City if the employee fails to report or arrives late.
2. If the employee providing the specimen requests it, present your identification as well.
3. Request that the employee check his/her belongings, including unnecessary outer garments, purses, and brief cases. The emp,loyee may retain. his/her wallet. If the employee requests it, provide a receipt for his/her personal belongings.
4. Request the employee to rins.e his/her hands with water and dry them.
5 ~ Provide the employee with a specimen bottle and direct him/her to the privacy enclosure·. Do not enter the enclosure . You should not observe the specimen collection unless special circumstances exist. Instruct the employee that at least 45 milliliters of urine are required and that the temperature will be taken to ensure the integrity of the sample.
6. If the employee refuses to provide a specimen or otherwise fails to cooperate with the process, inform the employer and document the refusal on the custody and control form.
7. If the employee is unable to provide at least 45 milliliters, the original specimen shall be discarded and the employee will be instructed to drink not more than 24 ounces of fluid in a period of up to two hours. If 45 milliliters cannot be
provided within the two-hour limit, notify the City.
8 . After providing the specimen, allow the employee to wash his/her hands.
9. Measure the temperature of the specimen. If the temperature of the specimen is outside the acceptable range (90.5 to 99.8 F), the collection site person will require the employee to have his/her oral temperature taken to counter any suspicion of tampering with or substitution of the ·specimen. Note the temperature in the appropriate place on the custody and control form.
10. If there is any reason to suspect adulteration or
substitution, notify a higher level Supervisor, have the samegender technician directly observe the collection of a second specimen, note the unusual behavior on the Custody and Control A'ITACBMENT A - 6
form, and submit both specimens for testing.
11. Pour the first 30 ml. of urine into the specimen bottle for the original ("primary") specimen. Up to 15 ml . is to be used for the split specimen.
12. Keep the specimens in view at all times prior to sealing and labeling. The specimens must also be in view of the employee. 13 . Seal and label the specimens in view of the employee. Record the date on the specimen label. Have the employee initial the label verifying that the specimens are his/hers.
14. Complete the custody and Control form ensuring that you and· the employee have signed the appropriate certification
statements. Document receipt and release of specimen and shipment courier in Chain of custody section of the form.
15. Place the specimens and the copies of the custody and Control form in a container suitable for shipment, and seal. Initial the seal and record the time and date of closure for shipment.
16. Store all specimens in a secure location until shipment. 17 . Ship the specimens to the laboratory (certified by the Department of Health and Human Services) using the designated courier.
ATTACHMENT A - 7
DRUG TESTING SPECIMEN COLLECTION PROCEDURES FOR THE EMPLOYEE
1. Report to the specimen collection site as soon as possible after notification to report. Refusal to report for
collection or refusal to cooperate with the collection process will result in a determination of a refusal to provide a specimen.
2. Show the collection site personnel an official photo identification card.
3. Check your outer garments with the collection site personnel for safekeeping. You have the right to retain your wallet and to ask for a receipt for your belongings.
4. Rinse and dry your hands.
5. Obtain a wrapped specimen container from the specimen collection personnel.
6 . Proceed to the privacy enclosure and provide a specimen in the collection container. At least 45 milliliters of urine are required for analysis. If an insufficient amount of urine is ·provided, the original specimen will be discarded and you will be required to consume not more than 24 ounces of fluids in two hours to provide another specimen. Do not tamper with the specimen or make substitutions . The specimen will be visually inspected for unusual color and sediment.
7. The temperature of the specimen will be measured and must fall within an acceptable range. If the temperature falls outside the acceptable range, you will be required to provide an oral temperature to counter any suspicion of tampering.
8 . Give the specimen to the specimen collection personnel and watch the sealing and labeling of the bottles. Initial the labels verifying that the specimen is yours.
9 . You may wish to indicate on the back of your copy of the Custody and Control form ~ny medications you are currently using. This may serve as a memory jogger in the event a Medical Review Officer calls you to discuss the results of your test.
10. The results of the laboratory analysis will be forwarded to the City's Medical Review Officer. If the results are
negative (no drugs detected), the MRO will notify the City. If the laboratory confirms a positive result {drugs detected), the MRO will contact you at the telephone number you provided to give you the opportunity to discuss the test results and to submit information demonstrating authorized use of the drugs in question.
ATrACBMENT A - 8
, A'ITACBMENT B
CITY OF ARROYO GRANDE
PRE-EMPLOYMENT URIDLYSIS FOR DRUG TESTING CONSENT FORM
I understand that as required by the City of Arroyo Grande' s Department of Transportation ("DOT") Drug and Alcohol Testing Policy, as to applicants whose positions require commercial drivers' licenses, prior to being offered a position with the City of Arroyo Grande, applicants must be tested for controlled substances as a pre-condition for employment. ·
I consent to give a urine specimen collection that will be used to detect the presence of controlled substances.
I understand that a positive test result for controlled substances will renqer me unqualified to assume a position of employment with the City of Arroyo Grande.
The Medical Review Officer will maintain the results of my test.
Negative and positive results will be reported to the City of Arroyo Grande. If the results are positive, the controlled substances will be identified.
I further consent and agree that, upon request by the City of Arroyo Grande, the laboratory results of my test shall be furnished to the City of Arroyo Grande by the facility chosen.
I understand the above conditions and hereby agree to comply with them.
Date Applicant's Signature
Witness Applicant's Printed Name
Applicant's Address:
Applicant's Telephone:
ATI'ACBMENT C
CITY OF ARROYO GRANDE
OBSERVED BEHAVIOR
REASONABLE SUSPICION RECORD
Employees Name: Identification No. ~
Observation Date: _____ am/pm to ____ __ am/pm
Location:
(Street) (City) (State) (Zip)
QUESTIONS:
1. Do you have any ~edical problems for which you are currently
2. being treated: If yes, for what are you being treated? ------------------------------------------------ What is your doctor's name, address,_ and telephone number?
Are iou taking any medication?
and for what reason?
If yes, what medication
3. Do you have any medical problem for which you are not currently being treated? If yes, describe
4. Are you using any type of drug? If yes, what?
_______________________________ When?------------------------ ----------------~Where?----------------------------------~ --------------- With Whom?
5. Have you had alcohol, alcoholic beverage, other substance with alcohol in it?
When?
With Whom?
If yes, what?
Where?
I hereby certify that my responses are true and correct.
Date Employee's Signature
Witness
CITY OF ARROYO GRANDE - CAUSE FOR SUSPICION
1. Presence of drugs and/or drugs paraphernalia (specify):
2. Appearance:
3. Behavior/Speech
4 . Awareness :
Normal
Puncture Marks
Bloodshot Eyes
Dilated/Constrictive
Pupils
Flushed
Disheveled
Profuse Sweating
Runny Nose/Sores
Dry-Mouth Symptoms
Tremors
Inappropriate
wearing of sunglasses
Other
Normal Incoherent Slurred
Silent Confused Slowed
Whispering Other --------------------------------------- Normal
Euphoria
Paranoid
Confused
Lethargic
Disoriented
__ Mood Swings
Lack of
Coordination
Other ----------------------------------------------------- s. Motor Skills/Balance:
6 . Walking & Turning:
Normal
Falling
Swaying
Staggering Other
Normal Swaying __ Arms Rais~d
Other
for Balance
Stumbling __ Falling __ Reaching for
Support
7. Other Observed Actions or Behavior (specify):
WITNESSED BY:
am/;gm
{Supervisor's Signature) {Title) {Date) (Time)
I concur with the above written causes:
am/;gm
(Witness• Signature) {Title) (Date) (Time)
This document must be prepared and signed by the Supervisor and witness within 24 hours of the observed behavior or before the results of the tests are released, whichever is earlier.
ATI'ACBMBNT C - 2
POLICY#: 8-009
! ..
ATTACHMENT D
CITY OF ARROYO GRANDE
ACKNOWLEDGEMENT AND CONSENT
I hereby acknowledge that I have received a copy of the City of Arroyo Grande Drug and Alcohol Testing Policy concerning drug and alcohol testing as required by the Federal Highway Administration (
11FHWA11 ), 49 CFR Part 382 and DOT Procedures for
Transportation Workplace Drug Testing Program, 49 CFR Part 40.
I have read and clarified with my Supervisor any questions regarding the provisions outlined in the City's Drug and Alcohol Testing Policy. I agree to comply with all the requirements_ contained therein, including consenting to any drug and/or alcohol testing when requested and permitting the release of test results to the City officials on a strictly need-to-know basis. I understand that compliance with the Drug and Alcohol Testing Policy is a condition of employment with the City. I understand that disciplinary action, up to and including termination, may be taken if I am found in violation of the policy.
Date Employee's Signature
Employee's Printed Name
Date Witness' Signature
Witness' Printed Name
POLICY #: 8-009
ATTACHMENT E
Covered Employees - Any full-time, permanent part-time, temporary part-time, and Fire volunteer employee of the City who operates a commercial motor vehicle (
11CMV11 ) and has a COL.
I. Public Works
A. . Public 'Norks Supel"'i·isor
&.-A. Public Works Water Services Worker
&.-8. Public Works Maintenance Person Worker Ill
&.C. Public Works Maintenance Person Worker II
E-D. Public Works Supervisory Mechanic
r.-E. Public Works Maintenance Person Worker
II. Parks
A. Parks Maintenance Person Worker II
Ill. Fire
A. Designated Fire Fighters
8. Engineers
C. Captains
Revised: September 1, 1997
CITY OF ARROYO GRANDE
POLICY #: _B...._-0...,1..,.0..__ ____ _
ISSUED: _ ..... 6..... /l"""/.....,9 .... 6..__ ___ _
EFFECTIVE: 6/1/96
CANCELLATION DATE: N/A
SUPERSEDES: NEW
POLICY:
ADMINISTRATIVE POLICY AND PROCEDURES
SUBJECT: RELEASE OF INFORMATION ON
PERSONNEL ACTIVITIES OR
MATTERS INVOLVING DISCIPLINE
It is the policy of the City that all specific information regarding Personnel actions be kept in a confidential manner.
1. Departmental press contacts shall not release specific information regarding employee conduct or an investigation into employee conduct including affirmation or denials of
information.
2. Except as specified by law, specific information that includes names and/or types of disciplinary action may only be released to City Council Members or other appropriate employees through the City Manager and/or City Attorney or Police Department's Legal Advisor. 3 . Information regarding employee conduct, investigations into employee conduct, and disciplinary actions may be released to the effect that "an investigation is in progress: or
"disciplinary action is being considered" or "disciplinary action has been taken. " The press should otherwise be inf armed that personnel actions are confidential matters and an
employee' s rights may be jeopardized by the release of more specific information. Any contacts with the press regarding employee personnel actions should be reported to the City Manager.
4. General data regarding the number of disciplinary actions or official investigations for a non-specific group of employees may be released for publication through the City Manager's office. Such data must be reflective of imposed disciplinary actions not intended or proposed actions.
POLICY #: B-010
PAGE 2
5. An exception to this policy shall be approved by the City Manager after review by the City Attorney or the Police Department's Legal Advisor if necessary.
a. The Chief of Police may release information regarding personnel actions involving Police Department employees to the District Attorney, County Grand Jury, and/ or
California Attorney General (832.8 P.C.) or to another law enforcement agency conducting a background investigation on a Public Safety applicant (1031(d) G.C.).
ROBERT L. HUNT
CITY MANAGER
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY #: --=B_-0_1_1 __________ _ SUBJECT: WITNESS FEES ISSUED: __ 6 ...... / ..... 1....,,/ ...... 9.....,6.___ ___ _ EFFECTIVE: 6/1/96
CANCELLATION DATE: NIA
SUPERSEDES: NEW
POLICY:
It is the policy of the City that whenever an employee is summoned to any legal proceeding in connection with City business, and receives witness fees in connection with such legal proceeding, such fees shall be remitted to the City.
1. Employees should request witness fees when being subpoenaed. 2 . Employees shall receive their regular compensation for any regularly scheduled working hours spent as a witness in court actions relating to City business.
3. Employees who receive fees as a witness shall remit such fees to the City as soon as possible after receiving su9h fees.
4. Any fees that represent a reimbursement of mileage expenses or travel expenses are not required to be remitted to the City.
In such cases where mileage or travel expense reimbursement is provided by the summoning party, the employee shall not claim any reimbursement from the City. If mileage reimbursement is a portion of a total reimbursement check, the City will separate such mileage reimbursement amounts and return this amount to the employee.
ROBERT L. HONT
CITY MANAGER
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY #: -=B_-0_1_2=------- SUBJECT: STAND-BY ASSIGNMENT ISSUED: _....,6.._/1..._/._.9... 6..__ ___ _
EFFECTIVE: 6/1/96
CANCELLATION DATE: NIA
SUPERSEDES: NEW
POLICY:
A. It is the policy of the City to require non-management employees to be available for emergency call-out when such employees are directed by their immediate Supervisor to be on "stand-by" status.
B. It is the policy of the City while on such "stand-by" status, compensation shall be in accordance with the City's Employees' Manual and any Memorandum of Understanding with the recognized .employees' association.
PRQCJIDQRB:
1. Non-management employees on stand-by status must be able to be contacted by telephone, two-way radio, or pager. Non-management employees may not be required to remain at their residence or at other specific locations while on stand-by status.
2. Non-management employees who are not provided with a two-way radio or pager shall notify the Department of the telephone numbers ~t which they may be contacted during the period of their stand-by status.
3 . Non-management police employees may be directed to be on standby status by representatives of the Court system. Such employees must notify representatives of the Court of the telephone number at which they may be contacted. Such employees may also be required to remain at locations that are within onehour travel time from the specified Court location
4. All assignments to stand-by status, not required by the Court system, shall be made by the Department Director or the employee's immediate supervisor.
POLICY #: B-01.2
PAGE 2
5. Assignments to stand-by status may be for any amount of hours specified by the immediate supervisor or Department Director, except employees shall not be considered to be on stand-by status during their assigned work hours or any non-paid meal breaks.
ROBERT L. HUNT
CITY MANAGER
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY #: _.B=--_.0....,1=3....._ ___ _
ISSUED: _..._6 ..... 11=......./9....,6..__ ___ _
EFFECTIVE: 6/1/96
CANCELLATION DATE: NIA
SUPERSEDES: NEW
POLICY_:
SUBJECT: ORAL APPRAISAL
BOARD MEMBERS
It is the policy of the City to provide objective Personnel processes in the ranking and selection of applicants. The oral board appraisal process is designed to be an objective review of individual applicant qualifications through the use of oral responses to general and technical job-related questions. The result of the process is a group-scored ranking of candidates based upon the average rating of the individual oral board members.
ORAL BOARD MEMBER QUALIFICATIONS:
1 . Oral board members should be aware of the appropriate knowledge, skills, and abilities required for successful job performance.
Where technical knowledge ~s required, oral board members s_hould be competent in those technical areas.
2. Whenever possible, oral boards should respect the culture,· ethnic, and gender composition of the applicant pool. All oral board members will be made aware that the City does not discriminate based upon the race, creed, color, religion, or gender of the applicant. Members will also be advised that questions cannot be asked to ascertain any information that could be used to make judgments or determinations as to the ethnic background of any applicant. Oral board members' selections will be made in conformance with the applicable provisions of the Affirmative Action Plan.
3. Whenever possible, oral board members should not be further involved in the subsequent selection processes for the position being filled.
4. The appointing authority may not participate as a rating member on the oral appraisal board. However, the appointing authority may participate in the oral board interview as an observer.
CROSS REFERENCE: INTERVIEW
GUIDELINES.; CITY MANAGER'S
OFFICE
ROBERT L. HUNT
CITY MANAGER
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY #: --=B_-.... 01_4 _____ _ SUBJECT: LIGHT OR MODIFIED DUTY ISSUED: _..,.6.._l ..... 1,__/9"'-6..__ ___ _
EFFECTIVE: 6/1/96
CANCELLATION DATE: N/A
SUPERSEDES: NEW
POLICY:
A. The purpose of this policy is to define.the City's position regarding the application and administration of light or modified duty assignments for all employees in cases of either job- or non-job-related illness or injury.
B. On occasion, employees might incur an injury or illness that precludes their performing their regular duties. Further, such instances may impose {a) a financial hardship upon the employee by virtue of insufficient accrued leave, or {b) a hardship upon the City because of reduced personnel resources. Consequently, it will be the policy of this City to consider and evaluate light or modified duty assignments on a case-to-case basis and that such assignments shall be the exception rather than the rule.
PROCEDURE:
A. Evaluation Criteria
No light or modified duty assignment shall be approved or ordered unless the following conditions exist:
1. Endorsement for assignments must be obtained from the employee's physician in cases of non-job-related injury or illness or the endorsement of a physician designated by the City of Arroyo Grande in cases of job-related injury or illness.
2 . A statement from the physician must contain an estimate as to a specific date of recovery from the illness or injury to the extent the employee can be returned to full duty.
Such dates can be adjusted based upon accelerated
rehabilitation or recovery or a prolonged period due to aggravated circumstances.
3. The duration of light or modified duty assignments shall be determined on a case-to-case basis, but long-term situations will not be allowed.
POLICY #: B-014
PAGE 2
4. An employee may be as~igned modified duty in a department other than the department normally assigned, subject to approval of the respective Department Director {not
applicable to sworn personnel) .
5. The final approval rests with the Department Director. a. A light/modified duty assignment that is expected to, last more than twenty (20) working days requires the
approval of the City Manager.
B. Administration of Light or Modified Duty Assignments
1. Employees assigned to light or modified duty shall receive line supervision from the supervisor of the section to
which the employee is assigned. The Department Director shall process applications or directives for light and
modified duty and monitor the bulk of such assignments in terms of achieving the successful return of the employee to full duty under the general provisions of this order.
2. Assignment to modified or light duty can be initiated by either a request by the employee or in the form of a
directive by the Department Director.
3. An employee assigned to modified or light duty shall be evaluated every two weeks or at appropriate times as
directed by his/her supervisor. The evaluation shall be in narrative memorandum form and routed to the Department Director. The Department Director will review the
evaluation and determine whether or not the assignment
shall continue.
C. Special Conditions Required of Employees Assigned to Modified or Light Duty
1. Sworn Police Officers assigned to modified or light duty shall retain their Peace Officer status. However, since the intent of this order is to keep employee's working, but not subject them to conditions that might aggravate their medical conditions, such employees, as well as their supervisor, are to use their good judgement and confine any direct intervention to those instances that present an immediate and clear jeopardy of life or substantial
property loss.
2. Assignments will be determined based upon the individual characteristics and the injury and illnesses involved.
ROBERT L. HUNT
CITY MANAGER
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY #: _B=--0~1~5...._ ________ _ SUBJECT: BLOOD-BORNE PATHOGENS ISSUED: --=-6..,./1=/....,9.....,6..__ ______ __
EFFECTIVE: 6/1/96
CANCELLATION DATE: NIA
SUPERSEDES: NEW
POLICY:
The City of Arroyo Grande will establish a blood-borne pathogen training program.
PQRPOSE:
The purpose of the City of Arroyo Grande Blood Pathogen Program is to:
A. Reduce the potential for injuries to employees and the public; B. Reduce accidents in job-related illnesses involving City employees;
C. Minimize City liability by being in compliance with State and Federal worker standards; and
D. Identify training policy and procedure implications, and recommend appropriate actions.
1. Each City Department with personnel classifications
involving "at risk" employees will develop procedures to implement this policy.
DBTERMINA.TIQN OF RISK:
A. High Risk
1. High risk employees are those employees who may be exposed to blood or Other Potential Infectious Materials (OPIM} as a result of performing their primary job duties.
2 . Employees classified as "high risk" must be offered the Hepatitis-B vaccination series, while "low-risk" employees are not. ·
B. Low Risk
1. Low-risk employees are only at a slight risk of exposure to blood or.OPIM, usually due to unplanned, emergency job activities.
POLICY #: B-015
PAGE 2
2. Job activities associated with the risk that are not the primary job duties, but are collateral duties employees may have to perform as part of their job function.
3. An example is the employee who is trained in first aid and CPR, who is required to be trained for such, and who must perform emergency medical response to an injured co-worker during a confined space rescue situation.
BLOOD-BORNE PATHOGEN PROGRAM
A. Employee Training
1. Initial and annual training shall be provided to all 11 atrisk11 employees.
2. Additional training shall be provided when changes, such as modification of tasks or procedures or institution of new tasks procedures, affect the employees' occupational exposure.
3 . Material will be appropriate in content vocabulary to educational level, literacy; and language of employees.
4. The training program will include at a minimum the
following elements:
a. An accessible copy of the regulatory test of the
State standard and an explanation of its context;
b. A general explanation of the epidemiology and
symptoms of blood-borne diseases;
c. An explanation of the modes of transmission of bloodborne pathogens; d. An explanation of the City's exposure-control plan
and the means by which the employee can obtain a copy
of the written plan;
e. An explanation of the appropriate methods for
recognizing tasks and other activities that might
involve exposure to blood and other potentially
infectious materials;
f. An explanation of the uses and limitations of methods that prevent or reduce exposure, including appropriate engineering controls, work practices, and personal protective equipment;
POLICY #: B-015
PAGE 3
g. Information on the types, proper use, location,
removal, handling, decontamination, and· disposal of
personal protective equipment;
h. An explanation of the basis for selection of personal protective equipment;
i. Information on the Hepatitis-B vaccine, including
information on its efficacy, safety, method of
administration, the benefits of being vaccinated, and
the fact that the vaccine and vaccination will be
offered at City's expense;
j. Information on the appropriate actions to take and
persons to contact in an emergency involving blood or
other potentially infectious materials;
k. An explanation of the procedure to fallow if an
exposure incident occurs, including the method of
reporting the incident and the medical follow-up that
will be made available;
1. Information on the post-exposure evaluation and
follow-up that the City is required to provide for
the employee following an exposure incident;
m. An explanation of the signs and labels and/or color
coding required by the City; and
n. An opportunity for interactive questions and answers with the person conducting the training session.
PERSONAL PROTECTIVE EOUIPHENT:
1. When there is occupational exposure, each Department shall provide, at no cost to the employee, appropriate· personal protective equipment such as, but not limited to, gloves, gowns, laboratory coats, face shields or masks for
protection, mouth pieces, resuscitation bags, pocket
masks, or other ventilation devices. Personal protective equipment will be considered "appropriate" only if it does not permit blood or other potentially infectious materials to pass through to or reach the employees' work clothes, undergarments, skin, eyes, mouth, or other mucous
membranes under normal conditions of use and for the
duration of time for which the protective equipment will be used.
2. Each Department will ensure that each employee uses
appropriate protective equipment, unless the supervisor shows that the employee temporarily and briefly declined to use personal protective equipment when under rare and extraordinary circumstances it was the employee's
POLICY #: B-015
PAGE 4
professional judgment that in the specific instance its use would have prevented the delivery of health care or public safety services or would have posed an increased hazard to the safety of the worker or co-workers. When
the employee makes this judgement, the circumstances shall be investigated and documented in order to determine
whether changes can be instituted to prevent such
occurrences in the future. The employer will encourage
employees to report all such instances without fear of
reprisal.
3 . Each Department shall ensure that appropriate personal protective equipment in the appropriate sizes is readily accessible at the work site or is issued to the employees.
Hypoallergenic gloves, glove liners, powderless gloves, or other similar alternatives shall be readily accessible to the employees who are allergic to the gloves normally
provided. The employee is responsible for making these
allergies known to his/her Supervisor.
4. Each Department shall clean, launder, and dispose of personal protective equipment required at no cost to the employees.
5 . Each Department shall repair or replace personal
protective equipment as needed to maintain its
effectiveness at no cost to the employees.
6 . If the garment is penetrated by blood or other potentially infectious materials, the garment shall be removed
immediately or as soon as is feasible.
7. All personal protective equipment shall be removed prior to leaving the work area.
8. When personal protective material is removed, it shall be placed in an appropriately-designed area or container for storing, washing, decontamination, or disposal.
9. Gloves shall be worn when it can be reasonably anticipated that the employee will have hand contact with blood, other potentially infectious materials, mucous membranes and
non-intact skin, and when handling or touching contaminated items or surfaces; a. Disposable, single-use gloves, such as surgical or
examination gloves, shall be replaced as soon as
practical or as soon as feasible if they are torn or
punctured or when the ability to function as a
barrier is compromised.
b. Disposable, single-use gloves should not be washed or decontaminated for reuse.
POLICY #: B-015
PAGE 5
c. Utility gloves may be decontaminated for reuse if the integrity of the glove is not compromised. However,
they must be discarded if they are cracked, peeling,
torn or punctured, or exhibit other signs of
deterioration, when their ability as a barrier is
compromised.
10. Masks, in combination with other protection devices such as goggles or glasses with solid side shields or chin-link face shields, shall be worn whenever splashes, sprays,
spatters or droplets of blood, or other potentially
infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated.
11. Appropriate protective clothing such as, but not limited t_o, gowns, aprons, lab coats, clinic jackets, or similar qther garments shall be worn in occupational-exposure
s_ituations. The types and characteristics will depend
upon the task and the degree of exposure anticipated.
12. Surgical caps or hoods and/or shoe covers or boots shall be worn in instances where gross contamination can be
reasonably anticipated.
WRI'ITEN EXPOSURE CONTROL PLAN
1. Each Department that has employees with occupational exposure shall prepare an Exposure Determination. This
Exposure Determination shall contain the following:
a. A list of all job classifications in which all
employees in those job classifications have
occupational exposure;
b. A list of job classifications in which some employees have occupational exposure;
c. A list of all tasks and procedures, or groups of
closely-related tasks and procedures, in which
occupational exposure occurs and are performed by
employees in job classifications; and
d. This exposure determination shall be made without
regard to the use of personal protective equipment.
2. Methods of Compliance
a. Universal precautions shali, be observed to protect
contact with blood or other potentially infectious
materials. Under circumstances in which
differentiation between body fluid types is difficult
or impossible, all body fluids shall be considered
potentially infectious materials.
POLICY #: B-015
PAGE 6
b. Engineering and work-practice controls shall be used to eliminate or minimize employee exposure. Where
occupational exposure remains after institution of
these controls, personal protective equipment shall
also be used.
c. Engineering controls shall be examined and maintained or replaced on a regular schedule to ensure their
effectiveness.
d. Each Department shall provide hand-washing facilities that are readily accessible to employees.
e. When provisions of hand-washing facilities is not
feasible, each Department shall provide either an
appropriate antiseptic hand cleaner, in conjunction
with clean cloth/paper towels, or antiseptic
towelettes. When antiseptic hand cleaners or
towelettes are used, hands shall be washed with soap
and running water as soon as feasible.
f. Each Department shall ensure that employees wash
their hands immediately, or as soon as feasible,
after removal of gloves or other personal protective
equipment.
g. Each Department shall ensure that employees wash
their hands and any other skin with soap and water of
flush mucous membranes with water immediately or as
soon as feasible following contact of such body areas
with blood or other infectious materials.
h. Eating, drinking, smoking, applying cosmetics or lip balm, or handling contact lenses are prohibited
activities in work areas where there is a reasonable
likelihood of occupational exposure.
i . All procedures involving blood or other potential
infectious material shall be performed in such a
manner as to minimize splashing, spraying,
spattering, or generation of these droplets of
substances.
j. Mouth pipetting/suctioning of blood or other
potential infectious materials is prohibited.
k. Specimens of blood or other potentially infectious
materials shall be placed in a container that
prevents leakage during collection, handling,
processing, storage, transport, or shipping.
POL;I:CY #: B-015
PAGE 7
1. The equipment that may become contaminated with blood or other potentially infectious materials shall be
examined prior to servicing or shipping and shall be
decontaminated as necessary, unless the employer can
demonstrate that decontamination of such equipment,
or portions of such equipment, i.s not feasible.
POST EXPOSURE MRJ)ICAL EYALUATION PLAN
1. Following a report of an exposure incident, each
Department shall make immediately available to the exposed employee(s) a confidential medical evaluation and followup, including at least the following elements:
a. Documentation of the route or routes of exposure and the circumstances under which the exposure incident
occurred;
b. Identification and documentation of the source
individual, unless the City can establish that
identification is infeasible or prohibited by local
law;
2. The source individual's blood shall be tested as soon as feasible, and after consent is obtained, in order to
determine HBV and HIV ineffectiveness. If consent is not obtained, the City shall establish that legally-required consent cannot be obtained. When the source individual' s consent is not required by law, the source individual's blood, if available, shall be tested and the results
document ..
3. When the source individual is already known to be infected with HBV or HIV, testing for the source individual's known HBV or HIV status may not be repeated.
4. Results of the source individual's testing shall be made available to the exposed employee, and the employee shall be informed of applicable laws and regulations concerning disclosure of the identity and infectious status of the source individual.
5. Collection and testing of blood for HBV and HIV
serological status;
a. The exposed employee's blood shall be collected as
soon as feasible and tested after consent is
obtained.
POLICY #: B-015
PAGE 8
b. If the employee consents to base-line blood
collection but does not give consent at that time
for HIV serologic testing, a sample shall be
preserved for at least ninety (90) days. If within
ninety days of the exposure incident, the employee
would like to have the base-line sample tested, such
testing shall be done as soon as feasible.
c. Additional collection and testing shall be made
available, as recommended by the United States
Public Health Service.
6 . Counseling
The City may provide counseling to employees who have been exposed to potential blood-borne pathogens.
7. Evaluation of Reported Illnesses
8. Information Provided to the Health Care Professional a. The City will ensure that the health care
professional responsible for the employee's
Hepatitis-B vaccination is provided a copy of this
regulation.
b. The City will ensure that
professional evaluating the
exposure incident is provided
information:
i. A copy of this regulation;
the heal th care
employee after an
with the following
ii. A description of the exposed employee's duties
as they relate to the exposure incident;
iii. Documentation of the route/routes of exposure
and the circumstances under which the exposure
occurred;
iv. Results of the individual's blood testing, if
available; and
v. All medical records relevant to the appropriate
.treatment of the employee, including
vaccination status.
9. The City shall obtain and provide the employee with a copy of the evaluating health care professional' s written
opinion within fifteen (15) days of the completion of the evaluation.
POLICY #: B-015
PAGE 9
a. The health care professional' s written opinion of
the Hepatitis-B vaccination shall be limited to
whether Hepatitis-B vaccination is indicated for an
employee and if the employee has received such
vaccination.
b. The health care professional' s written opinion of
the post-exposure evaluation and follow-up shall be
limited to the following information:
i. that the employee has been inf armed of the
results of the evaluation;
ii. the employee has been told about any medical
conditions resulting in exposure to blood or
other potentially infectious materials that
would require further evaluation or treatment;
c. All other findings and diagnoses shall remain
confidential and shall not be included in the work
report.
ROBERT L. HUNT
CITY MANAGER
APPENDIX A - HEPATITIS B. VACCINE DECLINATION
(MANDATORY)
The employer shall assure that employees who decline to accept Hepatitis B vaccination offered by the employer sign the following statement as required by Subsection (f) (2) (D) :
I understand that due to my occupational exposure to.blood or other potentially infectious materials I may be at risk of acquiring Hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with Hepatitis B vaccine at no charge to my~elf. However, I decline Hepatitis B vaccination at this time.
I understand that by declining this vaccine I continue to be at risk of acquiring Hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with Hepatitis B vaccine, I can receive this vaccination series at no charge to me.
NOTE: Authority cited: Section 142.3, Labor code. Reference:
Section 142.3, Labor Code
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY #: -=B--O"""'l=-6..__ ____ _ SUBJECT: OUTSIDE EMPLOYMENT ISSUED: _..._6._./1_,/._.9._.6....._ ___ _
EFFECTIVE: 6/1/96
CANCELLATION DATE: NIA
SUPERSEDES: NEW
POLICY:
A. The pqlicy of the City is that full-time employees of this City have a primary duty to perform their professional/occupational responsibilities for the City. Additionally, it is necessary that an employee have adequate rest to be alert during his/her tour of duty. For these reasons, and because certain
occupations inherently conflict with an employee's primary responsibility to the City, the City may impose conditions on outside employment, as delineated in Section XII. D. 3 of the City of Arroyo Grande Personnel Regulations, or may prohibit it altogether as authorized by.Government Code Sections 1126 and 1127. Determination of the degree of limitations will be based upon the interest· of the employee and the City and ensuring that the City received full and faithful service in return for its expenditure of resources.
Employees who are on disability leave shall not be permitted to engage in outside employment.
B. Permission from the City to hold outside employment shall not mean nor be construed to imply any encouragement,
responsibility, or liability by the City of Arroyo Grande to the employee or his/her outside employer as a result of that outside employment . Every employee should be fully aware that injuries or other liabilities incurred as a result of that outside employment can adversely impact their employment with the City.
PROCRQIJRB:
A. Prior to accepting any outside employment, including self employment, all City employees shall submit an "Outside Employment Authorization Request" farm to their Department Director (Exhibit "A").
B. No employee shall accept nor begin outside employment until he/she has received the written permission of his/her Department Director.
POLICY #: B-016
PAGE 2
C. If approval is given, the employee may begin the requested employment. If approval with conditions is given, the employee may begin the requested employment subject to the conditions attached to the form. If the request is denied, the employee shall neither accept nor begin the prospective employment.
Approval/denial may be withheld pending further information, which will be outlined in the response from the Department Director.
D. All City employees currently holding outside employment shall submit the request form to their Department Director within five {5) days of the effective date of this policy. The request shall be subject to the same conditions as requests for prospective outside employment. City employees who currently have outside employment shall terminate within thirty {30) working days that employment if they are denied permission from _their Department Director to continue this employment.
CROSS REFERENCE: CITY OF
ARROYO GRANDE PERSONNEL
REGULATIONS SECTION XII. D. 3
ROBERT L. HUNT
CITY MANAGER
EXHIBIT "A"
CITY OF ARROYO GRANDE
OUTSIDE EMPLOYMENT AUTHORIZATION REQUEST
Name:
(Last) (First) (Middle)
Position:
Supervisor:
Outside Employment
Employer:
Address:
(Street) (City) (Zip)
Type of Business:
Position Title:
Length of Emp~oyment:
Description of Duties:
I understand and agree to the following provisions relative to my request for outside employment:
- I have read, understand, and received a copy of the City's policy regarding outside employment. - I will not be per,forming official duties under governmental authority but rather performing private duties pursuant to the terms of my outside employment.
- I will not use equipment issued by the City of Arroyo Grande while engaged in my outside employment.
You are cautioned that outside activity that brings you into contact with onduty City employees is prohibited if your outside employment activity
involved the performance of an act
which act may later be subject
directly or indirectly to the control,
inspection, review, audit, or
enforcement of any other officer or
employee of the City, or if your
outside employment activity is otherwise inconsistent, incompatible, or conflicting within the meaning of
Government Code Section 1126.
Employee's Signature Date
Department Director Date
( ) Recommend Approval
( ) Recommend Approval with
Conditions (Attached)
Recommend Denial
City
( )
( )
(
Manager
Approved
Approved with
(Attached)
Denied
Date
Conditions
. CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY#: B-017 SUBJECT: CONFLICT OF INTEREST
ISSUED: 08/02/00
-------- EFFECTIVE: 08/02/00
CANCELLATION DATE: N/A
SUPERSEDES:06ffi1ffi6
POLICY:
PROCEDURE
A. The California Political Reform Act of 197 4 provides that certain municipal officials must disclose their 11economic interests" periodically on forms provided by the State Fair Political Practices Commission (FPPC). These municipal officials are members of the City Council, members of the City Planning Commission, the City Manager, the City Attorney, and the City Treasurer. They must file the statements when they assume office, leave office, and annually.
B. The Political Reform Act requires that cities adopt a Conflict of Interests Code, which states that certain other 11designated employees" file Statements of Economic Interests. These employees hold City positions that entail the making or participation in the making of governmental decisions that may foreseeably have a material effect on their financial interests. Arroyo Grande's Designated Employee positions are Department Directors and their deputies or assistants, supervisors, inspectors, the business license clerk, the City Clerk, consultants, and members of the various City commissions, board, and committees. Redevelopment Agency Board Members and appointed ex officio positions are subject to the Agency's Conflict of Interest Code.
C. In addition to disclosure of their financial interests, the Political Reform Act requires that all filers must disqualify themselves from voting on or participating in the making of decisions that foreseeably may materjally affect any of their financial interests.
D. The designated officials and employees must file their Statements of Economic Interests with the Director of Administtative Services when they assume office, leave office, and annually.
PROCEDURE:
A. Positions S!Jbject to Filing Statements of Economic Interests ·1. Mayor and Members of the City Council
2. City Planning Commission Members
3. City Manager
4. City Attorney
5. City Treasurer
6. City Clerk
7. Other City Commissions, Boards, and Committees
a. Traffic Commission Members
b. Downtown Parking Advisory Board Members
c. Parks and Recreation Commission Members
d. Senior Advisory Commission Members
e. Architectural Review Committee Members
8. Designated City Employees
a. Police Chief
b. Director of Building and Fire
c. Director of Community Development
d. Director of Public Works
e. Director of Parks and Recreation
f. Director of Financial Services
g. Executive Assistant - City Administration
h. Assistant City Attorney
i. Police Commander
j. Associate Planner
k. Associate Engineer
I. Deputy Public Works Director( Assistant City Engineer m. Public Works Supervisor
n. Chief Building Inspector
o. Building and Fire Safety Inspector
p. Code Enforcement Officer
q. Business License Clerk
r. Fire Division Chief
s. Director of Economic Development
t. Director of Administrative Services
u. Management Assistant
9. Consultants Hired by the City
10. Redevelopment Agency Board Members (City Council)
11. Redevelopment Agency Ex Officio Positions
a. Executive Director (City Manager)
b. Administrative Officer (Economic Development Director) c. Secretary (Administrative Services Director)
d. Finance Officer (Financial Services Director)
e. General Counsel (City Attorney)
f. Special Counsel (Special Counsel)
B. Filing Requirements
1. The Director of Administrative Services will forward the required Statement of Economic Interests form to the affected officials and/or employee(s).
2. The employees designated in Section II.A. of this Policy shall file the necessary Statement of Economic Interests form according to the following criteria:
a. Assuming Office
i. Elected official - within 30 days of assuming office ii. Appointed official - within 10 days of assuming office iii. Designated City employees - within 30 days of assuming office
b. Annual Statements
The Annual Statement is due on April 1st of the following year (i.e., the Annual Statement for 2000 is due on April 1, 2001 ). c. Leaving Office Statement
Elected and appointed officials and designated employees must file a Leaving Office Statement within 30 days after leaving office.
The Statements of Economic Interests are submitted by the designated officials/employees to the Director of Administrative Services, who makes and retains a copy of each statement and forwards the original to the FPPC in Sacramento. By February 1 of each year the Director of Administrative Services must submit to the FPPC the name and position of each employee whose statement is sent to the Commission. ·
3. For information on the Statements of Economic Interest, the Conflict of Interest Code, and "disqualification," contact the Director of Administrative Services.
RICK TERBORCH
INTERIM CITY MANAGER
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY #: _B=--0=-1=8......_ ____ _ SUBJECT: CITY PERSONNEL FILES ISSUED: _ ...... 6_/1=---/9....,6......_ ___ _
EFFECTIVE: 6/1/96
CANCELLATION DATE: NIA
SUPERSEDES: NEW
POLICY:
A. Personnel files for all employees of the City of Arroyo Grande shall be maintained by the Office of the City Manager.
B. Department Directors may maintain personnel ·files -on .employees within their Departments for purposes of·:maintaining personnel information specific to the employees'. duties·and·performance information necessary to complete required ·performance evaluations.
A. Contents
The following personnel information shall be maintained in the employee's City personnel file.
1. Original Documents
a. City application and/or filing resume'
b. INS form # I-9, proof of legal residency
c. Oath of Office (when required)
d. Personnel Action Forms
e. Employee Performance Evaluations
B. Restricted Information
1. The following information shall not be maintained in the personne~ files:
a. Medical information subject to
restrictions/confidentiality under the Americans'
with Disabilities Act (ADA) . b. Workers' Compensation information. c. Police Department Internal Affairs files restricted
by law.
d. Police Department and Fire Department background investigation files.
POLICY #: B-018
PAGE 2
2. Information subject to ADA restrictions and Workers' Compensation information shall be maintained in separate files.
3 . Restricted Police D~partment and Fire Department personnel information shall be maintained by the. respective
Department Directors.
C. Confidentiality
City personnel files are confidential and, as such, .information contained therein may not be disclosed, except as follows:
1. The employee's Department Director or his/her designee;
2. The City Council only while in Executive Session or while hearing an Administrative Appeal of a personnel action; .3. The City Attorney for purposes of legal review or
personnel actions and civil litigation;
a. This privilege may extend to outside legal counsel
under contract with the City.
4. A designated City employee or agent of the City who has been charged with conducting a personnel investigati~n
into alleged misconduct;
5 . An outside third party only when that person has in his/her possession a valid waiver signed and dated by the affected employee authorizing that person access to the employee's personnel file; or
a. A waiver more than 60 days from the date of execution shall not be considered valid.
6. Through a competent order of a Court or by subpoena of a County of Federal Grand Jury.
D. Examination by City Employees
A City employee may inspect his/her personnel file as provided in Section XII. G. of the City's Personnel Regulations.
E. Employee Notification
1. An employee shall be notified any time a document of an adverse nature is placed into his/her personnel file. The employee should be given an opportunity to read and sign that document. containing the adverse comment.
POLICY #: B-018
PAGE 3
a. A employee shall have thirty (30) days within which
to file a written response to any adverse comment
entered into his/her personnel file. Such written
response shall be attached to the adverse document.
2. An employee shall be notified when a document is
permanently removed from his/her C~ty personnel file.
ROBERT L. HDNT
CITY MANAGER
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICY AND PROCEDURES POLICY #: ~B_-~01~9~--------- SUBJECT: SUMMER DRESS CODE POLICY ISSUED: B/15/96
EFFECTIVE: 8/15/96
CANCELLATION DATE: NIA
SUPERSEDES: NEW
The City's Summer Dress Code Policy shall be limited to field personnel.
Implementation of this policy is subject to the approval of the respective Department Director; "final authorization rests with the City Manager. This policy is not applicable to off ice personnel that have the benefit of a climate-controlled environment. ·
Summer dress may be worn only during sunnner work hours, defined as May 1st through October 1st of each calendar year.
The Summer Dress Code Policy shall not relieve any employee from putting forth anything less than a professional image. With this foremost objective in mind, the following guidelines shall be met:
* All shirts must have a collar, be tucked into the pants, and in all other aspects conform w~~h the employer dress guidelines. * Shorts shall be limited to earth tone colors, be mid-thigh length, hemmed, with a minimum of two pockets, a fly, and worn with a belt. * Approved shoes shall remain as is currently accepted by employer dress guidelines.
* All appropriate safety equipment and clothing shall continue to be required. These requirements may be, but are not limited to: steeltoed shoes, orange or brown shirts, reflective vests, and long pants for certain maintenance functions.
* This policy shall cause no expense to the City.
* This policy does not apply to Police Department personnel (refer to General Order 0800 - Authorized Uniform and Equipment) .
Failure to adhere to this policy may result in disciplinary action.
ROBERT L. HUNT
CITY MANAGER
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICIES AND PROCEDURES POLICY#: B-020 SUBJECT: OCCUPATIONAL INJURY/ILLNESS
ISSUED: 07/17/00
EFFECTIVE: 07/17/00
CANCELLATION DATE: N/A
SUPERSEDES: 01/01/98
POLICY:
POLICY
It is the policy of the City of Arroyo Grande to manage all claims of occupational injury/illness in an efficient, consistent, and timely manner.
PROCEDURE:
The purpose of this policy is to set forth the procedures to be followed in the event of an occupational injury/illness to any employee, including registered volunteers. The following procedures have been established to ensure the City manages occupational injury/illness claims as required by the State, and responsibilities of employees are clearly defined and set forth.
REPORTING OCCUPATIONAL INJURIES/ILLNESSES
A. Employees are responsible for reporting occupational injuries/illnesses to his/her supervisor immediately or as soon as practicable and, in any event, prior to seeking medical care or losing time from work.
B. Supervisors shall complete the Medical Service Order (Attachment A) immediately upon knowledge that an injury/illness will result in an employee losing time from work and/or receiving medical care. The completed report should be submitted to the Management Assistant or his/her designee within 24 hours. The report is not required for occupational injuries/illnesses that do not result in loss of time from work or medical treatment. The report should be completed if the employee requests a workers' compensation claim be filed or if it is probable that the employee may, at a later date, lose time from work or seek medical care.
· C. The supervisor, upon knowledge of an occupational injury/illness, shall immediately present to the employee the Employee's Claim For Workers' Compensation Benefits form DWC-1 (Attachment B). The employee shall complete the "employee" section and the supervisor shall complete the "employer'' section within 24 hours of knowledge of an injury/illness. If the employee is unavailable or unable to complete the "employee" section of the DWC-1 form, the supervisor will contact the Management Assistant or his/her designee. The report is not required for occupational injuries/illnesses that do not result in loss of time from work or medical treatment. The report should be completed if the employee requests a workers' compensation claim
POLICY #: 8-020
PAGE2
be filed or if it is probable that the employee may, at a later date, lose time from work or seek medical care.
D. Failure to provide the employee with the DWC-1 form within five days may result in the City being fined up to $5,000 for each violation. Failure of the City to report an injury/illness to the City's claims administrator within ten days may result in the City being fined up to $100 per late reported claim.
E. The injured employee and supervisor will investigate the circumstances of the injury or illness. The supervisor prepares the Supervisor's Report (Attachment C) and sends the original copy to the Management Assistant within five days of the accident.
F. In the event of seri9us injury or death the supervisor must contact the City Manager and City Attorney immediately. The City Manager or his/her designee will call CALOSHA, as required by law.
G. Delays in ·reporting could raise questions as to whether the injury or illness occurred on-the-job or away from work. The City may delay or disallow an employee's claim if there is an unexplained delay in reporting, especially if there are no witnesses to verify the on-the-job nature of the injury/illness.
H. The filing of an occupational injury/illness claim is not an admission of acceptance by the City. The City and/or the City's claim administrator have the right to delay and investigate claims to determine if the proximate cause of the injury/illness was employment-related. Departments should provide any information to the Management Assistant or his/her designee that would allow the City or the City's claims administrator to properly investigate and evaluate the claim.
MEDICAL TREATMENT
A. If there is any question regarding the need for medical treatment of the injury/illness, or the ability of the employee to ·perform his/her usual range of work duties, or if the employee requests medical treatment, the employee shall receive medical treatment immediately. The employee shall take a completed Medical Service Order form (Attachment A) to the treating physician. A treating physician is a physician that is directing the medical treatment of the employee.
B. The employee must see a treating physician within 24 hours if the injury/illness is going to result in the employee losing any time from work. The treating physician must prescribe time off work for the time to be treated as off duty. This applies to a new injury/illness as well as a relapse due to a prior injury/illness. In cases consisting solety of first aid treatment, the employee is to return to work for the remainder of the shift unless otherwise directed by the treating physician.
C. The employee should receive medical treatment for all non-emergency work-related injuries/illnesses at the City's designated medical facility during normal operating hours. During hours the medical facility is closed, employees should be taken to the most convenient hospital emergency room. Employees may designate his/her
POLICY#: 8-020
PAGE3
personal physician to treat work-related injuries/illnesses by contacting the Management Assistant or his/her designee prior to an injury/illness. Any request to change a treating physician must be made in writing to the Management Assistant or his/her designee·. Thirty days after reporting the injury, the employee may switch to their own physician after notifying the Management Assistant in writing.
D. A supervisor should normally accompany the employee on the first visit to the physician. This allows the supervisor to exchange first-hand information with the physician and to discuss the possibility of modified duty assignments when appropriate.
E. All employees, whether off duty or on modified duty, due to occupational injury/illness shall adhere to all restrictions and/or limitations placed upon his/her activities by the treating physician. ·
F. The employee shall keep all scheduled appointments for treatment, diagnosis and/or therapy, and must notify his/her Department Director, in advance, of the inability to do so and the reasons therefore. Failure to keep scheduled appointments may result in termination of workers' compensation benefits.
G. The supervisor and/or Management Assistant shall maintain periodic contact with the employee while off work and recovering from an injury/illness.
H. Any supervisor or manager disputing the medical status, diagnosis, and/or treatment reported by the treating physician should contact the City Manager and/or his/her designee immediately and state the reasons for disputing the medical report. The employer has 20 days from knowledge of the medical report to provide rebuttal.
MODIFIED DUTY
The City may elect to place an employee in a temporary modified work assignment if such an assignment is available and corresponds with the employee's work restriction.
A. Any employee off duty due to an industrial injury/illness shall immediately notify his/her supervisor of any changes in medical status that may have a bearing on return to duty, including modified duty.
B. The physician should be requested by the supervisor to provide written physical restrictions for release to modified duty, if such assignments are available.
C. · The supervisor should complete the Modified Duty Assignment Agreement (Attachment D) for all employees placed on a modified duty assignment and obtain the required approvals. Physician restrictions should be attached to the agreement. Each modified duty assignment agreement shall not exceed thirty (30) consecutive days and a new agreement completed if additional days are required.
D. Failure or refusal of an employee to return to a temporary modified duty assignment may result in termination of workers' compensation benefits.
POLICY#: B-020
PAGE4
E. The modified duty assignment shall not exceed the date the employee's condition is determined to be permanent and stationary by the treating physician, or the City's evaluating physician.
F. An employee's ability to perform in a modified duty assignment may be evaluated by the treating physician or the City's evaluating physician, at any time, at the City's request. Any refusal to submit to a medical evaluation will result in termination of the modified duty assignment and may result in termination of workers' compensation benefits.
G. The City reserves the right to terminate the ·modified duty assignment when, in its opinion, such an assignment will not enhance the employee's ability to return to full duty, or such an assignment is not in the best interest of the City.
MEDICAL RELEASE TO WORK
A disabled employee shall return to full duty, or to available modified duty, as soon as medically appropriate.
A written release from the treating physician is required prior to any return to full duty or modified duty, and must specify the release date. This release should be given to the supervisor by the employee upon his/her return to work. A copy of the release shall be forwarded immediately to the Management Assistant. The City may require additional medical evaluation to determine an employee's fitness for duty.
RELAPSE INJURY/ILLNESS
An employee that has concluded treatment must contact the Management Assistant or representative prior to receiving treatment of a relapse of an occupational injury/illness or as soon as possible for emergency visits to the physician and/or hospital.
EMPLOYEE AVAILABILITY
It is the responsibility of employees on disability to keep his/her department informed of his/her whereabouts at all times. Employees on disability are not on vacation, and must be available for telephone contact and medical treatment. If not at a regular telephone number for more than 24 hours, they must leave a number with their supervisor where they can be reached.
RESPONSIBILITY FOR CONTACT POST INJURY
Communication between the various parties involved, i.e. the injured employee, the Management Assistant, the Department Director, the supervisor, the doctor, and the third party administrator is critical in accomplishing an early return to work, to either regular or modified duty. This communication is a shared responsibility between the parties.
POLICY #: B-020
PAGE5
A. The injured worker needs to inform his/her supervisor of return to work and to produce a written release, either to full duty or modified duty when reporting back to work.
B. The doctor is required to produce a written return to work notice, as outlined in the Medical Service Order, Attachment A. The doctor is required to send this notice to the employer and per California Code of Regulations Section 9785, to the third party administrator.
C. The supervisor is required to give a copy of the return to work notice to the Management Assistant and in the case of modified duty to evaluate per the requirements set forth under Mod.ified Duty.
D. The Management Assistant is required to ensure this policy is being followed and to communicate with the parties as necessary to maintain the flow of information to and from the employee and to and from the third party administrator.
E. The third party administrator is required to contact the doctor's office on the date of exam (if known) and determine return to work ·status. This information is to be relayed to the City. The administrator will communicate with all parties as necessary to ensure the prompt provi~ion of benefits to the injured employee.
PAYMENT OF BENEFITS
Benefits may be paid in accordance to the Workers' Compensation Act of California through the claims administrator. Benefits may include:
A. Medical care to cure the injury. This may include services such as doctor visits, medicines, hospital costs, and lab tests.
B. Cash payments to help replace lost wages. Currently temporary disability payments are generally two-thirds of the employee's wages, up to a maximum of $490 per week, as set by the State Legislature. Compensation is not paid for the first three days unless the employee is hospitalized as an inpatient or unable to work for more than 14 days. Under these circumstances, the "waiting period" may be paid. Additional cash payments may be made if there is a permanent disability.
An employee may use a portion or all of their accumulated paid leave to supplement compensation received under the Workers' Compensation Act of California in an amount not to exceed the employer's regular rate of pay.
C. Rehabilitation ·services necessary to return to work. This may includes services such as physical therapy.
POLICY#: 8-020
PAGE6
FAMILY MEDICAL LEAVE ACT AND CALIFORNIA FAMILY RIGHTS ACT (FMLA/CFRA) An employee who is injured under these regulations must request for time off that will count towards their FMLA/CFRA leave. The FMLA/CFRA policy may be found under Administrative Policies and Procedures # 8-023.
ATTACHMENTS
A) Medical Service Order
8) Employee's Claim for Workers' Compensation Benefits
C) Supervisor's Report
D) Modified Duty
CROSSREFERENCEES
A) City of Arroyo Grande Personnel Regulations
8) Applicable Memoranda of Understanding (MOU's)
C) City of Arroyo Grande Administrative Policies and Procedures Manual Section #8-023, Family Care and Medical Leave ·
D) Police Department General Order #0209, Light or Modified Duty and Pregnant Employees
~-RICK TERBORCH
INTERIM CITY MANAGER
POLICY #: 8-020
PAGE7
SUPERVISORY TRAINING
WORKERS' COMPENSATION
A. INITIAL INJURY
Workers' Compensation is a no fault system designed to provide benefits to employees injured in the course and scope of employment.
There are certain requirements of both the injured employee and the employer in the event of an on-the-job injury. This text is designed to help you as the .supervisor or manager in fulfilling your legal obligations as the employer and minimizing to the extent possible any delays in a prompt recovery and return to work by your injured employee.
The law requires that wit~in one (1) working day of notice of an injury, the employer must provide Employee's Claim For Workers' Compensation Benefits (DWC-1) to the injured worker or to their dependents in the case of death.
Notice of an injury can come from any source, including, but not limited to the following: 1) the injured employee, 2) co-workers, 3) treating physicians, 4) family members in the case of serious injury or death.
Who is the "employer'' for purposes of notice of an injury? "Managing agent, superintendent, leadperson, or other person in authority ... " This basically means YOU.
·SUPERVISOR/MANAGER CHECKLIST
INITIAL INJURY
When the supervisor or manager receives notice of injury, the following procedure must be followed within one (1) working day. All required forms are in the white envelope marked "Central Coast Cities Self Insurance Fund".
D Supervisor or manager completes lines 9 through 17 of the DWC-1.
D Provide the employee with the DWC-1 and, whenever possible, have them fill out the employee section (lines 1 through 8) immediately. If serious injury, send to family member via certified mail.
D If employee completes the DWC-1 as in #2, give them green copy (Employees Temporary Receipt).
D Complete Supervisor's Report of Injury (WC001) and send it along with the Employee Claim Form (DWC-1) to the Management Assistant or representative.
POLICY#: 8-020
PAGEB
B. SUPERVISORY TRAINING
Initial Medical Treatment/Supervisory Responsibility
When an industrial injury occurs, the employer has the right to control medical care for 30 days unless the employee has designated in writing prior to the injury that he wants to see his/her own doctor. Please check with the Management Assistant or designated individual in your organization to determine status.
Following is a che<?klist to use in the event injured employee needs to see a doctor.
SUPERVISOR/MANAGER CHECKLIST
MEDICAL TREATMENT
D Complete the industrial medical service order and send with employee to doctor.
D In the event of a serious or life threatening injury, transport to nearest hospital:
Return to Work/Follow-Up Issues
D Insist on return to work slip from the doctor before allowing employee to return to job.
Send copy of return to work slip immediately to Personnel Department and fax Bragg & Associates (925) 933-2994.
D Modified Work/Light Duty. Obtain return to work slip from doctor listing both the restrictions and duration of modified work before allowing employee to return to work.
D At end of period of modified work authorized by doctor, if employee cannot resume full duties, send employee back to doctor for further authorization of modified duty.
D Your employer may have a limit as to the period an employee may perform modified duty. Please check with your Management Assistant.
POLICY #: 8-020
PAGE9
ATTACHMENT A
MEDICAL SERVICE ORDER
TO: DOCTOR
ADDRESS
FROM: EMPLOYER
OUR EMPLOYEE ------~---~--------~WAS INJURED
ON (DATE) _____ AT (TIME) ______ (A.M./P.M.)
SUPERVISOR: _________ DEPARTMENT: _______ DATE: ___ _
PLEASE EXAMINE THIS PATIENT AND PROVIDE THE MEDICAL TREATMENT WHICH MAY BE REQUIRED AS A RESULT OF THIS INJURY. PLEASE FORWARD THIS REPORT, YOUR "DOCTOR'S FIRST REPORT OF WORK INJURY," AND YOUR BILL TO:
GREGORY B. BRAGG & ASSOCIATES
P. 0. BOX 5372
WALNUT CREEK, CA 94596
1-800-932-2992
DOCTOR- PLEASE COMPLETE THE FOLLOWING AND RETAIN THE PINK COPY FOR YOUR CHART. CAN THIS 1 ATIENT RETURN TO WORK WITH NO RESTRICTIONS? D YES D NO
F NOT, PLEASE COMPLETE THE FOLLOWING:
This patient is physically able to perform the following functions:
I. In an 8-hour day, this patient can: (Circle full capacity for each activity).
A. Sit Number of Hours: 1 2 3 4 5 6 7 8 9 10
B. Stand Number of Hours: 1 2 3 4 5 6 7 8 9 10
C. Walk Number of Hours: 1 2 3 4 5 6 7 8 9 10
II. This patient is able to: Not at all Times/Da)l Times/Hr. Continuousl)l A. Bend/Stoop . ( ) ( ) ( ) ( )
B. Squat ( ) ( ) ( ) ( )
C. Crawl ( ) ( ) ( ) ( )
D. Climb. ( ) ( ) ( ) ( )
E. Crouch ( ) ( ) ( ) ( )
F. Kneel ( ) ( ) ( ) ( )
G. Balance ( ) ( ) ( ) ( )
H. Push/Pull ( ) ( ) ( ) ( )
Ill. This patient can lift: Not at all Times/Da)l Times/Hr. Continuousl)l A. Up to 1 O pounds ( ) ( ) ( ) ( )
B. 11 to 24 pounds ( ) ( ) ( ) ( )
C. 25 to 50 pounds ( ) ( ) ( ) ( )
D. 51 to 100 pounds ( ) ( ) ( ) ( )
EXPECTED PERIOD OF DISABILITY:
DATE OF NEXT DOCTORS APPOINTMENT:
DOCTOR'S SIGNATURE . DATE: ------- EMPLOYEE - PLEASE RETURN THE YELLOW COPY TO YOUR DEPARTMENT
EMPLEADO - POR FAVOR REGRESE LA COPIA AMARILLA A SU DEPARTAMENT White - Gregory B. Bragg & Associates • Yellow - Employer• Pink· Dactor
POLICY #: B-020
PAGE10
ATTACHMENT E
r:g'"""?.9.-~W(:;t(i'J.ijil(M Ul'IHfiCt~."'·:a:;i::J? -', Jl,61 \9ZOt8&t'iMf!& "'1"'"\,DCIJ ~·. ,': a. !.P,-.o~;b140&."f.ltseVtiie. CA9567$ - . 'Tef.(916) 7as-01¢ FAX (916)793-o335 0 P.o, ~ 491749, ~!Id~. QA $3049-1749 Tel (530) ~.:3-W4 f'~ (~ &2679 .' Estado de CaHfomia "State-Of Caflfomia . .
:~rtn:ieoi.of lilclus,ti'ialReiations . OIVISION·~~~~~- ow SION OFWORKERS' COMP~~1J9>~~. . • . : - . . . . PETl.CION DEL EMPLEAOO'PARA. BENEFICIOS Ef'.t'~~PY.~E~PL;AJ~.f'.Q.ft ..,.' : .. ; . · : ...-:~ •. - .. ;• .. · _, be.coMPENs.Ac16N net. TSAaAJAi>bR WOR~RS. -COM~.1:3"JSAl10N !J.,~N.JSf;=l]itk "..~:-'1'.;.., •:. •• !SI l:/d..:'-!f}htt '!f!~ o se ha enlermado a ca~ ~ ~1r.iibajo. Ud. . lfyouarelnltl •. or·~~l~-~·~.t . ...-Y9'.'·~~.,.-~~-·., ;tleneda . . rf ~beOeflciosdecompensac/Onal~r. to WQrkens~CO!tlP! .. t¥fflefik· -:~> •· · . · " Cqm.pfelB · •f:ir!pftNldo• y entregue ta forma a .slJ ·e~leador. Compleie '. . . 0yea .. sectioo:aod give tha form to your employer. QUic(Bs$.. ' · i:Opia· if.~. •RflClbo Temporal del Empteado":hasta t:SeeP the ~~"em.,.oYe8•s::Temponuy Receipt"· until you.rece~ · que. Ud. · . fa· copfB~?iiCbad4 de ~u emp/eador. Si Ud. neciSlta ayuda the ~d.:'c:CJPY fiOm;your employer. You may call the Division.of W9rk~rs para comjJ/Btar:fisla fomia.d.p~.ra.obtener.sus beneticJos, Ud. puade. hablar eon_,pen8attornt 1-800-~&-7401 lf yoµ !1~ help In. mling out this form or in con la DMslon cte.·CompensadOri alTrabajacloc Hamsndo al . obtaining your benefits. An.exp,tana,ttan.ofwor!aipi.'~mJ>!3'158tion benefrts ls f.1100-736-7401. En la Parfe·<de;atrlit d« esta fonna se eflCUBntra una lnc.luded on the"back.ofthls·form.. • - • - e1Cp1/cac/6n de·los bensficlos decornpe"n~.al'trabajador.
You should &!80 tJave fflC&~.:a· pamphlet.•from·.Y.Our'.~~- Ud. tambfiJri deberfa haPer r6cibldo".i/J4 ,SU·fl.mpleador un follsto •describing worke~. compensatlon...benellfis .• and the ·Pmce4UreS-to obtain- ctescriblendq tos baneficlos de compensacl6n ·ar ttsbajador lssionado y los them. _procdm/entOJI para obtenerlos.
Any person who makes or causes to be made any knowingly false er fraudulent material statement or material
representation for the purpose of obtaining or denying
workers' compensation benefits or payments is guilty of a felony.
~pJoyee: Empteado:
Toda aquel!a persona que a prop6sito haga o cause que se produzca cualquier declaracion o representacion material falsa a fraudulenta con el fin de obtener o negar beneficios o pages de compensac1on a trabajadores lesionados es culpable de un crimen ma or "felonia". , ·.
1. Name. Nombro. _________________________ Today's Date. Fechadshoy. ---------
2. j-lomeAdclress. Direccl6n Resldenclal. __________________________________ _
3. City. CJU$d.._..,..,... ____________________ State. Estado. ______ Zip. Cddigo Postal. _____ _ ·4. Date· of Injury. Fecha ds la tesiOn (accidente). Time ot Injury-. Hora en que ocu1T16, _____ a.m. ----- p.m.
5. Address and dffcriplion of wher.e ~ry happened. Dt~i:dOOde~·et·'a~n.t{I;~-·-· ------------------
6. Descnbe. Injury and part of body affecled. Dsscrlba la Jssi6n y parts del·CU8rpo afectada. ---------------------
7. SOCial Security Number. NtimerQ·dil Segura So¢al·de/.Empleado. ---------------------------
8. Signature of employee. F/rma de/emp/eado. __________________________________ _ Employer - complete this section and giVe the employee a copy Immediately as a receipt.
Erripleador - complete esta secci6n y dale lnmedlatamente una copla al empleado coma reclbo.
9. Nameotemployer. Nomble·delempleador. __________________________________ _
10. Address. Direccl6n. __________________________________________ _
11. Date employer first knew of injury. Fscha en que el empleadorsupo por primsra vez de la losi6n o accidents. _____________ _
12. Data claim form was provided to employee. Fecha en qua sale entregd al empleado la peticidn. ----------,.---------
13. Date employer received claim form. .Fscha en que el empleado devolvf6 la petlc/On al emp/6ador. ------------------
14. Name and address of insur.ance carrier or adlusUng agency. Nombra y dlreccl6n de la compaiifa de ssguros o agencla admlnlstraclora de seguros.
15. Insurance Policy Number. El nl1mero'ds la.p61/za Ciel Segura. -----------------------------
16. Signature of employer representallve. Flrma ·de/ rspres~mtante de/ empleador. ------------------------ 17. Tit!~ T/turo. ____________________ _ Employer: You are required to ckite this. form anct provide copies to your Insurer or claim administrator and to the employee, dependent or repreaenta!IVe who filed the claim within one warkfna dav of receipt or the form.frOm the employee.
SIGNING THIS FORM IS NOT AN-ADMISSION OF LIABILITY
18. Telephone. Te/8fono. ----------------
Empleador: Se requiem que Ud. fBChe esta forms y que provda copias a su compallfa de seguros, aclminlstrador ds ffilC/amos, o dependlentel t0prastmtantil de reclamos y al emplsado qus hayan presentado esta peticldn dentro de/~ ds un dfs lilbll dssde el momento de haber sldo reciblda la lorma del empleiJdo.
EL FIRMAR ESTA FORMA NO SIGNIFICA ADMISION DE
RESPONSABILIDAD
DWC l'olm I (Fl9v 11&4) EMPLOYER'S COPY/COPIA DEL EMPLEADOR DWCl'omla I (ReV 1l94J
POLICY #: 8-020
PAGE 11
-- r·•· ~ • ., .. ---. .... ,..._. --·· • ATTACHMENT C
) . :: ~ Report Control #
..
;·•wuo: Employee Name: Emplc)yee Number: .. :
, Dq>artment and Division: Job Classificationff"rtle:
· "Si.iPervisor's name & phone/extension:
.: W"ltlleSs(es) Name(s) and Phone Numbers: . . . . . . : •WBA T: Descnllc what happened leading up to. during and immediately after the acc:ident *WHERE: (Specifi.ca1ly where did the acc:idcnt oa:ui?) Address, intersection of. buildmg, I001D, etc. *WHEN: Accident Date/Day: Accident Time: AM/PM
*WHY: Why did this accident happen? Dete:rmine the cause. Site location assessment; equipment/vehicle condition; employee training/limitations; weather, etc ~nTC'· lndit.ale ~ •!::111Se c.adc(is): 1:t tbe a=ad a£ibis naa:atisre 1bllll Siie Jists 111 •oided CD !be~ of.:tWs flQCD :
I
i
Cause Code(s):[ J
; ·INJURIES SUSTAINED: YES [ ] NO [ ] If yes, fill out Section A l PROPERTY DAMA.GE: YES [ ] NO [ ] If yes,_ fill out Section B *WSTORY: Has the employee been involved in other similar accidents? YES [ ] NO[ ] I If yes, list Report Control Numbers: ~ *SUPERVISOR'S STATEMENT OF CORRECTIVE ACTION(S): What have you specifically done to prevent the recurrence of ' this or similar accideats? Options: Retraining, counseling or other personnel actions, cost recovery, etc. ~
' .•
*If additioual pages have been added please number and state total number of pages including this form ----
POLICY #: 8-020
PAGE12
ATTACHMENT C
SECTION A - INJURY(IES) ·SUSTAINED:
Report·Contr0l #
What is/arc the injury(ies)? (Strain, sprain. cut, bruised, etc.) List what body part(_s'fl (Be specific, for example: Left. right, upper, lower. lhst. second. etc.) ''X" the location ofinjury(ies) on diagram. (Check an that apply) First Aid __
Doctor only _ Hospitalized _
No Medical Care Provided _
Lost time from work? YES{ ] NO ( ]
If~ dato offinn day lost and estimated date of return to work) Right FRONT Ledl Left BACK Right
Name(s) and phone number(s) and related report control numbers of others injured:
<Name1 (Phone) CRemrt Con1rol #)
<Namel <Phonol CReport Contml #l
<Name) CPhopel CReport Cmbt!I #l
SECTION B • PROPERTY DAMAGE:
CITYOWHED PRQPER77
Describe what was damaged and the type and extent of damage? Include inventory control DU1111x:r (if applicable and llVllilable):
SUBROGATION POTENTIAL: YES ( ) NO ( I AMOUNT ...._$ ---
PRWATE PROPERTY
Describe what was damaged and the type and ex.tent of damage. List.address(es) and phone number(s) of owner(s):
SUPJ!R.Vll!Oll SIGNATURBIDATB DBPAll.lMENT HBAD SKINA'RJRBIDATB Distribution: Original- Division/Departme Copies-Personnel, Safety Officer and Employee ear
POLICY #: 8-020
PAGE13
MODIFIED DUTY ASSIGNMENT AGREEMENT
ATTACHMENT D
It is the City's policy to offer modified duty assignments to injured employees, when the injury is jobrelated, when such assignments would facilitate the employee's ability to return to full duty, and when such assignments are available within the department. Such assignments must conform to the employee's work restrictions and not seriously impact the operational effectiveness of the department. All modified work assignments shall be temporary, with specific timelines and periodic evaluations established to return the employee to full duty. The employee's Department Director and the City Manager shall make the initial determination of eligibility for participation. . .
This specific agreement pertains to-----------' a City employee, recovering from a job-related injury.
This employee will be afforded a temporary modified duty assignment, consistent with the written and clearly stated limitations and restrictions of his/her treating physician. The written limitations and restrictions must be appended to this agreement.
Timelines for temporary modified duty assignments may not exceed thirty (30) consecutive day increments. This specific agreement may not exceed the following specific time frame:
Starting:---------Ending: ________ _
fhis modified assignment shall not exceed the date this employee's condition is determined to be permanent and stationary by the treating physician, or the City's evaluating physician.
This employee's ability to perform in the modified duty assignment may be evaluated by the treating physician or the City evaluating physician, at any time, at the City's request. Any refusal to submit to a medical evaluation will result in termination of the modified duty assignment. The employee agrees that the modified duty assignment is an accommodation for a job injury and waives any right to out of class pay.
The City reserves the right to terminate the modified duty assignment when, in their opinion, such as assignment will not enhance this employee's ability to return to full duty, or such an assignment is not in the best interest of the City.
Parties agreeing to the terms of this agreement will sign below:
Employee:
Signature Date
Department Director:
Signature Date
City Manager's Office:
Signature Date
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICIES AND PROCEDURES POLICY#: 8-021 SUBJECT: RECRUITMENT PROCEDURES
ISSUED: 07/17/00
-------
EFFECTIVE: 07/17/00
CANCELLATION DATE: N/A
SUPERSEDES: NEW
POLICY:
It is the policy of the City of Arroyo Grande to establish procedures for recruitment and hiring of City personnel.
PROCEDURE:
The following are the procedures for hiring full-time permanent and part-time permanent employees with the City of Arroyo Grande. The recruitment process for temporary employees will be at the direction of the City Manager. Promotional procedures are outlined in Policy # B-022. Recruitment and promotional procedures for the Police Department are as outlined in the Police Department's General Order Manual, General Order#0203 and General Order#0217.
A. Job Requisition
1) The department Supervisor shall complete a job requisition for the vacancy and forward it to their Department Director for signed approval. (See Exhibit #1) 2) The Department Director shall approve/disapprove the requisition. If approved, they will forward the requisition to the City Manager for their signed approval. 3) The City Manager shall approve/disapprove the requisition. If approved, the requisition will be forwarded to the Management Assistant.
B. Eligibility Lists
The Management Assistant will verify if there is an Eligibility List for the position. Should there be a list, the recruitment will begin with that list of eligible candidates. Should there not be an Eligibility List, then the recruitment process will continue as follows.
POLICY#: B-021
PAGE2
C. Internal/External Recruitment
The Job Requisition will indicate if the position is to be an internal or open recruitment. If the position is internal, follow Policy# B-022.
D. Job Advertising
1) The Management Assistant will prepare the employment announcement for the position. The announcement will contain the job description, job qualifications, current salary and benefits, selection process, and final filing date. 2) If the position is for outside recruitment, ads will be placed in the appropriate media which may include newspapers,.trade journals, and employment websites. 3) The job will be posted for a minimum of ten (10) days.
E. Applications and Close Date
A City Application (see Exhibit #2) must be completely filled out in order for the applicant to be considered for the position. Resumes may be attached, but will not take the place of the application. Applications will be accepted until 5:00 P.M. on the close date for the position.
F. Application Screening Board
1) The Department Director will give the Management Assistant three (3) names of people who will screen the applications for job qualifications. The Screening Board may be comprised of City employees and/or members of the community at large.
The Screening Board will rank the applicants as being "qualified", "potential", or "not qualified".
2) The Management Assistant will rank the results. Up to a maximum of the top ten (10) candidates may be interviewed for the position.
G. Oral Board
1) The Department Director will provide the Management Assistant with three (3) names for the Oral Interview Board. The Oral Board may be comprised of City employees and/or members of the general public who are unbiased to the applicants and have knowledge and/or expertise regarding the position being recruited for.
2) The Department Director will provide the Management Assistant with a minimum of ten (10) interview questions which are specific to the job classification under · consideration.
POLICY# B-021
PAGE3
3) The Management Assistant shall prepare the interview binders for the Oral Board arid distribute them. Oral Board Evaluation Sheets (see Exhibit #3) will also be included.
4) The Management Assistant shall notify the successful candidates in writing of their interview time and date for the Oral Board. The ·unsuccessful candidates will also be notified in writing.
5) The Management Assistant and Department Director, or representative shall meet with the Oral Board at the start of the day to provide interview instructions. 6) At the end of the interview day, the Management Assistant and Department Director, or representative shall conduct a wrap-up with the Oral Board to receive feedback on all interviewed candidates. ·
H. Job Testing
Certain tests, in addition to the oral interview may may required for a paticular position.
I. Scoring
1) The Management Assistant will compile the scores from the oral interviews and other testing completed, and prepare an eligibility list for the City Manager. In order to have their name placed on the eligibility list, a candidate must score seventy (70) percent or better.
2) The City Manager shall certify the eligibility list.
J. Secondary Interviews
1) The Department Director shall select finalists from the top scoring eligible candidates for the secondary interview. The number interviewed will be at the Director's discretion.
2) The Managment Assistant will set the appointments for the interviews. 3) The Department Director and Management Assistant and/or Department Supervisor shall conduct the secondary interviews. There will be a minimum of two City employees conducting the secondary interview.
POLICY# 8-021
PAGE4
K. Final Interview
The Department Director may recommend a candidate after the secondary interview, however, a final interview may be required depending on the level of the candidate, or to further aid in the decision making process.
L. Selection
The Department Director shall recommend the candidate selected for appointment. The Management Assistant will conduct reference checks on the candidate. If the references are successful, the Department Director shall prepare the recommendation to the City Manager for approval to hire·.
M. Offer and Testing
1) The Management.Assistant will prepare the offer letter for the candidate-which must be signed by the City Manager. The offer letter will state that the candidate must be successful in the testing of section #M (2) as it applies to the position for the employment process to be continued.
2) Upon written acceptance of the conditional offer for employment and a signed Release and Waiver form by the candidate, the Management Assistant will coordinate the scheduling of the medical examination, pre-employment drug screening, and fingerprinting. The applicant must also provide the Management Assistant with a copy of their OMV print-out should their position require driving a City vehicle.
3) The results of the testing will be provided to the City. The candidate must successfully complete and pass the tests to City standards (see Disqualifications, #0).
N. Presentation for Employment
The appointed candidate must present themselves for employment on the date perscribed to the Management Assistant. He/she will go through the City orientation. He/she must present documents for their 1-9 form verifying their eligibility to work in the United States.
He/she will also take the loyalty oath.
Once the orientation and new hire paperwork is completed, the appointed candidate will be sent to their department for further new hire training.
POLICY# B-021
PAGES
0. Probationary Period
The probationary period shall be for twelve (12) months.
P. Disqualifying Factors
1) Any false statement, or any omission of information on either the employment application, or verbally to the oral board is grounds for termination of employment. 2) A positive pre-employment drug test.
3) A felony conviction that would be job-related.
4) Lack of a valid California Driver's License at the time of appointment if required for the position.
5) Unable to perform the essential duties of the position where the City is unable to provide necessary accomodation for the position.
6) Failure to keep any assigned selection process appointments without a valid excuse.
7) Failure to submit the required completed documenation by the designated dates without a valid excuse.
May Be Disqualifying:
1) Adult convictions for three (3) moving violations within the past three (3) years if the position requires driving a City vehicle.
2) Applicants with more that one (1) adult D.U.I. conviction if the position requires driving a City vehicle.
3) Being at fault in three (3) traffic accidents within the past five (5) years if the position requires driving a City vehicle.
NOTE: The above lists are not meant to be all encompassing. Factors such as employment history, credit history, personal and professional references, educational history, etc. will be used in conjunction with the above in determining an applicant's fitness to be a City employee.
POLICY# 8-021
PAGE6
Q. Attachments
1) Job Requisition
2) City Application Form
3) Oral Interview Evaluation Form
R. Cross References
1) City of Arroyo Grande Personnel Regulations
2) City of Arroyo Grande Job Classification Manual
3) Applicable Memoranda of Understanding (MOU's)
4) Police Department General Order #0203 - Recruitment and Hiring Procedures 5) Police Department General Order #0217 - Promotional Procedures ~·
INTERIM CITY MANAGER
CITY OF ARROYO GRANDE
JOB REQUISITION
EXHIBIT #1
Department Requesting:----------- Date: _____ _
Position Title: ------------------------ • Please check all that apply:
D Full-time D Part-time D Seasonal D Permanent D Temporary D Promotional internal posting D Open external posting
• Hours of work: ------------------------ • Reason for Recruitment:
D Replacement
Name of person replacing:, _______________ _
D Budgeted New Position
D Special Project
D Temporary Agency
• Pay grade: Salary Range:, ___________ _
• Have duties of position changed from existing job description? Yes D No D
•Date position to close: ___________________ _
• Date candidate to commence work: ---------------
Supervisor's Signature: ____________ _ Date: ----- Department Director's Approval: ________ _ Date: ____ _ City Manager Approval:, ____________ _ Date: -----
For HR Use Only
I ~N~am~e-o_f_P_e_rs_o_n~H-i~_e_d_=~~_.__l_s_ta-rt~D-at_e_=~~~~~~l_S_a_la_ry_=~~~~~~,~
CITY OF ARROYO GRANDE
Personnel Department
P.O. Box550
214 East Branch Street
Arroyo Grande, CA 93421
(805) 473-5410
EXHIBIT#2
The law prohibits discrimination because of age, sex, religion, race, color, marital status, disability, national origin, sexual orientation, or any legally protected status and requires affirmative action in the hiring of disabled and veterans. The City of Arroyo Grande is an equal opportunity employer. If you need assistance in completing this application, please let us know.
POSITION APPL YING FOR: _________ _
NAME: SOCIAL SECURITY NO. HOME TELEPHONE NO. ARE YOU LEGALLY AUTHORIZED TO WORK IN THE U.S.?
Last First . Middle Yes D No D
PRESENT ADDRESS: ARE YOU RELATED TO ANY CITY IF UNDER 18, CAN YOU SUBMIT A WORK EMPLOYEE? Yes D No D PERMIT or GED, AFTER EMPLOYMENT?
No. Street City State Zip Code Name: Yes D No D
HAVE YOU EVER USED A DIFFERENT NAME? Yes D No D WOULD YOU OBJECT TO THIS OFFICE CONTACTING YOUR CURRENT OR PREVIOUS EMPLOYERS? Yes D No D
If yes what name(s)? IF YES EXPLAIN:
HAVE YOU EVER BEEN CONVICTED OF A FELONY? Yes 0 No D (Conviction will not necessarily disqualify an applicant from employment. Attach additional sheets if necessary).
If yes, please state date, charge, and circumstances:
HAVE YOU EVER BEEN FIRED OR ASKED TO RESIGN FROM ANY EMPLOYMENT? Yes D No D If yes, please state company, date, and explain circumstances:
EDUCATION
TYPE OF SCHOOL NAME AND ADDRESS OF SCHOOL Number of Units Completed DEGREE, DIPLOMA OR MAJOR COURSE OF
SEMESTERS QUARTERS CERTIFICATE AWARDED STUDY
HIGH SCHOOL
TRADE SCHOOL
COLLEGE/UNIVERSITY -
GRADUATE
SKILLS
LIST ANY PROFESSIONAL LICENSES OR CERTIFICATES YOU HAVE (if required): TYPING (if required): Yes D No D SPEED:
LIST ANY COMPUTER SKILLS YOU HAVE (if required): LIST ANY SPECIAL EQUIPMENT OR MACHINES YOU CAN OPERATE (if required):
EMPLOYMENT RECORD (Resumes may be attached, but cannot be substituted for the application.) (Please start with your most recent employer. List all jobs from the last 10 years. List U.S. Military experience as a job.) COMPANY NAME: SUPERVISOR'S ADDRESS AND TELEPHONE: EMPLOYMENT DATES POSITION: SALARY: REASON FOR LEAVING:
NAME AND TITLE: Street City State From:
Telephone To:
GIVE A BRIEF DESCRIPTION OF YOUR DUTIES AND RESPONSIBILITIES IN THE ABOVE POSITION:
= Page 1123 of 1799
EX T#2
EMPLOYMENT RECORD (cont'd)
COMPANY NAME: SUPERVISOR'S ADDRESS AND TELEPHONE: EMPLOYMENT DATES POSITION: SALARY: REASON FOR LEAVING:
NAME AND TITLE: Street City State From:
Telephone To:
GIVE A BRIEF DESCRIPTION OF YOUR DUTIES AND RESPONSIBILITIES IN THE ABOVE POSITION:
COMPANY NAME: SUPERVISOR'S ADDRESS AND TELEPHONE: EMPLOYMENT DATES POSITION: SALARY: REASON FOR LEAVING:
NAME AND TITLE: Street City State From:
Telephone To:
GIVE A BRIEF DESCRIPTION OF YOUR DUTIES AND RESPONSIBILITIES IN THE ABOVE POSITION:
COMPANY NAME: SUPERVISOR'S ADDRESS AND TELEPHONE: EMPLOYMENT DATES POSITION: SALARY: REASON FOR LEAVING:
NAME AND TITLE: Street City State From:
Telephone To:
GIVE A BRIEF DESCRIPTION OF YOUR DUTIES AND RESPONSIBILITIES IN THE ABOVE POSITION:
If required for the position, do you hold a valid Driver's License? D Yes Class. ___ _ Lie.# _________ _ D No D Ability to get one I understand that completion of this application does not In any way obligate the City to hire me or offer me a position. I understand that to be employed I must produce documents establishing my identity and legal authorization for employment in the United States.
I understand that If hired, my employment may be terminated by the City due to any misrepresentation, misinformation or inaccuracy of my statements contained herein. I authorize the City to investigate all statements contained in this application for accuracy and completeness, and to obtain any transcripts, records, or documents pertaining to my background and business experience, as required by the City. I hereby release the City, its officers, employees, representatives, or agents, from any and all liability and/or damage incurred to myself in obtaining such information.
If offered employment, the City may require me to take a physical examination, the results of which I agree can be reported to the City. This evaluation may also include a pre-employment drug screening examination as part of my application for employment to which I also consent I understand that either refusal to submit to the pre-employment drug screening examination or physical, or failure to qualify according to the standards established by the City may disqualify me from further consideration for employment. I also agree to and understand that I may have to be fingerprinted and take a loyalty oath. '
If hired, I agree to conform to the rules and regulations of this City as issued. These rules may be changed and updated periodically.
I certify that all statements made on this application are true, complete, and accurate to the best of my knowledge.
APPLICANT'S SIGNATURE: ________________ _ DATE: _________________________ __ (Please attach on a separate sheet, any other. information you think would be heipful to us in Page 1124 of 1799 considering you for employment.) EXHIBIT #2
AFFIRMATIVE ACTION FORM
Completing this form is voluntary.
The City of Arroyo Grande is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, ·religion, sex, age, national origin, disability, veteran status, sexual orientation or any other classification protected by Federal, State or local law.
The information below will be used only in the compilation of data for Affirmative Action reporting to the government.
Completion of this form is voluntary and will not affect your opportunity for employment, or term or conditions of employment, if hired. This information will not be retained with your application and will be kept confidential.
Position applied for: ________________ _ Filing close date: ____________ _ Gender: D Female D Male
ETHNIC GROUP:
(please check one of the descriptions below corresponding to the ethnic group to which you most identify) __ WHITE (not of Hispanic origin)
__ BLACK (not of Hispanic origin)
__ HISPANIC, includes persons of Mexican, Puerto Rican, Cuban, Latin Central or South American, or other Spanish origin. _ ___.ASIAN OR PACIFIC ISLANDER, includes Asian-Americans and persons of Japanese, Chinese, Korean or Filipino descent. _ ___.AMERICAN INDIAN OR ALASKAN NATIVE, includes persons having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition. __ OTHER, please indicate __________________________________ _ How did you hear about this job opening?
1per D City's We.bsite D Other website D Comm ·· r Organization D School D Other _____ _ Page 1125 of 1799 EXHIBIT #3
CITY OF ARROYO GRANDE
ORAL INTERVIEW EVALUATION FORM
Candidate's Name: Date: ~-------------~ ------- This form is to assist you in evaluating the applicant. In each section, check the box indicating the evaluation you feel is most descriptive of the applicant. In the large box at the bottom, please place your overall score based on the applicant's potential for success on the job. A score of 70 or above indicates that you feel the applicant is capable of handling all requirements for the position.
Education:
0 0
0 0
Excellent
Above average
Meets job requirements
Not applicable for this position
Technical Skills:
0 0
0 0
Excellent
Above average
Meets job requirements
Not applicable for this position
Motivation/Potential for Development:
0 0
0 0
Excellent
Above average
Meets job requirements
Not applic~ble for this position
Relevant Job Experience/Knowledge:
0 0
0 0
Excellent
Above average
Meets job requirements
Not applicable for this position
Interpersonal Skills:
0 0
0 0
Excellent
Above average
Meets job requirements
Not applicable for this position
Supervisory Skills (if applicable):
0 0
0 0
Excellent
Above average
Meets job requirements
Not applicable for this position
Candidate's Strengths: ______________________ _
Candidate's Deficiencies: ~-------------------------
Overall Ranking: Ranking on a scale of 1 - 100.
90 - 100 Excellent - outstanding candidate
BO - 90 Above average candidate
70 - 80 Meets qualifications for position
Under 70 Not qualified for position
Comments: ------------------------------~
Signature of Rater: ________________________ _
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICIES AND PROCEDURES POLICY#: 8-022 SUBJECT: PROMOTIONAL RECRUITMENT
ISSUED: """""07:....;../...:....;17""'-/0;:_;;0'------
EFFECTIVE: 07/17/00
CANCELLATION DATE: N/A
SUPERSEDES: NEW
POLICY:
PROCEDURES
It is the policy of the City of Arroyo Grande to establish procedures for the requirements, assessment and promotion of _internal City personnel.
. PROCEDURE:
The following are the procedures for promotional (internal hiring) recruitment of full-time permanent and part-time permanent positions with the City of Arroyo Grande. Internal po~tings are· not open to temporary employees. Promotional procedures for the Police Department are as outlined in the Police Department's General Order Manual, General Order# 0217.
A. Job Requisition
1) The department Supervisor shall complete a job requisition for the vacancy, indicating it as an internal posting, and forward it to their Department Director for signed approval. (See Policy# 8-021, Exhibit #1)
2) The Department Director shall approve/disapprove the requisition. If approved, they will forward the requisition to the City Manager for their signed approval. 3) The City Manager shall approve/disapprove the requisition. If approved, the requisition will be forwarded to the Management Assistant.
B. Job Advertising
1) The Management Assistant will prepare the employment announcement for the position. The announcement will contain the job description, job qualifications, current salary and benefits, selection process, and final filing date.
POLICY#: B-022
PAGE2
2) The job posting will be distribute.d to all departments for posting. The posting will be for a minimum of ten (10) working days.
C. Applications and Close Date
A Request for Promotional Consideration (see Exhibit #1) along with a City Application must be completely filled out in order to be considered for the position. Resumes may be attached, but will not take place of the application. Applications will be accepted until 5:00 P.M. on the close date for the position. An employee must meet the minimum requirements for the position on or before the filing date in order to be eligible to apply for the position. Only full-time permanent and part-time permanent employees may apply for the position.
D. Oral Board
1) The Department Director will provide the Management Assistant with up to three (3) names for the Oral Interview Board. The Oral Board may be comprised of City employees and/or members of the general public who are unbiased to the applicants and have knowledge and/or expertise regarding the position being recruited for.
2) The Department Director shall provide the Management Assistant with a minimum of ten (10) interview questions which are specific to the job classification under consideration.
3) The Management Assistant shall prepare the interview materials for the Oral Board and distribute them. Oral Board Evaluation Sheets (see Policy# B-021, Exhibit #3) will also be included.
4) The Management Assistant shall notify the candidates in writing of their interview time and date for the Oral Board.
5) The Management Assistant or representative shall meet with the Oral Board at the start of the day to provide interview instructions.
6) At the end of the interview day, the Management Assistant or representative shall conduct a wrap-up with the Oral Board to receive feedback on all interviewed candidates.
E. Job Testing
Certain tests, in addition to the oral interview may may required for a paticular position.
POLICY# 8-022
PAGE3
F. Scoring
1) The Management Assistant will compile the scores from the oral interviews and other testing completed, and prepare an eligibility list for the City Manager. In order to have their name placed on the eligibility list, a candidate must score seventy (70) percent or better.
2) The City Manager shall certify the eligibility list.
G. Final Interview
1) The Department Director shall select finalists from the top scoring eligible candidates for the.final interview. The number interviewed will be at the Director's discretion.
2) The Management Assistant will set the appointments for the interviews. 3) The Department Director and Management Assistant and/or representative shall conduct the final interviews. There will be a minimum of two City employees conducting the final interview.
H. Selection
The Department Director shall recommend the candidate selected for appointment.
I. Offer and Testing
1) The Management Assistant will prepare the offer letter for the candidate which must be signed by the City Manager. The offer letter will state that the candidate must be successful in the testing of section M #(2) as it applies to the position for the employment process to be continued.
2) Upon written acceptance of the conditional offer for employment and a signed Release and Waiver form by the candidate, the Management Assistant will coordinate the scheduling of any required medical exa!llinations. 3) · The results of the testing will be provided to the City. The candidate must successfully complete and pass the tests to City standards. (see Disqualifying Factors, #N).
J. Probationary Period
The probationary period shall be twelve (12) months in the new position.
POLICY# B-022
PAGE4
K. Disqualifying Factors
1) Any false statement, or any omission of information on either the employment application, or verbally to the oral board is grounds for termination of employment. 2) A positive drug test.
3) A felony conviction that would be job-related.
4) Lack 9f a valid California Driver's License at the time of appointment if required for the position.
5) Unable to perform the essential duties of the position where the City is unable to provide necessary accomodation for the position.
May Be Disqualifying:
1) Adult convictions for three (3) moving violations within the past three (3) years if the position requires driving a City vehicle.
2) Applicants with more that one (1) adult D.U.1. conviction if the position requires driving a City vehicle.
3) Being at fault in three (3) traffic accidents within the past five (5) years if the position requires driving a City vehicle.
NOTE: The above lists are not meant to be all encompassing. Factors such as employment history, credit history, personal and professional references, educational history, etc. will be used in conjunction with the above in determining an applicant's fitness for the promotion.
L. Attachments
1) Request for Promotional Consideration
M. Cross References
1) City of Arroyo Grande Personnel Regulations
2) City of Arroyo Grande Job Classification Manual
3) Applicable Memoranda of Understanding (MOU's)
POLICY# 8-022
PAGE5
4) City of Arroyo Grande Administrative Policy and Procedures #8-021 - Recruitment Procedures
5) Police Department General Order #0217 - Promotional Procedures ~2/7 INTERIM CITY MANAGER
______________________________________________________________________________
CITY OF ARROYO GRANDE ADMINISTRATIVE POLICIES AND PROCEDURES POLICY #: B-023
ISSUED: 09/ 17/2020
EFFECTIVE: 09/17/2020
CANCELLATION DATE: N/A
SUPERSEDES: 07/1/00
SUBJECT: FAMILY AND MEDICAL LEAVE ACT (“FMLA”)
AND CALIFORNIA FAMILY RIGHTS ACT
(“CFRA”)
POLICY:
To the extent not already provided for under current leave policies and provisions, the City of Arroyo Grande will provide family and medical care leave for eligible employees as required by state and federal law. The following provisions set forth certain rights and obligations with respect to such leave. Rights and obligations which are not specifically set forth below are set forth in the Department of Labor regulations implementing the federal Family and Medical Leave Act of 1993 (“FMLA”), and the regulations of the California Family Rights Act (“CFRA”). Unless otherwise provided by this article, “Leave” under this article shall mean leave pursuant to the FMLA and CFRA.
The function of this policy is to provide employees with a general description of their FMLA/CFRA rights. In the event of conflict between this policy and the applicable law, employees will be afforded all rights required by law. Further, nothing in this policy is intended to exceed the City’s obligations beyond what is required by law.
PROCEDURE:
A. EMPLOYEES ELIGIBLE FOR LEAVE
An employee is eligible for leave if the employee:
1. Has been employed for at least 12 months; and
2. Has been employed for at least 1,250 hours during the 12-month period immediately preceding the commencement of the leave.
B. REASONS FOR LEAVE
Leave is only permitted for the following reasons:
1. The birth of a child or to care for a newborn of an employee;
2. The placement of a child with an employee in connection with the adoption or foster care of a child;
3. Leave to care for a child, parent, spouse, or domestic partner who has a serious health condition; or
Policy # B-023
FAMILY AND MEDICAL LEAVE ACT (“FMLA”) AND CALIFORNIA FAMILY RIGHTS ACT (“CFRA”)
4. Leave because of a serious health condition that makes the employee unable to perform the functions of his/her position (i.e. an employee is unable to perform any one or more of the essential functions of his/her position); or
5. Leave for a “qualifying exigency” may be taken arising out of the fact that an employee’s spouse, son, daughter, or parent is on covered active duty or call to active duty status (under FMLA only, not the CFRA); or
6. Leave to care for a spouse, son, daughter, parent, or “next of kin” who is a covered servicemember of the United States Armed Forces who has a serious injury or illness incurred in the line of duty while on active military duty or existed before the beginning of the member’s active duty and was aggravated by the service in the line of duty on active duty in the Armed Forces (this leave can run up to 26 weeks of unpaid leave during a single 12-month period) under FMLA only, not the CFRA.
Employees who misuse or abuse FMLA leave may be disciplined up to and including termination.
An employee who fraudulently obtains or uses CFRA leave is not protected by the CFRA’s job restoration or maintenance of health benefits provisions.
C. AMOUNT OF LEAVE
Eligible employees are entitled to a total of 12 workweeks of leave (or 26 weeks to care for a covered servicemember) during any 12-month period. Where FMLA leave qualifies as both military caregiver leave and care for a family member with a serious health condition, the leave will be designated as military caregiver leave first.
1. Minimum Duration of Leave
If leave is requested for the birth, adoption or foster care placement of a child of the employee, leave must be concluded within one year of the birth or placement of the child. In addition, the basic minimum duration of such leave is two weeks. However, an employee is entitled to leave for one of these purposes (e.g., bonding with a newborn) for at least one day, but less than two weeks duration on any two occasions.
If leave is requested to care for a child, parent, spouse or the employee him/herself with a serious health condition, there is no minimum amount of leave that must be taken. However, the notice and medical certification provisions of this policy must be complied with.
Spouses Both Employed by the City
In any case in which both parents are employed by the City and are entitled to leave, the aggregate number of workweeks of CFRA leave to which both may be entitled may be limited to 12 workweeks during any 12-month period if leave is taken for the birth or placement for adoption or foster care of the employee’s child (ie. bonding leave). Similarly, where married spouses both work for the City, they may be limited to a total of 12 weeks of FMLA leave for bonding leave.
Policy # B-023
FAMILY AND MEDICAL LEAVE ACT (“FMLA”) AND CALIFORNIA FAMILY RIGHTS ACT (“CFRA”)
In any case in which married spouses both employed by the City are entitled to leave, the aggregate number of workweeks of leave to which both may be entitled may be limited to 26 workweeks during a 12-month period if leave is taken to care for a covered servicemember under the FMLA.
Except as noted above, this limitation does not apply to any other type of leave under this policy.
D. EMPLOYEE BENEFITS WHILE ON LEAVE
1. Group Health Insurance During Unpaid Leave
Leave under this Policy is unpaid. While on unpaid leave, employees will continue to be covered by the City’s group health insurance, dental, vision and life insurance for up to 12 weeks each leave year to the same extent that coverage is provided while the employee is on the job. If the employee is disabled by pregnancy, coverage will continue up to four months each leave year. If an employee disabled by pregnancy also uses leave under the CFRA for baby-bonding, the City will maintain her coverage while she is disabled by pregnancy (up to four months or 17 1/3 weeks) and during her CFRA leave (up to 12 weeks).
2. Benefit Plans Not Provided through the City’s Group Health Plan During Unpaid Leave Do Continue
While on unpaid leave, employees will continue to be covered by the City’s benefits plans (e.g., AFLAC, LegalShield) that are not part of its group health plan for up to 12 weeks each leave year to the same extent that coverage is provided while the employee is on the job.
3. Payment of Premiums
Employees may make the appropriate contributions for continued coverage under the health and benefits plans by payroll deductions (if the employee is using his or her paid leave) or direct payments (if the employee is not using his or her paid leave). The City will inform the employee whether the direct payments for premiums should be paid to the carrier or to the City, and when these premiums are due. Your coverage on a particular plan may be dropped if you are more than 30 days late in making a premium payment and you will be offered continuation coverage under COBRA. However, you will receive a notice at least 15 days before coverage is to cease, advising you that you will be dropped if your premium payment is not paid by a certain date. Employee contribution rates are subject to any changes in rates that occur while employee is on leave.
4. Recovery of Premium if the Employee Fails to Return from Leave If an employee fails to return to work after his/her leave entitlement has been exhausted or expires, the City shall have the right to recover its share of health plan premiums for the entire leave period, unless the employee does not return because of the continuation, recurrence, or onset of a serious health condition of the employee or his/her family member which would entitle the employee to leave, or because of circumstances beyond the employee’s control.
Policy # B-023
FAMILY AND MEDICAL LEAVE ACT (“FMLA”) AND CALIFORNIA FAMILY RIGHTS ACT (“CFRA”)
The City shall have the right to recover premiums through deduction from any sums due the City (e.g. unpaid wages, vacation pay, etc.).
E. SUBSTITUTION OF PAID ACCRUED LEAVES
While on leave under this policy, as set forth herein, an employee may elect to concurrently use paid accrued leaves. Similarly, the City may require an employee to concurrently use paid accrued leaves after requesting FMLA and/or CFRA leave, and may also require an employee to use Family and Medical Care Leave concurrently with a non-FMLA and/or CFRA leave which is FMLA and/or CFRAqualifying. If an employee is receiving a paid benefit (e.g. State Disability Insurance or Workers’ Compensation), the employee is not considered to be on an unpaid leave, and an employee may, at his/her option, coordinate the use of paid time off, sick leave, or accrued vacation up to his/her regular salary amount.
1. Employee’s Right to Use Paid Accrued Leaves Concurrently with Family Leave Where an employee has earned or accrued paid vacation, administrative leave, compensatory time, or personal leave, that paid leave may be substituted for all or part of any (otherwise) unpaid leave under this policy.
As for sick leave, an employee is entitled to use sick leave concurrently with leave under this policy if:
a) The leave is for the employee’s own serious health condition; or b) The leave is needed to care for a child, parent, spouse or domestic partner with a serious health condition, and would be permitted as sick leave under the City’s sick leave policy.
2. The City of Arroyo Grande’s Right to Require an Employee to Use Paid Leave When Using FMLA and/or CFRA Leave
Employees must exhaust their accrued leaves concurrently with FMLA and/or CFRA leave to the same extent that employees have the right to use their accrued leaves concurrently with FMLA and/or CFRA leave with two exceptions:
a) Employees are not required to use accrued compensatory time earned in lieu of overtime earned pursuant to the Fair Labor Standards Act; and b) Employees will only be required to use sick leave concurrently with FMLA and/or CFRA leave if the leave is for a purpose which would be permitted under the City of Arroyo Grande’s sick leave policy.
Policy # B-023
FAMILY AND MEDICAL LEAVE ACT (“FMLA”) AND CALIFORNIA FAMILY RIGHTS ACT (“CFRA”)
3. The City of Arroyo Grande’s Right to Require an Employee to Exhaust FMLA and/or CFRA Leave Concurrently with Other Leaves
If an employee takes a leave of absence for any reason which is FMLA and/or CFRA qualifying, the City may designate that non-FMLA and/or CFRA leave as running concurrently with the employee’s 12-week FMLA and/or CFRA leave entitlement. The only exception is for peace officers and firefighters who are on leave pursuant to Labor Code §4850.
4. The City’s and Employee’s Right if an Employee Requests Accrued Leave, Other than Accrued Sick Leave, Without Mentioning Either the FMLA or CFRA If an employee requests to utilize accrued vacation leave or other accrued paid time off, other than accrued sick leave, without reference to a FMLA and/or CFRA qualifying purpose, the City may not ask the employee if the leave is for a FMLA/CFRA qualifying purpose. However, if the City denies the employee’s request and the employee provides information that the requested time off is for a FMLA and/or CFRA qualifying purpose, the City may inquire further into the reason for the absence. If the reason is FMLA and/or CFRA qualifying, the City may require the employee to exhaust accrued leave as described above.
F. EMPLOYEE NOTICE OF LEAVE
Although the City of Arroyo Grande recognizes that emergencies arise which may require employees to request immediate leave, employees are required to give as much verbal or written notice as possible of their need for leave. If leave is foreseeable, at least 30 days written notice (Request for Family/Medical Leave – Attachment 1) is required. In addition, if an employee knows that he/she will need leave in the future, but does not know the exact date(s) (e.g. for the birth of a child or to take care of a newborn), the employee shall inform his/her supervisor as soon as possible that such leave will be needed. Such notice may be orally given. If the City determines that an employee’s notice is inadequate or the employee knew about the requested leave in advance of the request, the City may delay the granting of the leave until it can, in its discretion, adequately cover the position with a substitute.
For foreseeable leave due to a qualifying exigency, an employee must provide notice of the need for leave as soon as practicable, regardless of how far in advance such leave is foreseeable.
G. MEDICAL CERTIFICATION
Employees who request leave for their own serious health condition or to care for a child, parent, spouse or domestic partner who has a serious health condition, must provide written certification from the health care provider of the individual requiring care if requested by the City.
If the leave is requested because of the employee’s own serious health condition, the certification must include a statement that the employee is unable to work at all or is unable to perform the essential functions of his/her position.
Policy # B-023
FAMILY AND MEDICAL LEAVE ACT (“FMLA”) AND CALIFORNIA FAMILY RIGHTS ACT (“CFRA”)
Employees who request leave to care for a covered servicemember who is a child, spouse, parent or “next of kin” of the employee must provide written certification from a health care provider regarding the injured servicemember’s serious injury or illness.
The first time an employee requests leave because of a qualifying exigency, an employer may require the employee to provide a copy of the military member’s active duty orders or other documentation issued by the military which indicates that the military member is on covered active duty or call to active duty status in a foreign country, and the dates of the military member’s active duty service. A copy of new active duty orders or similar documentation shall be provided to the employer if the need for leave because of a qualifying exigency arises out of a different active duty or call to active duty status of the same or a different military member.
1. Time to Provide Certification
When an employee’s leave is foreseeable and at least 30 days notice has been provided, if a medical certification is requested, the employee must provide it before the leave begins.
When this in not possible, the employee must provide the requested certification to the City within 15 days after the request, unless it is not practicable under the particular circumstances to do so despite the employee’s diligent, good faith efforts.
2. Consequences for Failure to Provide an Adequate or Timely Certification If an employee provides an incomplete medical certification, the employee will be given a reasonable opportunity to cure any such deficiency.
However, if an employee fails to provide a medical certification within the time frame established by this policy, the City may delay the taking of FMLA and/or CFRA leave until the required certification is provided.
3. Second and Third Medical Opinions
If the City has a good faith, objective reason to doubt the validity of a certification, the City may require a medical opinion of a second health care provider chosen and paid for by the City. If the second opinion is different from the first, the City may require the opinion of a third provider jointly approved by the City and the employee, but paid for by the City. The opinion of the third provider will be binding. An employee may request a copy of the health care provider’s opinion when there is a second or third opinion.
4. Intermittent Leave or Leave on a Reduced Leave Schedule If an employee requests leave intermittently (a few days or hours at a time) or on a reduced leave schedule to care for an immediate family member with a serious health condition, the employee must provide medical certification that such leave is medically necessary. “Medically necessary” means there must be a medical need for the leave and that the leave can best be accomplished through an intermittent or reduced leave schedule.
Policy # B-023
FAMILY AND MEDICAL LEAVE ACT (“FMLA”) AND CALIFORNIA FAMILY RIGHTS ACT (“CFRA”)
H. REINSTATEMENT UPON RETURN FROM LEAVE
1. Right to Reinstatement
Upon expiration of leave, an employee is entitled to be reinstated to the position of employment held when the leave commenced, or to an equivalent position with equivalent employment benefits, pay, and other terms and conditions of employment. Employees have no greater rights to reinstatement, benefits and other conditions of employment than if the employee had been continuously employed during the FMLA and/or CFRA period.
If a definite date of reinstatement has been agreed upon at the beginning of the leave, the employee will be reinstated on the date agreed upon. If the reinstatement date differs from the original agreement between the employee and the City, the employee will be reinstated within two business days, where feasible, after the employee notifies the employer of his/her readiness to return.
2. Employee’s Obligation to Periodically Report On His/Her Condition Employees may be required to periodically report on their status and intent to return to work.
This will avoid any delays to reinstatement when the employee is ready to return.
3. Fitness for Duty Certification
As a condition of reinstatement of any employee whose leave was due to the employee’s own serious health condition, which made the employee unable to perform his/her job, the employee must obtain and present a “Fitness for Duty to Return from Leave” (Attachment 4) certification from the health care provider that the employee is able to resume work. Failure to provide such certification will result in denial of reinstatement.
4. Reinstatement of “Key Employees”
The City may deny reinstatement to a “key” employee (i.e., an employee who is among the highest paid 10 percent of all employed by the City within 75 miles of the work site) if such denial is necessary to prevent substantial and grievous economic injury to the operations of the City, and the employee is notified of the City’s intent to deny reinstatement on such basis at the time the employer determines that such injury would occur.
I. REQUIRED FORMS
Employees must fill out the following applicable forms in connection with leave under this policy:
1. “Request for Family/Medical Leave” (Attachment 1) to be eligible for leave. On the form, the employee must indicate the reason for the leave.
NOTE: EMPLOYEES WILL RECEIVE A CITY RESPONSE TO THEIR REQUEST (Attachment 2) WHICH WILL SET FORTH CERTAIN CONDITIONS OF THE LEAVE.
2. Medical certification – either for the employee’s own serious health condition or for the
Policy # B-023
FAMILY AND MEDICAL LEAVE ACT (“FMLA”) AND CALIFORNIA FAMILY RIGHTS ACT (“CFRA”)
serious health condition of a child, parent, spouse, or domestic partner;
3. Authorization for payroll deductions for benefit plan continuation coverage. (Attachment 3)
4. “Fitness for Duty to Return from Leave Form”. (Attachment 4) J. DEFINITIONS
1. “12-Month Period” means a rolling 12-month period measured backward from the date leave is taken and continuous with each additional leave day taken.
2. “Single 12-Month Period” means a 12-month period which begins on the first day the eligible employee takes FMLA leave to take care of a covered servicemember and ends 12 months after that date.
3. “Child” means a child under the age of 18 years of age, or 18 years of age or older who is incapable of self-care because of a mental or physical disability. An employee’s child is one for whom the employee has actual day-to-day responsibility for care and includes, a biological, adopted, foster or step-child, legal ward, or a child of a person standing in loco parentis.
A child is “incapable of self care” if he/she requires active assistance or supervision to provide daily self-care in three or more of the activities of daily living or instrumental activities of daily living – such as, caring for grooming and hygiene, bathing, dressing, eating, cooking, cleaning, shopping, taking public transportation, paying bills, maintaining a residence, using telephones and directories, etc.
4. “Parent” means the biological, adoptive, step or foster parent of an employee or an individual who stands or stood in loco parentis (in place of a parent) to an employee when the employee was a child. This term does not include parents-in-law.
5. “Spouse” means a husband or wife as defined or recognized under California state law for purposes of marriage. “Spouse” also includes registered domestic partners and same-sex partners in marriage.
6. “Domestic Partner,” as defined by Family Code §§ 297 and 299.2, shall have the same meaning as “Spouse” for purposes of CFRA Leave.
7. “Serious health condition” means an illness, injury impairment, or physical or mental condition that involves:
a) Inpatient Care in a hospital, hospice, or residential medical care facility, including any period of incapacity (i.e., inability to work, or perform other regular daily activities due to their serious health condition, treatment involved, or recovery there from). A person is considered an “inpatient” when a health care facility formally admits him or her to the facility with the expectation that he or she will remain at least overnight, even if it later develops that such person can be discharged or transferred to another facility, and does not actually remain overnight; or
Policy # B-023
FAMILY AND MEDICAL LEAVE ACT (“FMLA”) AND CALIFORNIA FAMILY RIGHTS ACT (“CFRA”)
b) Continuing treatment by a health care provider; a serious condition involving continuing treatment by a health care provider includes any one or more of the following:
i) A period of incapacity (i.e. inability to work, or perform other regular daily activities) due to a serious health condition of more than three consecutive calendar days, and any subsequent treatment or period of incapacity relating to the same condition, that also involves:
1) Treatment two or more times within 30 days of the first day of incapacity, unless extenuating circumstances exist, by a health care provider, by a nurse or by a provider of health care services (e.g. a physical therapist) under orders of, or on referral by a health care provider. The first in-person treatment visit must take place within seven days of the first day of incapacity; or 2) Treatment by a health care provider on at least one occasion which must take place within seven days of the first day of incapacity and results in a regimen of continuing treatment under the supervision of the health care provider. This includes for example, a course of prescription medication or therapy requiring special equipment to resolve or alleviate the health condition. If the medication is over the counter, and can be initiated without a visit to a health care provider, it does not constitute a regimen of continuing treatment. ii) Any period of incapacity due to pregnancy or for prenatal care. This entitles the employee to FMLA leave, but not CFRA leave. (Under California law an employee disabled by pregnancy is entitled to pregnancy disability leave.) iii) Any period of incapacity or treatment for such incapacity due to a chronic serious health condition. A chronic serious health condition is one which:
1) Requires periodic visits for treatment by a health care provider, or by a nurse or physician’s assistant under direct supervision of a health care provider; 2) Continues over an extended period of time (including recurring episodes of a single underlying condition); and
3) May cause episodic rather than a continuing period of incapacity (e.g. asthma, diabetes, epilepsy, etc.). Absences for such incapacity qualify for leave even if the absences only last one day.
iv) A period of incapacity which is permanent or long-term due to a condition for which treatment may not be effective. The employee or family member must be under the continuing supervision of, but need not be receiving active treatment by a health care provider.
v) Any period of absence to receive multiple treatments (including any period of recovery therefrom) by a health care provider or by a provider of health care services under
Policy # B-023
FAMILY AND MEDICAL LEAVE ACT (“FMLA”) AND CALIFORNIA FAMILY RIGHTS ACT (“CFRA”)
orders of, or on referral by, a health care provider, either for restorative surgery after an accident or other injury, or for a condition that would likely result in a period of incapacity of more than three consecutive calendar days in the absence of medical intervention or treatment.
8. “Health Care Provider” means:
a) A doctor of medicine or osteopathy who is authorized to practice medicine or surgery by the State of California;
b) Individuals duly licensed as a physician, surgeon, or osteopathic physician or surgeon in another state or jurisdiction, including another country, who directly treats or supervises treatment of a serious health condition;
c) Podiatrists, dentists, clinical psychologists, optometrists, and chiropractors (limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by X-ray to exist) authorized to practice in California and performing within the scope of their practice as defined under California state law; d) Nurse practitioners, nurse-midwives, clinical social workers and physician assistants who are authorized to practice under California state law and who are performing within the scope of their practice as defined under California state law; e) Christian Science practitioners listed with the First Church of Christ, Scientist in Boston Massachusetts; and
f) Any health care provider from whom an employer or group health plan’s benefits manager will accept certification of the existence of a serious health condition to substantiate a claim for benefits.
9. “Covered active duty” means: (1) in the case of a member of a regular component of the Armed Forces, duty during the deployment of the member with Armed Forces to a foreign country, or (2) in the case of a member of a reserve component of the Armed Forces, duty during the deployment of a member of the Armed Forces to a foreign country under a call or order to active duty under certain specified provisions.
10.“Covered Servicemember” means (1) a current member of the Armed Forces, including a member of the National Guard or Reserves, who is undergoing medical treatment, recuperation, or therapy, is otherwise in outpatient status, or is otherwise on the temporary disability retired list, for a serious injury or illness; or (2) a veteran who is undergoing medical treatment, recuperation, or therapy, for a serious injury or illness and who was a member of the Armed Forces, including a member of the National Guard or Reserves, at any time during the period of five years preceding the date on which the veteran undergoes that medical treatment, recuperation, or therapy.
11.“Outpatient Status” means, with respect to a covered servicemember, the status of a member of the Armed Forces assigned to either: (1) a military medical treatment facility as an
Policy # B-023
FAMILY AND MEDICAL LEAVE ACT (“FMLA”) AND CALIFORNIA FAMILY RIGHTS ACT (“CFRA”)
outpatient; or (2) a unit established for the purpose of providing command and control of members of the Armed Forces receiving medical care as outpatients.
12.“Next of Kin of a Covered Servicemember” means the nearest blood relative other than the covered service member’s spouse, parent, son, or daughter, in the following order of priority:
Blood relatives who have been granted legal custody of the covered servicemember by court decree or statutory provisions, brothers and sisters, grandparents, aunts and uncles, and first cousins, unless the covered servicemember has specifically designated in writing another blood relative as his or her nearest blood relative for purposes of military caregiver leave under the FMLA.
13.“Serious Injury or Illness” (1) in the case of a member of the Armed Forces, including a member of the National Guard or Reserves, means an injury or illness that was incurred by the member in the line of duty on active duty in the Armed Forces (or existed before the beginning of the member’s active duty and was aggravated by service in the line of duty on active duty in the Armed Forces) and that may render the member medically unfit to perform the duties of the member’s office, grade, rank, or rating; or (2) in the case of a veteran who was a member of the Armed Forces, including a member of the National Guard or Reserves, at any time during the period of five years preceding the date on which the veteran undergoes that medical treatment, recuperation, or therapy, means a qualifying injury or illness that was incurred by the member in the line of duty on active duty in the Armed Forces (or existed before the beginning of the member’s active duty and was aggravated by service in the line of duty on active duty in the Armed Forces) and that manifested itself before or after the member became a veteran.
K. ATTACHMENTS
1. Request for Family/Medical Leave
2. Employer Response to Request for FMLA and/or CFRA Leave
3. Authorization for Payroll Deductions for Benefit Plan Continuance
4. Fitness for Duty to Return from Leave
L. CROSS REFERENCES
1. City of Arroyo Grande Personnel Regulations
2. Applicable Memoranda of Understanding (MOU’s)
_____________________________
Whitney McDonald
City Manager
Policy # B-023
FAMILY AND MEDICAL LEAVE ACT (“FMLA”) AND CALIFORNIA FAMILY RIGHTS ACT (“CFRA”)
ATTACHMENT 1
REQUEST FOR FAMILY/MEDICAL LEAVE
Employee Name __________________ Date of Request ______________________ Department ______________________ Position Title ________________________ Hire Date ________________________
I request a Family/Medical Leave for the following reason (check one):
_______ A. The birth of a child and/or in order to care for such child. _______ B. The placement of a child for adoption or foster care. _______ C. In order to care for an immediate family member because such family member has a serious health condition.
Check one: CHILD SPOUSE PARENT DOMESTIC PARTNER (Must submit “Medical Certification” within 15 days.)
_______ D. Care for an adult child who is incapable of self-care. (A child is “incapable of self-care” if he/she requires active assistance or supervision to provide daily self-care in three or more of the activities of daily living or instrumental activities of daily living, such as caring for grooming and hygiene, bathing, dressing and eating, cooking, cleaning, shopping, taking public transportation, paying bills, maintaining a residence, using telephones and directories, etc.)
________ E. Employee’s own serious health condition that makes the employee unable to perform the functions of his/her position. (Must submit “Physician Certification” within 15 days.) _______ F. To assist a son, daughter, spouse, or parent who is a member of the Armed Forces, including the National Guard or Reserves with a “qualifying exigency” related to covered active duty or a call to active duty status.
Check one: SON DAUGHTER SPOUSE PARENT
(Must submit “Certification” of Qualifying Exigency)
_______ G. To care for a son or daughter, spouse, parent or “next of kin” covered servicemember with a serious injury or illness
Check one: SON DAUGHTER SPOUSE PARENT NEXT OF KIN (Must submit “Certification” from Department of Defense or Department of Veteran Affairs within 15 days.)
Policy # B-023
FAMILY AND MEDICAL LEAVE ACT (“FMLA”) AND CALIFORNIA FAMILY RIGHTS ACT (“CFRA”)
ATTACHMENT 1
Method of Leave Requested
_________ A. Consecutive Leave
_________ B. Intermittent or Reduced Leave Schedule (Specify schedule below) ____________________________________________________________ Date leave is to begin: ____________________ Expected duration of leave: ______________ If the duration of my family/medical leave (total of paid and unpaid time) does not exceed 12 weeks (or 26 weeks to care for an injured servicemember), I will be returned to my same or equivalent position. I understand that if my family/medical leave should exceed 12 weeks (or 26 weeks to care for an injured servicemember), I will be returned to my same or equivalent position, only if available. If my same or equivalent position is not available, I understand that I may be terminated.
Date____________________
Employee’s Signature_____________________________
Policy # B-023
FAMILY AND MEDICAL LEAVE ACT (“FMLA”) AND CALIFORNIA FAMILY RIGHTS ACT (“CFRA”)
ATTACHMENT 2
CITY OF ARROYO GRANDE
EMPLOYER RESPONSE TO REQUEST FOR FMLA AND/OR CFRA LEAVE TO:
FROM: HUMAN RESOURCES MANAGER
SUBJECT: REQUEST FOR FMLA/CFRA LEAVE
DATE:
PART A - NOTICE OF ELIGIBILITY
On _________ you notified us of your need to take FMLA/CFRA Leave beginning on ________________ due to:
The birth of a child, or the placement of a child with you for adoption or foster care; Your own serious health condition;
Because you are needed to care for your spouse; child; parent; next of kin of a covered servicemember with a serious injury or illness. Because of a qualifying exigency arising out of the fat that your spouse; child; parent is on covered active duty or call to covered active duty status with the Armed Forces. Because you are the spouse; son or daughter; parent; next of kin of a covered servicemember with a serious injury or illness.
It is uncertain how much leave you will require at this point. You are eligible for FMLA/CFRA leave until (insert date – 12 weeks from date send letter) providing that certification is provided by your doctor. Under FMLA/CFRA leave, you are entitled to twelve weeks of leave. Your leave is measured on a rolling 12- month period measured backward from the date leave is taken and continuous with each additional leave day taken.
This notice is to inform you that:
You are eligible for FMLA/CFRA leave (See Part B below for Rights and Responsibilities) You are not eligible for FMLA/CFRA leave, because
____ You have not met the FMLA/CFRA’s 12-month length of service requirement. As of the first date of requested leave, you will have worked approximately ___months towards this requirement.
____ You have not met the FMLA/CFRA’s hours of service requirement.
If you have any questions, please contact the Human Resources Manager or view the FMLA/CFRA poster located in your department.
Policy # B-023
FAMILY AND MEDICAL LEAVE ACT (“FMLA”) AND CALIFORNIA FAMILY RIGHTS ACT (“CFRA”)
PART B – RIGHTS AND RESPONSIBILITIES FOR TAKING FMLA/CFRA LEAVE As explained in Part A, you meet the eligibility requirements for taking FMLA/CFRA leave available in the applicable 12-month period. However, in order for us to determine whether your absence qualifies as FMLA/CFRA leave, you must return the following information to us by ______________________ (give 15 calendar days from receipt of notice). If sufficient information is not provided in a timely manner, your leave may be denied.
Sufficient certification to support your request for FMLA/CFRA leave. A certification form that sets forth the information necessary to support your request ____ is/ _____is not enclosed. Sufficient documentation to establish the required relationship between you and your family member. Other information needed (such as documentation for military family leave):
________________________________________________________________________ _________________________________________________________________________ No additional information is requested.
If your leave does qualify as FMLA/CFRA leave you will have the following responsibilities while on FMLA/CFRA leave:
Contact payroll at (805) 473-5434 to make arrangements to continue to make your share of the premium payments on your health insurance to maintain health benefits while you are on leave. You have a minimum 30-day grace period in which to make premium payments. If payment is not made timely, your group health insurance may be cancelled, provided we notify you in writing at least 15 days before the date that your health coverage will lapse, or, at our option, we may pay your share of the premiums during FMLA/CFRA leave, and recover these payments from you upon your return to work.
You will be required to use your available paid_____sick, _______vacation, and/or_____other leave during your FMLA absence. This means that you will receive your paid leave and the leave will also be considered protected FMLA leave.
Your requested time off will be against your FMLA/CFRA leave entitlement. Due to your status within the company, you are considered a “key employee” as defined in the FMLA/CFRA. As a “key employee”, restoration to employment may be denied following FMLA/CFRA leave on the grounds that such restoration will cause substantial and grievous economic injury to us.
We_____have/______have not determined that restoring you to employment at the conclusion of FMLA/CFRA leave will cause substantial and grievous economic harm to us. While on leave you will be required to furnish us with periodic reports of your status and intent to return to work every ____________________________days.
If the circumstances of your leave change, and you are able to return to work earlier than the date indicated on this form, you will be required to notify us at least two workdays prior to the date you intend to report for work.
Policy # B-023
FAMILY AND MEDICAL LEAVE ACT (“FMLA”) AND CALIFORNIA FAMILY RIGHTS ACT (“CFRA”)
ATTACHMENT 3
AUTHORIZATION FOR PAYROLL DEDUCTIONS FOR BENEFIT
COVERAGE CONTINUATION DURING FAMILY/MEDICAL CARE LEAVE
I, authorize the City of Arroyo Grande to make deductions from income I will receive from accrued leave during my upcoming family/medical care leave which will commence on_________________________ and end on _________________________.
I authorize deductions to be made from income I will receive from accrued leave for the following benefits:
______________________________________________________________________ (list benefits which employee is entitled to contribute to during family/medical care leave) Date: ___________________
___________________________________
Employee’s Signature
Policy # B-023
FAMILY AND MEDICAL LEAVE ACT (“FMLA”) AND CALIFORNIA FAMILY RIGHTS ACT (“CFRA”)
ATTACHMENT 4
CITY OF ARROYO GRANDE
FITNESS FOR DUTY TO RETURN FROM LEAVE
To City of Arroyo Grande Employee: You must present this release to your supervisor before or on the day you return to work. You may not work without this release.
To: Treating Physician or Practitioner
Our employee began a period of medical care leave for his/her serious health condition on __________.
As a condition of returning to work, the employee must take a physical examination and have his/her physician complete this form. This form must be completed before the employee is allowed to resume his/her job duties.
1. Employee Name:__________________________________________
2. Employee’s Job Title:_______________________________________
3. Date of Physical Examination:_________________________________
4. With respect to your understanding as to what are the employee’s essential job functions, please check the source(s) where you received your information:
_____City job description
_____Discussion with the employee’s supervisor
_____Discussion with the employee
_____Other. Please explain:________________________________
5. Please indicate the status of the employee’s release to duty:
_____Fully, unrestricted duty. Please skip question 6 and proceed to #7. _____Modified duty. You must complete question 6.
_____Not released for any type of duty.
6. If you are releasing the employee to modified work duty, you must complete this section thoroughly.
A. Estimated date that employee will be able to return to full, unrestricted duty:_______________________.
B. Indicate the exact work restrictions which apply to the employee at this time on the attached chart.
7. I hereby certify that the forgoing facts are true and correct, and are executed under penalty of perjury in____________, California, this ______day of __________, 20___. ____________________________________ _______________________ Signature of Treating Physician or Practitioner Date
_____________________________________ _________________________ Print Name of Treating Physician or PractitionerTelephone Number
Policy # B-023
FAMILY AND MEDICAL LEAVE ACT (“FMLA”) AND CALIFORNIA FAMILY RIGHTS ACT (“CFRA”)
ATTACHMENT 4
CITY OF ARROYO GRANDE
FITNESS FOR DUTY TO RETURN FROM LEAVE
TO: DOCTOR
ADDRESS
FROM: HUMAN RESOURCES MANAGER
RE:
CAN THIS PATIENT RETURN TO WORK WITH NO RESTRICTIONS? YES NO DATE EMPLOYEE CAN RETURN TO FULL DUTIES____________________________________________________ IF NOT, PLEASE COMPLETE THE FOLLOWING:
This patient is physically able to perform the following functions:
I. In an 8-hour day, this patient can: (Circle full capacity for each activity) A. Sit - Number of Hours: 1 2 3 4 5 6 7 8
B. Stand - Number of Hours: 1 2 3 4 5 6 7 8
C. Walk - Number of Hours: 1 2 3 4 5 6 7 8
II. This patient is able to: Not at all Times/Day Times/Hr. Continuously A. Bend/Stoop ( ) ( ) ( ) ( )
B. Squat ( ) ( ) ( ) ( )
C. Crawl ( ) ( ) ( ) ( )
D. Climb ( ) ( ) ( ) ( )
E. Crouch ( ) ( ) ( ) ( )
F. Kneel ( ) ( ) ( ) ( )
G. Balance ( ) ( ) ( ) ( )
H. Push/Pull ( ) ( ) ( ) ( )
III. This patient can lift: Not at all Times/Day Times/Hr. Continuously A. Up to 10 pounds ( ) ( ) ( ) ( )
B. 11 to 24 pounds ( ) ( ) ( ) ( )
C. 25 to 50 pounds ( ) ( ) ( ) ( )
D. 51 to 100 pounds ( ) ( ) ( ) ( )
EXPECTED PERIOD OF DISABILITY: _________________________________________________________ DATE OF NEXT DOCTORS APPOINTMENT: ___________________________________________________ DOCTOR’S SIGNATURE DATE: _________________________