Fillable Suggestion Form printable pdf download

Suggestion Form

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State of Wisconsin

SUGGESTION FORM

Employee Suggestion Program

DOA-15800 (C06/2015)

innovative

S. 230.48 WIS. STATS

Fill out this form completely.

ideas

Previously OSER-SESP-14

improve

Submit your idea on this form to your Agency/Campus Suggestion Program Coordinator to be considered for

a cash award and/or a Certificate of Commendation in recognition of your idea. If you do not know the name of your

Wisconsin

agency/campus coordinator, contact your Personnel/Human Resources Office or the Web site: suggest.state.wi.us

Any state or university employee (part-time, full-time, temporary, permanent, classified, unclassified) can submit

Employee Suggestion Program

his or her suggestions for improvement in any area of state government operations.

If entered text disappears when going to next field,

Agency Tracking Number:

EMPLOYEE INFORMATION

tap spacebar once before tabbing to next field.

Name of Suggester(s):

Job Classification Title:

Agency:

Division/Institution/Unit:

Work Address:

City, State, Postal Code:

E-Mail Address:

Telephone Number:

FAX Number:

Name of Supervisor:

Supervisor's Work Address (if different from above):

SUGGESTION INFORMATION

State the Problem, Concern, or Issue:

(Describe in detail. If more space is needed, attach separate sheet.)

Describe Your Proposed Solution:

(Attach examples, photos, charts, etc., as needed to explain.)

Benefits of Your Suggestion:

(Check all that apply.)

Monetary Savings

Safety/Health

Process Improvement

Improved Morale

Customer Service

Working Conditions

Product Improvement

Other:_____________________

If Monetary Savings, show amount over each of next five years (include calculations and how savings are determined):

Has the suggestion been implemented?

YES

Suggester's Signature:

Date:

[ If granted, cash awards are taxable, subject to federal/state reporting requirements. At end of year, W-2 form will be sent to employee. ]

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Suggestion Form

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