Employee Suggestion Awards Program Suggestion Form printable pdf download

This form is for use only by County employees. Please fill out the

online form then print and send with supporting materials via

interoffice mail to the Human Resources Department, 400 S. Fort

Harrison Ave., Clearwater, Attn: Employee Communications.

EMPLOYEE SUGGESTION AWARDS PROGRAM

Suggestion Form

Suggestion #: _______

(For HR use only)

Name: _______________________________________________ Title: ________________________________________

Select Dept Here

Department: _____________________________________________________ Work phone: ______________________

I have read the

program guidelines

(next page). The Non-Eligibility Rules do not pertain to my suggestion. I hereby

understand, and agree, that the acceptance by me of any monetary award from Pinellas County for this suggestion shall

be deemed payment in full for myself, my heirs, or my assignees. I hereby waive claim or claims against the County which

may arise as a consequence of the County adopting this suggestion.

Signature: ____________________________________________

Date: _____________________

If this is a group suggestion, all other joint suggesters must sign and print their names below:

________________________

_______________________ ______________________ _______________________

Signatures

________________________

_______________________ ______________________ _______________________

Print names

Before describing your suggestion in detail, please answer the following.

Does your suggestion apply to your own department/office?

Yes

If it applies to your work site only, list the site:

__________________________________________________________

If it is applicable also to other work departments/offices/work sites, please list them below:

______________________________________________________________________________________________

Will your suggestion result in dollar savings to the County? Yes

If yes, what is your estimate of net savings? $____________________

The savings should pertain to only the first year and deduct all start-up costs such as materials, new purchases

required, etc. You must also provide detailed documentation of how you arrived at your estimate.

Has your suggestion already been implemented? Yes

If yes, when? ___________________________

Give a brief, non-technical description of your suggestion:

__________________________________________________________________________________________________

Now, on separate sheets of paper, describe your suggestion in full. Clearly identify the problem prompting your

suggestion, and show in detail how your suggestion will solve the problem. Include sketches, samples, layouts or other

supporting information which will be helpful in understanding your suggestion.

Employee Suggestion Awards Program Suggestion Form