Supervisory Referral Forms - University Of Rochester Medical Center (Page 3 of 3) in pdf

Supervisory Referral Forms - University Of Rochester Medical Center Page 3

Describe disciplinary action that has taken place regarding referral problem

(verbal/written warning, suspension, etc.) Please attach copies of documentation re:

disciplinary action taken.

Name the people involved in this disciplinary process:

Describe what is expected of the employee’s involvement with UR Medicine EAP:

Describe what will happen if the employee chooses not to meet with EAP, or declines to

follow through with UR Medicine EAP recommendations?

Document when, in what form and by whom the consequences for problem behaviors

and/or mandated referral follow through have been clearly explained to the employee:

Thank you for completing this documentation. It is essential in order for

the supervisory referral process to be clear for all involved and will aid

toward effective resolution. If there are any questions with this process,

you may contact UR Medicine EAP at 475-0432.

Supervisory Referral Forms - University Of Rochester Medical Center Page 3