Skip to main content
Full Menu Close Menu

Search

Forms and Documents

Quick links to key forms.

Bloodborne Pathogens Exposure Incident Package

Use the forms in this package to report occupational exposure incidents. Exposure incident means a specific eye, mouth, other mucous membrane, non-intact skin or parenteral contact with blood or other potentially infectious materials that results...

OP 160: Leave of Absence Without Pay

All pedagogical personnel may apply for a medical leave of absence without pay only when they have exhausted all of their Cumulative Absence Reserve (CAR) days. This application must be completed, signed and submitted to HR Connect for approval...

Educational Paraprofessional Leave Application

Educational paraprofessionals should use this form for initial requests for leaves of absence as well as requests for extensions. Requests for extensions must be submitted prior to the date of expiration of the current leave.

Accommodation Request for Individuals with Disabilities

If an accommodation request is denied or cannot be provided through informal means, the employee may apply for a formal accommodation by submitting the Accommodation Request Form on page 2. Medical documentation to support the request must be...

Application for Retirement Leave of Absence (Terminal Leave)

Pedagogues and paraprofessionals use this form to apply for a retirement leave of absence. For every two days in the employee’s sick bank, one day of terminal leave is granted. The form must be filed 30 days in advance of the leave. The leave can...

Record Keeping and Taxes: A Guidebook For Family and Group Family Child Care Providers

The information and forms in this booklet can help you keep track of your child care business income and expenses in a way that will make sense to you and your tax preparer when the time comes to file your tax returns. (English)

OP 198: Application for Excuse of Absence for Personal Illness (Sick Leave)

This form is used by all pedagogues to apply for medical certification for absence up to 20 consecutive school days, for requests to borrow sick days, for excuse of absence due to children’s diseases, and for injury in the line of duty claims. Rules...

Declination of Welfare Fund Benefits - For Eligible Dependents

Use this form to decline Welfare Fund benefits for your eligible dependents. You must sign this form and have it notarized.

How to Upload Documents to the Welfare Fund

View instructions for uploading documents online to complete Welfare Fund forms.

Declination of Welfare Fund Benefits - All Benefits

Use this form to decline all Welfare Fund benefits for yourself and eligible dependents. You must sign this form and have it notarized.

Declination of Welfare Fund Benefits - Dental and/or Vision

Use this form to decline Welfare Fund dental and/or vision benefits for yourself and eligible dependents. You must sign this form and have it notarized.

RFA-1W (Request for Assistance by Injured Workers) - Workers Compensation form

File this form and any attachments with the Workers' Compensation Board when you want the board to take a specific action in your claim, or if you need to alert the board to any problem or situation that is affecting your claim. Many of the most...

Chemical Inventory Form

Form and instructions from the DOE Science Safety Manual.

In Hospital Private Duty Nursing Care Claim Form - HIP Subscribers Only

For HIP subscribers only, use this In-Hospital Private Duty Nursing Claim Form for the UFT Welfare Fund to cover the costs, after a 72-hour deductible, of 80% of the usual and customary costs of in-hospital services provided by a registered nurse...

HIPAA: Personal Representative Form (PR Form)

You can choose a personal representative(s) to share your health information with by filling out this form.

Request for Payment of Overtime

This form is used by school nurses and occupational and physical therapists.

TRS BK58: EFT Authorization Form

Electronic Fund Transfer (EFT) is a payment system that allows TRS retirees and beneficiaries receiving lifetime benefits to have their monthly Qualified Pension Plan (QPP) and/or Tax-Deferred Annuity (TDA) Program payments electronically transferred...

DOE Withdrawal of resignation

Use this form to submit a withdrawl of your resignation to the DOE.

OP 44 - Termination pay

Upon resignation, retirement, or termination, all pedagogical employees are eligible to receive a final entitlement payment for one-half of their sick leave balance, up to 100 days.

OP 505G: Claim for Loss or Damage of Eyeglasses

Use this form to file a claim if your eyeglasses were damaged in an assault.

Medical arbitration application

DOE application for medical arbitration, including instructions.