Usui Manager Toolbox

Stationary
Letterhead – MIO
Letterhead – SVP
Letterhead – WCP
Letterhead – VAP
Letterhead – SVP HR

Presentation
Presentation Template

Forms
Meeting Sign-in Sheet
Business Card Order Form
Poster Letter Size

Policy
UIC Staffing and Compensation Approval Policy and Procedure
OH Overtime Authorization Form

Forms
Payroll Status Change Notice
Position Requisition Form

Coaching

Forms/Resources:
Employee Coaching Form

Process:

• Consult with Human Resources
• Complete coaching form
• Perform coaching meeting
  • Signatures
    • Manager/Supervisor/GL/PC
    • Employee
    • Witness (if present)
• Submit completed Coaching Form, Improvement Plan/Action and/or Documentation to Human Resources

Performance Improvement

Forms/Resources:
Performance Improvement Plan
PIP Response Only Form

Process:

• Consult with Human Resources
• Complete Employee Performance Improvement Plan Program Form
• Review PIP and Documentation with Human Resources
• Perform Employee PIP Meeting
  • Signatures
    • Manager/Supervisor/GL/PC
    • Employee
    • Witness (if present)
• Submit completed PIP and Documentation to Human Resources

Counseling

Forms/Resources:
Employee Warning Notice
Employee Warning Notice – Attendance

Process:

• Consult with Human Resources
• Complete Employee Warning Notice Form
• Review Warning, Documentation and Action with Human Resources
• Perform Employee Warning Meeting/Action
  • Signatures
    • Manager/Supervisor/GL/PC
    • Employee
    • Witness (if present)
  • If Termination:
    • Escort Employee at all times until they have left UIC property.
• Submit completed Employee Warning Notice, Documentation and/or Corrective Action Plan to Human Resources

File a Report Link:
File A Report Now
Forms/Resources:
Accident Investigation Report Form
Employee Injury Report Form
Incident Reporting Form – OSHA Form 301
Injury Body Map Form
Employee Statement Form
General Incident Witness Statement Form
Injury Incident Witness Account of Incident Form
Near Miss Report Form

Local Emergency Numbers:
Medical Emergency or Other Immediate Threat: 911
Non-Emergency Phone Numbers:
Sharonville Police: (513) 563-1147
Sharonville Fire & EMS: (513) 563-0252
West Chester Police: (513) 777-2231
West Chester Fire & EMS: (513) 860-5544

Medical/First Aid and Reporting

• Provide immediate injury or illness support to employee.
  • If Medical Emergency:
    • Contact 911 Immediately
    • As Soon As Possible contact EHS Specialist
  • If First Aid Only
    • Provide any first aid supplies or first aid needed AND agreed to by the employee to care for the employee’s injury or illness.
  • If No First Aid or Other Assistance Required or First Aid is Declined by the Employee.
    • Offer/perform any assistance agreed to by employee
    • Offer to contact family or friend if employee cannot work or requests to leave work.
      • If employee refuses and there is any concern that the employee may be impaired or physically unable to operate a motor vehicle. If may be necessary to contact police or other authorities to intervene to mitigate risk of accident due to any impairment or physical incapacity.
• Complete Incident Reporting Form, Body Map and collect any supporting documents (witness statements, images, video, etc.).
• Report Accident to Safety/HR and submit completed forms and any supporting documents.
  • Post-Accident Form Kits are located in the Main Office printer rooms including all documents required to request and complete Post-Accident drug testing during and after business hours.

Near Miss Reporting

• Complete Near Miss Reporting Form and collect any supporting documents (witness statements, images, video, etc.).
• Report Incident to Safety/HR and submit completed forms and any supporting documents.

Drug Free Workplace Policy

Post-Accident Testing
Post-accident testing will be conducted whenever an accident occurs as defined below. For the purposes of this policy, an accident is considered an unplanned, unexpected or unintended event that occurs on Company property, during the conduct of the Company’s business, during working hours, or which involves Company-supplied equipment, motor vehicles or motor vehicles that are used in conducting Company business, or is within the scope of employment, and which results in any of the following:
1. A fatality of anyone involved in the accident;
2. An accident that causes a bodily injury to the employee and/or another person that requires off-site medical attention away from the Company’s place of employment and would include the injured worker and anyone contributing to the injury;
3. Vehicular/equipment damage in apparent excess of $750; or
4. Non-vehicular/equipment damage in apparent excess of $500.
When such an accident results in one of the situations above, any employee who may have contributed to the accident will be tested for drug and/or alcohol use, provided the Company has reasonable cause to believe that the employees involved may have violated this policy by using a prohibited substance. “Reasonable cause” includes a pattern of behavior or circumstances that involves an accident which includes an error in reason, timing or judgment.
For those employers wishing to take advantage of the presumptive denial of workers’ compensation benefits (section 4123.54 B), documentation of any evidence of reasonable cause to believe there may have been drug/alcohol use at the time of the accident/injury should be made.

Timing: Drug and/or alcohol testing after an accident
Urine specimen collection (for a drug test) and/or breath/saliva (for an alcohol test) is to occur immediately after a need has been determined. The Company will consider any employee who seeks to delay providing a specimen as refusing to be tested. If the employee responsible for an employment-related accident is injured, it is a condition of employment that the employee herein expressly grants to the Company, its officers and management, the right to request that attending medical personnel obtain appropriate specimens (breath and/or urine) for the purpose of conducting alcohol and/or drug testing. Furthermore, all employees herein expressly grant to the Company, its officers and management, access to any and all other medical information that may be relevant in conducting a complete and thorough investigation of the employment-related accident, to include, but not be limited to, a full medical report from the examining physician(s) or other health care providers.