HomeMy WebLinkAboutRes 2016-02-140 Personnel Policy AmendCITY OF ANNA, TEXAS
RESOLUTION NO. 2016-1-140
A RESOLUTION APPROVING AMENDMENTS TO THE CITY OF ANNA
PERSONNEL POLICY MANUAL
WHEREAS, on March 11, 2014, the City Council of the City of Anna, Texas ("City
Council") approved a Personnel Policy Manual that includes personnel guidelines for
use in certain operations of the City's departments/personnel and. in matters related to
human resources; and,
WHEREAS, said Personnel Policy Manual was amended on September 22, 2015; and,
WHEREAS, the City Manager has recommended approval. of certain amendments to
the Personnel Policy Manual, attached hereto as Exhibit 1; and,
WHEREAS, the City Council finds that its approval of the amendments to the Personnel
Policy Manual is not intended to and does not: (1) create any type of contract of
employment between the City and any employee; or (2) have the force or effect of law
or ordinance;
NOW THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
ANNA, TEXAS THAT:
Section 1. Recitals Incorporated
The recitals set forth above are incorporated herein for all purposes as if set forth in full.
Section 2. Personnel Policy Manual Amendments Approved
The City Council of the City of Anna, Texas hereby approves the amendments to the
City of Anna Personnel Policy Manual, attached hereto as Exhibit 1, for use by the City
Manager and City departments in relation to certain organizational operations and
matters related to personnel and human resources.
PASSED by the City Council of the City of Anna, Texas, on this 26t" day of January,
2016.
OF
ATTEST:°'•• �� APPRO D
• Y
Carrie L. Smith City Secretary `'�.,•rX f�*5��`,��'\`\ Mike Crist Mayor
Z
/4/1/11111111111 00
10
Exhibit 1
107.05 Medical Certification
(a) Any employee requesting family medical leave for a serious health condition of the
employee or of an eligible family member shallGGITIp:ete provide a completed
Certification of Health Care Provider for Employee's Serious Health Condition or a
completed Certification of Health Care Provider for Family Member's Serious
Health Condition fem4(refer to Appendix A-7 or Appendix A-7.1, as applicable).
Employees have at least 15 calendar days of the request for FMLA leave, but not
more than 20 calendar days to obtain and submit to the Human Resource
Administrator the required medical certification. The certification form must be
completed by the patient's health care provider(s) and must contain at least the
following:
(1) Date condition began;
(2) Probably duration of condition;
(3) Appropriate medical facts about the condition; and
(4) Statement that the employee is needed to care for the ill family member or,
in the case of their own illness, is unable to perform their job.
107.07 Use of Paid Leave
(b) Accrued sick: leave, and vacation leave, or other accrued paid leave must be used
concurrently with unpaid leave under the FMLA (administrative leave without pay)-
provided, however, that sick leave shall not be used concurrently with unpaid leave
under FMLA in any situation where sick leave is not authorized by the City's
personnel policies including without limitation Section 106.03(b) or when an
employee fails to provide the proof and/or certificate that may be required under
Section 106.03(i). If the City substitutes paid leave for unpaid FMLA leave, it may
be counted against the 12-week FMLA entitlement if the employee is notified of the
designation when the leaves substitution begins.
(c) In the case of family and medical leave, the Department Head shall send
notification to the employee, with a copy to the Human Resources Administrator
designating the time off as leave under the FMLA.
CITY OF ANNA, TEXAS RESOLUTION 2016-01-140 PAGE 2 OF 2
Exhibit 1
107.05 Medical Certification
(a) Any employee requesting family medical leave for a serious health conon of the
employee or of an eligible family member shall provide a completed Certification of Health
Care Provider for Employee's Serious Health Condition or a completed Certification of
Health Care Provider for Family Member's Serious Health Condition (refer to Appendix X7
or Appendix A-7.1, as applicable). Employees have at least 15 calendar days of the
request for FMLA leave, but not more than 20 calendar days to obtain and submit to the
Human Resource Administrator the required medical certification. The certification form
must be completed by the patient's healthcare provider(s) and must contain at least the
following:
(1) Date condition began;
(2) Probably duration of condition;
(3) Appropriate medical facts about the condition; and
(4) Statement that the employee is needed to care for the ill family member or, in the
case of their own illness, is unable to perform their job.
107.07 Use of Paid Leave
(b) Accrued sick leave, vacation leave, or other accrued paid leave must be used concurrently
with unpaid leave under the FMLA (administrative leave without pay); provided, however,
that sick leave shall not be used concurrently with unpaid leave under FMLA in any
situation where sick leave is not authorized by the City's personnel policies including
without limitation Section 106.03(b) or when an employee fails to provide the proof and/or
certificate that may be required under Section 106.03(i). If the City substitutes paid leave
for unpaid FMLA leave, it may be counted against the 12-week FMLA entitlement if the
employee is notified of the designation when the substitution begins.
(c) In the case of family and medical leave, the Department Head shall send notification to the
employee, with a copy to the Human Resources Administrator designating the time off as
leave under the FMLA.
Certification of Health Care Provider for
Employee's Serious Health Condition
(Family and Medical Leave Act)
U.S. Department of Labor
Wage and Hour Division
DO NOT SEND COMPLETED FORM TO THE DEPARTMENT OF LABOR; RETURN TO THE PATIENT
Nn
OMB Conh'ol Number: 1235-0003
Expires: 5/31/2018
SECTION L• For Completion by the EMPLOYER
INSTRUCTIONS to the EMPLOYER: The Family and Medical Leave Act (FMLA) provides that an employer may
require an employee seeking FMLA protections because of a need for leave due to a serious health condition to submit a
medical certification issued by the employee's health care provider. Please complete Section I before giving this form to
your employee. Your response is voluntary. While you are not required to use this form, you may not ask the employee to
provide more information than allowed under the FMLA regulations, 29 C.F.R. §§ 825.306425.308. Employers must
generally maintain records and documents relating to medical certifications, recertifications, or medical histories of
employees created for FMLA purposes as confidential medical records in separate files/records from the usual personnel
files and in accordance with 29 C.F.R. § 1630.14(c)(1), if the Americans with Disabilities Act applies, and in accordance
with 29 C.F.R. § 1635.9, if the Genetic Information Nondiscrimination Act applies.
Employer name and contact:
Employee's job title:
Employee's essential job functions:
Check if job description is attached:
Regular work schedule:
SECTION II: For Completion by the. EMPLOYEE
INSTRUCTIONS to the EMPLOYEE: Please complete Section II before giving this form to your medical provider.
The FMLA permits an employer to require that you submit a timely, complete, and sufficient medical certification to
support a request for FMLA leave due to your own serious health condition. If requested by your employer, your response
is required to obtain or retain the benefit of FMLA protections. 29 U.S.C. §§ 2613, 2614(c)(3). Failure to provide a
complete and sufficient medical certification may result in a denial of your FMLA request. 20 C.F.R. § 825313. Your
employer must give you at least 15 calendar days to return this form. 29 C.F.R. § 825.305(b).
Your name:
First
Middle
Last
SECTION III: For Completion by the HEALTH CARE PROVIDER
INSTRUCTIONS to the HEALTH CARE PROVIDER: Your patient has requested leave under the FMLA. Answer,
fully and completely, all applicable parts. Several questions seek a response as to the frequency or duration of a
condition, treatment, etc. Your answer should be your best estimate based upon your medical knowledge, experience, and
examination of the patient. Be as specific as you can; terms such as "lifetime," "unknown," or "indeterminate" may not
be sufficient to determine FMLA coverage. Limit your responses to the condition for which the employee is seeking
leave. Do not provide information about genetic tests, as defined in 29 C.F.R. § 1635.3(0, genetic services, as defined in
29 C.F.R. § 16353(e), or the manifestation of disease or disorder in the employee's family members, 29 C.F.R. §
1635.3(b). Please be sure to sign the form on the last page.
Provider's
name and business address:
Type of practice /Medical specialty:
Telephone:
Page 1 Form WH-380-E Revised May 2015
PART A: MEDICAL FACTS
1. Approximate date condition commenced:
Ptobable duration of condition:
Mark below as applicable:
Was the patient admitted for an overnight stay in a hospital, hospice, or residential medical care facility?
No _Yes. If so, dates of admission:
Dates) you treated the patient for condition:
Will the patient need to have treatment visits at least twice per year due to the condition? No _Yes.
Was medication, other than over-the-counter medication, prescribed? �I�lo Yes.
Was the patient referred to other health care providers) for evaluation ot• treatment (e.a., physical therapist)?
No Yes. If so, state the nature of such treatments and expected duration of treatment:
2. Is the medical condition pregnancy? No _Yes. If so, expected delivery date:
3. Use the information provided by the employer in Section I to answer° this question. If the employer fails to
provide a list of the employee's essential functions or a job description, answer these questions based upon
the employee's own description of his/her job functions.
Is the employee unable to perform any of his/her job functions due to the condition: No Yes.
If so, identify the job functions the employee is unable to perform:
4. Describe other relevant medical facts, if any, related to the condition for° which the employee seeks leave
(such medical facts may include symptoms, diagnosis, or any regimen of continuing treatment such as the use
of specialized equipment):
Page 2 CONTINUED ON NEXT PAGE Fonn WH-330-E Revised May 2015
PART B: AMOUNT OF LEAVE NEEDED
5. Will the employee be incapacitated for a single continuous period of time due to his/her medical condition,
including any time for treatment and recovery? No _Yes.
If so, estimate the beginning and ending dates for the period of incapacity:
6. Will the employee need to attend follow-up treatment appointments or work part-time or on a reduced
schedule because of the employee's medical condition? No _Yes.
If so, are the treatments or° the reduced number of hours of work medically necessary?
No _Yes.
Estimate treatment schedule, if any, including the dates of any scheduled appointments and the time
required for each appointment, including any recovery period:
Estimate the part-time or reduced work schedule the employee needs, if any:
hours) per day;
days per week from
through
7. Will the condition cause episodic flare-ups periodically preventing the employee from pet°forming his/her job
functions? No Yes.
Is it medically necessary for the employee to be absent from work during the flare-ups?
No Yes. If so, explain:
Based upon the patient's medical history and your knowledge of the medical condition, estimate the
frequency of flare-ups and the duration of related incapacity that the patient may have over the next 6
months (e g, 1 episode every 3 months lasting 1-2 days):
Frequency times per° week(s) month(s)
Duration: hours or _ day(s) per episode
Page 3 CONTINUED ON NExT PAGE Form WH-380-E Revised May 2015
Signature of Health Care Provider Date
PAPER`VORK REDUCTION ACT NOTICE AND PUBLIC BURDEN STATEMENT
If submitted, it is mandatory for employees to retain a copy of this disclosure in their records for three years. 29 U.S.C. § 2616; 29
C.F.R. § 825.500. Persons are not required to respond to this collection of information unless it displays a currently valid OMB
control number. The Department of Labor estimates that it will take an average of 20 minutes for respondents to complete this
collection of information, including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information. If you have any comments regarding this burden
estimate or any other aspect of this collection information, including suggestions for reducing this burden, send them to the
Administrator, Wage and Hour Division, U.S. Department of Labor, Room S-3502, 200 Constitution Ave., NW, Washington, DC
20210. DO NOT SEND COMPLETED FORM TO THE DEPARTMENT OF LABOR; RETURN TO THE PATIENT.
Page 4 Form W11-380-E Revised May 2015
Certification of Health Care Provider for U.S. Department of Labor
Family Member's Serious Health Condition Wage and Hour Division
(Family and Medical Leave Act) L; . WH
�_,i4,z.
DO NOT SEND COMPLETED FORM TO THE DEPARTMENT OF LABOR; RETURN TO THE PATIENT. OMB Control Number: 1235-0003
INSTRUCTIONS to the EMPLOYER: The Family and Medical Leave Act (FMLA) provides that an employer
may require an employee seeking FMLA protections because of a need for leave to care for a covered family
member with a serious health condition to submit a medical certification issued by the health care provider of the
covered family member. Please complete Section I before giving this form to your employee. Your response is
voluntary. While you are not required to use this form, you may not ask the employee to provide more information
than allowed under the FMLA regulations, 29 C.F.R. §§ 825.306425.308. Employers must generally maintain
records and documents relating to medical certifications, recertifications, or medical histories of employees' family
members, created for FMLA purposes as confidential medical records in separate files/records from the usual
personnel files and in accordance with 29 C.F.R. § 1630.14(c)(1), if the Americans with Disabilities Act applies,
and in accordance with 29 C.F.R. § 1635.9, if the Genetic Information Nondiscrimination Act applies.
Employer name and contact:
SECTION II: For Completion by the EMPLOYEE
INSTRUCTIONS to the EMPLOYEE: Please complete Section II before giving this form to your family
member or his/her medical provider. The FMLA permits an employer to require that you submit a timely,
complete, and sufficient medical certification to support a request for FMLA leave to care for a covered family
member with a serious health condition. If requested by your employer, your response is required to obtain or
retain the benefit of FMLA protections. 29 U.S.C. §§ 2613, 2614(c)(3). Failure to provide a complete and
sufficient medical certification may result in a denial of your FMLA request. 29 C.F.R. § 825.313. Your employer
must give you at least 15 calendar days to return this form to your employer. 29 C.F.R. § 825.305.
Your name:
First
Middle
Name of family member for whom you will provide care:
First
Relationship of family member• to you:
If family member is your son or daughter, date of birth:
Last
Middle
Describe care you will provide to your family member° and estimate leave needed to provide care:
Employee Signature
Page 1
Date
CONTINUED ON NEXT PAGE
Last
Form WH-380-F Revised May 2015
SECTION III: For Completion by the HEALTH CARE PROVIDER
INSTRUCTIONS to the HEALTH CARE PROVIDER: The employee listed above has requested leave under
the FMLA to care for your patient. Answer, fully and completely, all applicable parts below. Several questions
seek a response as to the frequency or duration of a condition, treatment, etc. Your answer should be your best
estimate based upon your medical knowledge, experience, and examination of the patient. Be as specific as you
can; terms such as "lifetime," "unknown," or "indeterminate" may not be sufficient to determine FMLA
coverage. Limit your responses to the condition for which the patient needs leave. Do not provide information
about genetic tests, as defined in 29 C.F.R. § 1635.3(f), or genetic services, as defined in 29 C.F.R. § 1635.3(e).
Page 3 provides space for additional information, should you need it. Please be sure to sign the form on the last
page.
Provider's name and business address:
Type of practice /Medical specialty:
Telephone: �)
PART A: MEDICAL FACTS
1. Approximate date condition commenced:
Probable duration of condition:
Was the patient admitted for an overnight stay in a hospital, hospice, or residential medical care facility?
No _Yes. If so, dates of admission:
Dates) you treated the patient for condition:
Was medication, other than over-the-counter medication, prescribed? No _Yes.
Will the patient need to have treatment visits at least twice per year due to the condition? No Yes
Was the patient referred to other health care provider(s) for evaluation or treatment (e.g„ physical therapist)?
No Yes. If so, state the nature of such treatments and expected duration of treatment:
2. Is the medical condition pregnancy? �No _Yes. If so, expected delivery date:
3. Describe other relevant medical facts, if any, related to the condition for which the patient needs care (such
medical facts may include symptoms, diagnosis, or any regimen of continuing treatment such as the use of
specialized equipment):
Page 2 CONTINUED ON NE�CT PAGE Form WH-330-F Revised May 2015
4. Will the patient be incapacitated for a single continuous pet°iod of time, including any time for treatment and
recovery? No Yes.
Estimate the beginning and ending dates for the period of incapacity:
During this time, will the patient need care? No . Yes.
Explain the care needed by the patient and why such care is medically necessary:
5. Will the patient require follow-up treatments, including any time for recovery? No _Yes.
Estimate treatment schedule, if any, including the dates of any scheduled appointments and the time required for
each appointment, including any recovery period:
Explain the care needed by the patient, and why such care is medically necessary:
6. Will the patient require care on an intermittent or reduced schedule basis, including any time for recovery? _
No Yes.
Estimate the hours the patient needs care on an intermittent basis, if any:
hour(s)
per day;
days pet• week from
Explain the care needed by the patient, and why such care is medically necessary:
through
Page 3 CONTINUED ON NEXT PAGE Form WH-380-F Revised May 2015
7, Will the condition cause episodic flare-ups periodically preventing the patient from participating in normal daily
activities? No Yes,
Based upon the patient's medical history and your knowledge of the medical condition, estimate the 1-1•equency of
flare-ups and the duration of related incapacity that the patient may have over the next 6 months (e.g_, 1 episode
every 3 months lasting 1-2 days):
Frequency: times per week(s) month(s)
Duration: hours or . day(s) per episode
Does the patient need care during these flare-ups? . No Yes.
Explain the care needed by the patient, and why such care is medically necessary:
ADDITIONA. INFORMATION: IDENTIFY QUESTIONI�1[JMBER WITH YOUR ADDITIONAL ANSWER<
Signature of Health Care Provider
Date
PAPERWORK REDUCTION ACT NOTICE AND PUBLIC BURDEN STATEMENT
If submitted, it is mandatory for employers to retain a copy of this disclosure in their records for three years. 29 U.S.C. § 2616;
29 C.F.R. § 825.500. Persons are not required to respond to this collection of information unless it displays a currently valid OMB
control number. The Department of Labor estimates that it will take an average of 20 minutes for respondents to complete this
collection of information, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information. If you have any comments regarding this burden estimate
or any other aspect of this collection information, including suggestions for reducing this burden, send them to the Administrator,
Wage and Hour Division, U.S. Department of Labor, Room S-3502, 200 Constitution Ave., NW, Washington, DC 20210.
DO NOT SEND COMPLETED FORM TO THE DEPARTMENT OF LABOR; RETURN TO THE PATIENT.
Page 4 Form w11-330-F Revised May 2015