HEALTH ASSESSMENT PREVENTATIVE SERVICES FORMS

Employees enrolled in the health plan are eligible to receive additional dollars in their Health Reimbursement Account (HRA) on an annual basis with completion of the Health Assessment (HA) and preventive exams. Health Assessments (HA’s) and preventative exams are not required for members to be eligible for the health plan, but are encouraged as the funding of the HRA will be affected by the participation in the Health Assessment and preventative exams. Below are the forms to be completed for the preventative exams.  All forms will now be accepted by the City’s Onsite Nurse Coach, Nurse Sabrina with Bellin Health. Forms will be accepted beginning October 1st in-person, interoffice, or emailed to nurse@mail.de-pere.org.  Forms must be received by Nurse Sabrina by December 31st.

  

Physical Preventative Services Form

Dental Preventative Services Form

 

WELLNESS NURSE 

City of De Pere benefit eligible employees and spouses have access to an on-site wellness nurse and nursing services, provided by Bellin.  The wellness nurse is available to help you improve your health and well-being.  The wellness nurse can treat and prevent injuries and diagnose and treat medical issues such as strep throat, head lice cold sores, pink eye and swimmers ear.

  

This benefit is voluntary, confidential, and completely free for benefit eligible employees. 

Onsite Nurse Coach Services Flyer

 

The Onsite Nurse Coach is available on the 1st and 3rd Tuesday of the month.  The Onsite Nurse Coach will be available during the following times:

12:00 - 1:30pm at City Hall
2:00-3:00pm at the Municipal Service Center

 

Use the link or phone number below to schedule your appointment.

800-528-7883
bellin.org/cityofdepere 

 

HALOGEN - ONLINE PERFORMANCE MANAGEMENT SYSTEM

Halogen - Online Performance Management System

 

RETIREE HANDBOOK

The Retiree Handbook has been developed to assist employees plan their retirement. The handbook outlines procedures, timelines, and resources to assist in making retirement as efficient and enjoyable as possible.

  

Retiree Handbook

 

WORKERS' COMPENSATION

The fillable form functionality for the Employee Injury, Exposure, Illness Packet and Supervisor form and instructions requires the use of Adobe Reader or similar dedicated PDF viewer/editor. If your work PC does not have Adobe Reader please contact IT. For your personal computer the free Adobe Reader download is available at https://get.adobe.com/reader/.

You will need to save the form prior to completing it. Please read instructions on how to save and email the forms. Fillable PDF Instructions

Employee Injury, Exposure, Illness Packet

Supervisor Injury, Exposure, Illness Investigation Form and Instructions 

 

Workers’ Compensation Frequently Asked Questions for Employees

Workers’ Compensation Return to Work/Restrictions Form

 

EMPLOYEE FORMS

Request To Carry-Over Earned Vacation

Voluntary Unpaid Time Off Request Form

Outside Employment Waiver Form

Grievance Policy and Procedure and Employee Grievance Form

Employee Data Sheet

Federal W4

WI Tax Withholding Form

Direct Deposit Form - Regular Employees (Please return amended direct deposit forms to the Payroll Department.)

Direct Deposit Form - Seasonal/Temporary Employees (Please return amended direct deposit forms to the Payroll Department.)

2020 Payroll Dates

FICA Alternative Information Sheet