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Employee assistance program supervisor referral form - douglascounty-ne

Employee assistance program supervisor referral form - douglascounty-ne 2026

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The document is an Employee Assistance Program Supervisor Referral Form designed for supervisors to evaluate and report on an employee's job performance, behavior, and attendance issues. It includes criteria for assessing deteriorating job performance, employee behavior, and attendance problems, with options for rating the severity of each issue. Supervisors are encouraged to provide comments and documentation to support their referral. The form can be submitted via email, fax, or mail.

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Click ‘Get Form’ to open the Employee Assistance Program Supervisor Referral Form in the editor.
Begin by entering the date, your name as the supervisor, and your phone number at the top of the form.
Next, input the employee's name in the designated field. This identifies who you are referring for assistance.
Evaluate each criterion listed below. For job performance, check 'NA' if not applicable or select a rating from 1 (Not a Problem) to 7 (Very Serious Problem) for each sub-section.
Provide specific comments or attach documentation where necessary to clarify your evaluation.
Repeat this process for employee behavior and attendance sections, ensuring all relevant fields are completed accurately.
Once finished, review your entries for accuracy before submitting. You can save and share this form directly through our platform.

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What is a mandatory EAP referral?

There is NO such thing as mandatory referral. Supervisors should allow members to be attracted to the EAP by themselves or through external factors that provide a sense of urgency. Members who are pressed to visit the EAP attend with little intent to discuss their problems. Supervisors should not use this approach.

How do I offer an employee assistance program?

How to start set up an Employee Assistance Program (EAP) Organize a committee. Discuss and outline your goals for the EAP. Explore different types of EAPs. Develop an EAP policy. Select an EAP provider. Train your leadership team. Prepare resources and support. Launch and promote your EAP to employees.

What is EAP assessment referral?

An Employee Assistance Program (EAP) is a voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work-related problems.

What is a supervisory referral?

The formal supervisor referral is a management tool used to improve work performance and resolve work-related problems. It is not intended as a disciplinary measure, nor does it replace the State of Californias policies and procedures for dealing with poor performance or conduct.

What is an EAP assessment?

EAP mental health professionals may need to refer clients to external resources (such as therapists, support groups for substance abuse, etc) for support. On the other hand, general counsellors and therapists typically address a broader range of mental health issues and work with clients on a more long-term basis.

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