Employee Forms

District Forms


Most commonly used forms


Some forms may require signing into your district Google account


Complaints and Grievances


Discipline Report Forms


End of Season, Field Trip Request, Fundraiser Forms


Health and Safety Reporting Forms

  • Employee Injury Report Form - 377 Staff injured on the job are required to complete an injury report form and file it with their immediate supervisor.

 

  • Student Injury Report Form - The following are student Injury/Accident Reporting Procedures  (to be used for athletics as well).  USD 377 school staff (i.e. teacher, office staff, or nurse) must complete a Student Accident / Injury Report Form on each injury that takes place while a student is under the jurisdiction of the school. This form is to be completed immediately following the occurrence of any athletic/student injury that is severe enough to (a) cause the loss of one-half day or more of school, or (b) warrant medical attention (i.e. M.D., E.R., etc.).


Please complete all blanks and boxes, front and back of form. Send form to Central Office ASAP following the injury/accident.


Human Resources Forms

  • Sick Leave Bank Request Form (Google) - This form is for those employees who participate in the Sick Leave Bank and need to request days from the Bank.
  • Background Screening Authorization and Disclosure (PDF) - All applicants for a classified position within the district must submit the Background Screening Authorization and Disclosure Form before being considered for employment.
  • Hepatitis B Consent/Declination Form (PDF) - statement of declaration for new employees.
  • Sick Leave Bank Participation FormStaff members may enroll in the sick leave bank at the beginning of each contract year but must submit the appropriate form by October 1. Any staff member on duty from the beginning of the contract year desiring to enroll after October 1 must wait until the following year. Staff members hired after the beginning of the contract year who desire to enroll must do so within thirty (30) calendar days after their first day at work or by October 1 of the current contract year, whichever is later - see Neg. Agreement or Personnel HB for more information.
  • Supplemental Application Form - for anyone wanting to be a coach or sponsor for the 2013-2014 school year.

Payroll/Leave Related Forms

Note - ​Time cards are due by noon on the 14th of every month.


​Transportation Forms


Work Order/Facility Report Forms


Workers Compensation

Employee and Supervisor Accident Reporting Procedures Sheet (PDF) - Guidelines and requirements for reporting on the job injuries.

Employee Injury Report Form! (PDF) - USD 377 employees injured on the job must complete an injury report form. Download the above PDF, fill out the form, and then give it to your principal or supervisor.

Supervisor Injury Report Form (PDF) - This form is to be completed by the supervisor/principal of any employee who is injured on the job. Upon completion, please submit to the Central Office.

Employee Injury Information Sheet (PDF) - District guidelines and instructions for on-the-job injuries and illnesses. Also provides information on how to file medical claims!

Employee Designated Health Care Provider (DHCP) Information Sheet (PDF) - Notice - USD 377 will only be responsible for $500 of unauthorized medical expenses if an employee seeks medical attention apart from DHCP’s.

Employee Workers Comp Compliance Signature Form (PDF) - Upon employment with USD 377, employees must have on file a signed Workers Comp Compliance Signature form.

Employee Injury Informational Sheet Provided by the Kansas Dept. of Labor (PDF) - This sheet provides information from the Department of Labor on what to do in the event of an on-the-job injury. It also provides information regarding the responsibilities of the employer and the company handling your claim.

Notice to Employees - K.S.A. 44-508 (f) precludes recovery of workers compensation benefits when the injury occurs while the employee is “engaged in recreational or social events under circumstances where the employee was under no duty to attend and where the injury did no result from the performance of tasks related to the employee’s normal job duties or as specifically instructed to be performed by the employer.”


CENTRAL OFFICE ONLY FORMS BELOW - TO BE COMPLETED BY CENTRAL OFFICE STAFF!


USD #377 An Equal Employment/Educational Opportunity Agency
The USD 377 Atchison County Community Schools does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities. The following person has been designated to handle inquiries regarding the non-discrimination policies:

Dr. Andrew K Gaddis
Superintendent of Schools
District Compliance Officer
306 Main Street
Effingham, KS 66023
(913) 833-5050


All Other Forms