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Employee Forms

District Forms

Some forms may require signing into your district Google account

Most commonly used forms

Complaints and Grievances

Discipline Report 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 - 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 Form - Staff 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.

Payroll/Leave Related Forms

Note - ​Time cards are due by noon on the 10th of every month.

​Transportation Forms

Work Order/Facility Report Forms

  • Copy Paper Request Form - complete this form if you need white copy paper.
  • Custodial Work Order – Please send an email to when you need to request something from the maintenance/custodial department.
  • Maintenance Incident Report Form – Please send an email to when you need to report a facility issue that is considered outside the realm of general maintenance, e.g., reporting vandalism.
  • Summer Maintenance Request Form - Submit your summer maintenance and technology projects for the summer
  • Technology Helpdesk supportPlease use this email link: - to send a technology ticket to the helpdesk.  This replaces the old google form. 
  • Request to Distribute Materials Form - this form is to be used when outside organizations/entities are requesting to distribute materials in school (BP KI Distributing Materials in Schools)

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 – To be completed by Central Office Staff

All Other Forms

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