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
Please complete all blanks and boxes, front and back of form. Send form to Central Office ASAP following the injury/accident.
Human Resources Forms
Payroll/Leave Related Forms
Note - Time cards are due by noon on the 14th of every month.
Work Order/Facility Report Forms
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