RESOURCE GUIDE

RESOURCE GUIDE

UPDATED: JULY 2017 1|Page

Contents

ADMINISTRATIVE SERVICES ......................................................................................................................................................... 5 Associated Student Body (ASB) ............................................................................................................................................... 5 Fundraising Event ................................................................................................................................................................ 5 Requesting Checks .............................................................................................................................................................. 5 Carryover Funds .................................................................................................................................................................. 5 Tips for Avoiding Audit Findings.......................................................................................................................................... 6 ASB Accounting – Quicken .................................................................................................................................................. 6 Reminders ........................................................................................................................................................................... 6 ASB Process Flow Chart ....................................................................................................................................................... 7 Attendance Deadlines ............................................................................................................................................................. 7 Attendance Reporting Process ................................................................................................................................................ 8 Accounts Payable .................................................................................................................................................................... 9 Invoice Only (No Purchase Orders Needed) ....................................................................................................................... 9 Confirming Purchase Orders (ICSIS Requisition Forms) ...................................................................................................... 9 Purchasing Cards ................................................................................................................................................................. 9 Food Purchases for Meetings.............................................................................................................................................. 9 Food Purchases for Staff Appreciation.............................................................................................................................. 10 Food Purchases for Students ............................................................................................................................................ 10 T-Shirt Purchases with School Logos for Students ............................................................................................................ 10 T-Shirt Purchases with School Logos for Adults/Staff ....................................................................................................... 10 Travel Expenses ................................................................................................................................................................. 10 Employees Traveling Out-of-County Vehicle Usage .......................................................................................................... 11 Meals for Same Day Travel (Effective January 1, 2016) .................................................................................................... 12 Purchase Order Process Flow Chart .................................................................................................................................. 13 Budget – School Site Allocations ........................................................................................................................................... 14 Budget- Running Reports in ICSIS .......................................................................................................................................... 15 Payroll .................................................................................................................................................................................... 19 Classified (blue) Timecards ............................................................................................................................................... 19 Certificated (pink) Timecards ............................................................................................................................................ 19 Classified & Management Absence (green) Form............................................................................................................. 19 Certificated Employees Absence (white) Form ................................................................................................................. 19 Hourly Absence Form (Effective July 1, 2015) ................................................................................................................... 19 Payroll Deadlines ............................................................................................................................................................... 20 Public / Student Records Requests........................................................................................................................................ 20 Guidelines for Student Records ........................................................................................................................................ 20 Guidelines for Student Records from Public Agencies ...................................................................................................... 21

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Guidelines for Public Records ........................................................................................................................................... 21 Records Retention (School Site) ............................................................................................................................................ 21 Student Accident Reporting .................................................................................................................................................. 22 Student Extra-Curricular Participation .................................................................................................................................. 22 Student Field Trips ................................................................................................................................................................. 22 1st.

Field Trip – Permission/Authorization ................................................................................................................. 22

2nd.

Field Trip – Transportation................................................................................................................................... 22

3rd.

Field Trip – Food Services..................................................................................................................................... 24

4th.

Field Trip – Parent Notification ............................................................................................................................ 24

5th.

Field Trip – Day of Checklist ................................................................................................................................. 24

CHILD NUTRITION SERVICES ...................................................................................................................................................... 25 Breakfast in the Classroom .................................................................................................................................................... 25 Lunch ..................................................................................................................................................................................... 26 Special Events During Breakfast/Lunch ................................................................................................................................. 27 After School Snack ................................................................................................................................................................. 27 Classroom Parties .................................................................................................................................................................. 27 Rewards/Incentives/Additional Snacks (Food) ...................................................................................................................... 27 Meal Application Distribution and Processing Procedures ................................................................................................... 27 Food & Beverages Sold on Campus -Adults .......................................................................................................................... 28 Food & Beverages Sold on Campus -Students ...................................................................................................................... 28 Rules for Food Sales on Elementary Campuses: ...................................................................................................... 28 Rules for Beverage Sales on Junior High and Middle School Campuses: ................................................................. 29 Rules for Beverage Sales on Elementary Campuses:................................................................................................ 29 Conditions of Sales ................................................................................................................................................... 30 Is Your Snack a Smart Snack? ................................................................................................................................... 30 Use of Kitchen Equipment and Storage Areas....................................................................................................................... 30 ASSOCIATE SUPERINTENDENT’S OFFICE .................................................................................................................................... 31 Cumulative Student Files ....................................................................................................................................................... 31 Cumulative File Order: ...................................................................................................................................................... 31 Cumulative Folder Request/Retention Procedures: ......................................................................................................... 32 Worker’s Compensation – Employee Injury Reporting ......................................................................................................... 32 Worker’s Compensation – Flow Chart................................................................................................................................... 33 HUMAN RESOURCES .................................................................................................................................................................. 34 Enrollment ............................................................................................................................................................................. 34 Administrative Transfers ................................................................................................................................................... 34 Enrollment Reports ........................................................................................................................................................... 34 First Day of School............................................................................................................................................................. 34

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Interdistrict and Intradistrict – Reminder ......................................................................................................................... 34 Mid-year Transitional Kindergarten and Kindergarten Enrollment .................................................................................. 35 Proof of Residency ............................................................................................................................................................ 35 Insurance ............................................................................................................................................................................... 35 Dependent Enrollment for Insurance Purposes ................................................................................................................ 35 Health and Welfare Insurance Presentations........................................................................................................................ 35 Certificated:....................................................................................................................................................................... 35 Classified/Certificated Management: ............................................................................................................................... 35 Child Welfare Issues .............................................................................................................................................................. 36 Removal of Child from the School..................................................................................................................................... 36 Interviewing Suspected Child Abuse Victims in School ..................................................................................................... 36 Photographs of Students Suspected of Being Abused ...................................................................................................... 36 Student Searches by Staff ................................................................................................................................................. 36 Employment .......................................................................................................................................................................... 37 Inquiries Regarding Employees (Former and Current)...................................................................................................... 37 Letters of Recommendation ............................................................................................................................................. 37 Work Study/SER/ICOE/CalWORKs..................................................................................................................................... 37 Certificated Employees.......................................................................................................................................................... 37 Absence Forms .................................................................................................................................................................. 37 Assignments ...................................................................................................................................................................... 37 BTSA Support Providers .................................................................................................................................................... 38 Evaluation List ................................................................................................................................................................... 38 All Day Kindergarten (ADK) Support ................................................................................................................................. 38 NCLB Letters to Parents .................................................................................................................................................... 38 Off-site Staff Meetings ...................................................................................................................................................... 38 Reassignments .................................................................................................................................................................. 38 Teacher/ Staff Meeting ..................................................................................................................................................... 38 Substitute Teachers ............................................................................................................................................................... 39 Automated Educational Substitute Operator (AESOP) ..................................................................................................... 39 Performance ..................................................................................................................................................................... 39 Classified Employees ............................................................................................................................................................. 39 ASES Employees/Other Program Tutors (Maximum of 3.75 Hour Work Limitation)........................................................ 39 Substitute Instructional Assistants .................................................................................................................................... 39 Hourly Employees.................................................................................................................................................................. 39 Hourly Employees ............................................................................................................................................................. 39 Pupil Supervisors ............................................................................................................................................................... 39 Release of Hourly Employees ............................................................................................................................................ 40

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All Employees ........................................................................................................................................................................ 40 AB 1825/2053 Sexual Harassment/Discrimination Training & Prevention of Abusive Conduct – Supervisors ................ 40 Absences – Management .................................................................................................................................................. 40 Child Abuse Mandated Reporter Training ........................................................................................................................ 40 Early Release of Employees............................................................................................................................................... 40 Leaves: Medical, Maternity or Other ............................................................................................................................... 40 Notice of Change of Address/Information ........................................................................................................................ 40 Personal Business v. Personal Necessity ........................................................................................................................... 40 Personnel File Language.................................................................................................................................................... 41 Prohibition of Sexual Harassment/Discrimination ............................................................................................................ 41 Use of Legal Names ........................................................................................................................................................... 41 Miscellaneous ........................................................................................................................................................................ 41 Calendars .......................................................................................................................................................................... 41 Incidents ............................................................................................................................................................................ 41 Individuals Requesting Information Regarding District Employees .................................................................................. 41 Tape Recording ................................................................................................................................................................. 41 MAINTENTANCE, OPERATIONS AND TRANSPORTATION........................................................................................................... 42 After School Event Air Conditioner Scheduling ..................................................................................................................... 42 Alarm Services – How to Report a False Alarm (Alarm set off by accident) .......................................................................... 42 Appliances, Candles and Air Fresheners in Classrooms ........................................................................................................ 43 District Radios........................................................................................................................................................................ 43 Storage Spaces (Gas Blowers/Electrical Rooms) ................................................................................................................... 43 Work Order Requests ............................................................................................................................................................ 44 Emergency Work Order Requests: .................................................................................................................................... 44 SUPERINTENDENT’S OFFICE ....................................................................................................................................................... 45 Proof of Residency Forms ...................................................................................................................................................... 45 Conference Room Request .................................................................................................................................................... 46 SPECIAL EDUCATION DEPARTMENT .......................................................................................................................................... 47 Discrimination, Harassment, Intimidation and Bullying Reporting and Investigating Process Flow Chart ........................... 47 Bullying Logging into DTS ...................................................................................................................................................... 48 WAREHOUSE .............................................................................................................................................................................. 49 Instructional Supplies ............................................................................................................................................................ 49 WH-10/ WH-11 ...................................................................................................................................................................... 49 Science Kits ............................................................................................................................................................................ 49 Reprographics........................................................................................................................................................................ 50 LIST OF ATTACHED FORMS ........................................................................................................................................................ 51

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ADMINISTRATIVE SERVICES CONTACTS: Kristy Curry, Assistant Superintendent, (760) 352-5712 ext. 8517 Carla Arguilez, Director of Fiscal Services, ext. 8528 Marta Angie Santillan, Admin. Secretary, ext. 8518 Alicia Diaz, Payroll (A-L), ext. 8520 Ann Marie Rascon, Payroll (M-Z), ext. 8519 Nadia Velazquez, Accounts Payable, ext. 8542 Victoria Tewalt, Accounts Payable, ext. 8539 Associated Student Body (ASB) Principals are to ensure all ASB funds are spent in accordance with the applicable laws and District’s policies. District forms can be found on our website ecesd.org – Departments – Assistant Superintendent – Fiscal Services – Internal Business Forms. Fundraising Event 1. Teacher will fill out “Fundraising Event Request” form and submit to School Site Principal for approval with event flyer. 2. If approved, send in Fundraiser Event/ Activity Request (FR-01) to Central Kitchen. Review Child Nutrition Section on Food & Beverages Sold on Campus for complete guidelines/rules. 3. If approved, all revenues received must be submitted to ASB Bookkeeper the day after the event ends. A “Tally Sheet of Sales” which is an itemized list of items sold should be submitted. 4. Both Teacher (holding fundraiser) and ASB Bookkeeper or designee will count revenue from the fundraiser. “ASB Cash/Check Count” form needs to be filled out. Two people should always be present when counting funds. This is a big audit area. 5. ASB Bookkeeper will deposit funds into ASB Bank Account within 3 business days of funds counted. If teachers are making the deposits, the deposit slip(s) must be submitted to the ASB Bookkeeper. ASB Bookkeeper will input in Quicken for the ASB accounts. **Raffles or games of chance (violation of the Penal Code) is not an allowable fundraiser. **If using receipts and/or tickets they should be pre-numbered. Requesting Checks 1. Teacher will need to fill out “Check Request” form and attach a quote for authorization. 2. Submit to Principal for review and approval. 3. If approved, teacher will give an original/detailed invoice to the ASB Bookkeeper to process a check for payment (once goods or services are received). 4. ASB Bookkeeper will pay for goods that were authorized and received. 5. Pre-payment of goods should be limited. A check request must be approved by the Principal and a receipt must be submitted to the ASB Bookkeeper afterwards Carryover Funds Carryover is the amount of money from ASB at the end of the year once all the bills have been paid (ending balance). Reasonable carryover balances can be carried over for a project in a new year, however large or 5|P age

excessive carryover balances are discouraged. Classroom ASB accounts should be close to a zero balance at the end of every school year. If funds are raised by students during a given school year, those funds should be spent on behalf of those students. ASB should not carryover more than 20% of total amount raised in a given school year. Tips for Avoiding Audit Findings • Make timely deposits. DO NOT hold on to funds in the desk. • The ASB Cash/Check Count and Tally Sheet totals should match. The auditors will look for these documents. • Use original invoices for payments. Auditors will verify if there is a receipt or invoice with the check request and that the amounts match. • Always have supporting documentation for expenses and revenues (Cash/Check Count and Tally Sheet). Make sure documents are attached to your check request and deposit slips. • Reconcile account monthly (Quicken Report with ASB Bank Statements to Business Office monthly) • DO NOT sign blank checks in advance. • ASB funds in ASB bank accounts cannot be used for anything other than ASB approved expenditures. • Referees: if he/she is a District employee, a Request to Employ Form (from HR) and timecard is needed. ASB Accounting – Quicken • School sites operating an ASB account shall maintain their own financial records through Quicken. • Training is available on the software program by request. Contact Marta Angie Santillan to setup a training. • Annually the Assistant Superintendent will be performing an audit on the financials. • Monthly bank statements and reconciliations should be sent to Marta Angie Santillan in business services. • A Quicken guide is part of this guide under attachments to aid you in common transactions. Reminders • P.T.O. is a separated entity from the school and it’s ASB. PTO events on campus containing food items can only be sold ½ hour before or ½ hour after the school day. This rule is based on CDE Child Nutrition requirements. The District could lose child nutrition funding if we do not follow this rule. • Checks that haven’t been cashed after 6 months need to be voided. • Compile a W-9 Vendor list (attached) on excel. Unincorporated vendors that receive payment under the ASB account should fill out and submit a W-9 form PRIOR to payment. • Donations: Donor can fill out the Donation form (attached) with their donation. If donation is to ASB, school site needs to e-mail a copy of donation form to [email protected]. We will report to the Board. • ASB Manual is available for download on http://fcmat.org/# under publications. Chapter 14 on appropriate expenses is included as an attachment to this guide.

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ASB Process Flow Chart Teacher: Submits an ASB Fundraising Event Request to your site Principal. Include a copy of the flyer you will send to parents.

Principal: Signs/approves event form and flyer. Sends copy of approval to Food Services.

Teacher: Conducts Fundraiser. Upon completion of fundraiser. A Tally Sheet of sales and the ASB Cash/Check Count Form are submitted to ASB Clerk.

ASB Clerk: Counts the cash/checks from sales and verifies with the teacher that they match the tally sheet and ASB Cash/Check Count Form. Two people must sign off on count.

ASB Clerk/Teacher: Staff designated by the school site Principal will take the deposit to the bank. Deposit slip should be given to ASB Clerk on the next business day.

ASB Clerk will record funds to class account. Entry will be made in Quicken.

Teacher: Check Requests for payments to vendor. Submit ASB Check Request Form to ASB Clerk with a quote from vendor.

ASB clerk verifies adequate club/class balance. Teacher provide receipts/invoice to match amount of check requested.

ASB Clerk audits and keeps all paperwork related to the fundraiser.

Attendance Deadlines Month

1 2 3 4 5 6 7 8 9 10 11

Month Periods

8/21/2017 9/18/2017 10/16/2017 11/10/2017 12/11/2017 12/22/2017 2/5/2017 3/2/2018 3/30/2018 4/30/2018 5/28/2018

9/15/2017 10/13/2017 11/9/2017 12/8/2017 12/21/2017 2/2/2018 3/1/2018 3/29/2018 4/27/2018 5/25/2018 6/8/2018

Due Date

9/22/2017 10/20/2017 11/17/2017 12/15/2017 1/12/2018 2/9/2018 3/8/2018 4/5/2018 5/4/2018 6/1/2018 6/13/2018

Reminders:

*Saturday school make-up attendance should be credited back to absences chronologically first in the school year. *If you are having attendance issues with students, there are many resources through the truancy office. Contact Celina Gonzales at the PACE Center. *Did you know every absence (excused or unexcused) is a loss of funding of $52 per day per student? Every day counts!

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Attendance Reporting Process

Daily Attendance Recorded

Verification of Absences

•Regular teacher enters attendance into Synergy. Should be done at the start of class/period. •Substitute teacher is given a printed roster that is signed and returned to site secretary. The secretary enters into Synergy. The substitute's signed roster must be kept with attendance records.

•An automated message through Blackboard Teleparent communication system will automatically be sent at 5:00 pm to the parent/guardian of any student marked absent. •As parents/guardians call into the school a pink slip (two part form) should be filled out. A copy will be given to the student to be "readmitted" into class upon their return. •If a student is tardy a pink slip should be filled out for them to enter class. •The secretary shall keep the carbon copy of all pink slips.

•Verify attendance was recorded for each class/period. •As parents call in to excuse absences fill out a pink slip to give to students when they return to school. Secretaries •Fill out pink slips for tardies and give to students as they enter school. Daily •For excused absences/tardies change from unexcused in Synergy. The pink slip should be Responsibilities your backup for the changes. •Print weekly attendance roster on Friday or the following Monday. This is critical, if this is missed, print as soon as possible. In case of a secretaries absence, ensure there are two people who are verifying this is done at your site. •Provide weekly rosters to teachers to sign and date. Auditors will verify this is done Secretaries timely, which is considered a day or two after the attendance week. Special Weekly circumstances; If a teacher is out sick on Monday, they can sign when they return on Responsibilities Tuesday. If a teacher is out on long term leave, a secretary can sign as long as they have rosters signed from the substitute teachers as back up.

•Weekly signed rosters with the Teleparent call logs and pink slips for the week should be attached. •There should be a pink slip for every excused absence. If you received an excuse after Paper Work the weekly attendance was printed and signed, first enter into Synergy. Second, you can Needed for either cross out the absence code and write the excused code on the form or you can Audit Purposes reprint the weekly log and attach it to the signed copy. •Keep the rosters filed by attendance month.

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Accounts Payable Invoice Only (No Purchase Orders Needed) • All Terminix invoices are to be sent to accounts payable. • All Aramark invoices are to be sent to accounts payable. Do not sign an invoice if delivery is not complete. Otherwise, the full amount on the invoice will be paid and no credits will be requested or applied. Confirming Purchase Orders (ICSIS Requisition Forms) • Will be processed on a requisition form through the ICSIS software effective 2015-16 school year. • Itemize receipts • Attach all original receipts to Confirming Purchase (Requisition Form) form • Place receipts only to be facing in one direction • Use legal name of vendor • DO NOT:  exceed $500.00 without prior approval  STAPLE receipts  tape receipts front and back on sheet  wrap long receipts  cover totals or items purchased with tape  purchase personal items on same receipt you are submitting for District reimbursement Purchasing Cards All cards can be checked out with Accounts Payable in the Business Office • Smart & Final Card –For purchases under $100.00, you will need the card and the Open P.O. number. For purchases over $100.00, you will need the card and a purchase order. • Wal-Mart, Home Depot and Costco Cards – you will need a purchase order regardless of the amount spending. • Read rules on food purchases below. Employees will be held accountable for unallowable purchases. Food Purchases for Meetings All purchases of food for meetings need pre-authorization from the Associate Superintendent or Assistant Superintendent. 1. Requests should be made via email and should include the following: a. Agenda of Meeting b. Purpose of Meeting c. Date of Meeting d. Start and End Time of Meeting e. Funding being used for payment i. Federal funds should not be used to purchase food. 2. If request is approved, print email and attach to purchase order being submitted for payment. Exceptions (these items may be purchased without prior approval): 1. Water bottles 2. Light snacks; includes items that have a longer shelf life (peanuts, granola bars, chocolates, etc.)

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Food Purchases for Staff Appreciation The Superintendent may authorize the purchase of food for special events (employee appreciation events, award celebrations, etc.). Prior authorization is required for these purchases. The total cost should not exceed $10.00 per employee for these limited events. Food Purchases for Students All food purchases for students for snacks should be pre-approved by the Director of Child Nutrition. There are very strict rules regarding competition with the school nutrition program limiting the type of snacks and time snacks can be given. *See section in guide in Child Nutrition Rewards/Incentives/Additional Snacks on snack requirements. T-Shirt Purchases with School Logos for Students Should be handled as a fundraiser through ASB • Purchases for shirts (intended for sale) should be made through ASB • Funds collected should be deposited into ASB account • At minimum, sites should charge students the cost for creating the shirt. For example, a t-shirt cost the site $9.00 to make. The site should charge at least $9.00 for the sale of the shirt. T-Shirt Purchases with School Logos for Adults/Staff • • • •

School site funds should not be used to purchase staff or parent t-shirts. The Superintendent, Associate Superintendent or Assistant Superintendent may approve these purchases for special events. For safety reasons, shirts can be purchased for ASES staff, yard duty personnel, security officers, and hall monitors. Shirts can be purchased by PTO for staff. All other Staff shirts must be purchased by employee

Travel Expenses • A Purchase Order must be submitted for room reservations for workshops/conferences/trainings submitted and is to include the following:  purpose of travel  date of arrival  date of departure  amount expected to pay for rooms  who’s sharing rooms  double beds or single • All Request for Conference/Travel Expense Claim forms must include a copy of workshop, conference, or training flyer information. • For out-of-county overnight travel, the current per diem (breakfast $14, lunch $17 and dinner $30) will apply. • Out-of-county single day travel, must include actual receipts for meals. Only the maximum amount per meal will be reimbursed. • Rates applied for breakfast if you leave before 6:00am. • Rates applied for dinner if you return after 6:00pm. • The District Visa can only be used for hotel room and parking charges, not food expenses.

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Employees Traveling Out-of-County Vehicle Usage Employees traveling out-of-county for official District business will be provided a vehicle for travel. This document explains the procedures, rules and regulations related to these requests. District Procedures for Vehicle Requests: Employees need to have DMV clearance prior to using the vehicle. At least one month prior to travel date, you will need to complete a “DMV Pull Notice” and send the form along with a copy of your driver’s license to the Director of MOT, Kimberly Dessert. This form is good for one year, you may verify with Kim Dessert if your clearance is current. This form is available on the District website, under Departments – Assistant Superintendent of Administrative Services – District Vehicle - DMV Pull Notice. Complete the "Request for Use of District Vehicle" form. The form is available on the district website under Departments - Assistant Superintendent - Fiscal Services - Internal District Business Office Forms. Based on the travel arrangements a determination will be made on the most economical means of travel either the district owned vehicle or a rental car. The requestor will be notified by Marta Angie Santillan at Administrative Services, with the arrangements and confirmations. If you need to cancel vehicle use, contact Marta Angie Santillan immediately. Site budgets will be charged for any costs incurred due to last minute cancellations. I. District Vehicle Guidance PROPER USE: The use of DISTRICT vehicles shall be limited to official and authorized school district purposes. Private and/or personal use of DISTRICT vehicles is strictly prohibited. Reasonable travel for meals is allowable. DRIVER: Driver must be an employee of the DISTRICT. PASSENGERS: Only DISTRICT employees may be passengers in DISTRICT vehicles, unless otherwise authorized by the Superintendent or Designee. RULES: When DISTRICT vehicles are in operation, the operator is to be considered on duty and his or her actions are subject to DISTRICT policies. It is the responsibility of the individual driver to observe and obey all state motor vehicle laws and ordinances. All violations and fines shall be the responsibility of the driver. DISTRICT owned vehicles are to be operated safely and courteously. Seat belts are to be worn by the driver and authorized passengers. Drivers must not transport more persons than the vehicle was originally designed to safely carry or more than the number of seat belts equipped in the vehicle. It is the responsibility of the driver when using a toll road to make sure toll fees are paid. Any fines for toll roads will be the responsibility of the driver. Smoking, use of alcohol, and/or use of any medicine (OTC or prescribed) where possible side effects can impair mechanical and cognitive abilities, when operating DISTRICT vehicles is strictly prohibited. While operating a DISTRICT vehicle, cell phones shall only be utilized with an alternate audible device and the operator shall comply with all laws regarding the use of cell phones in a vehicle. Use of cell phone text, internet, and e-mail services while driving is strictly prohibited. EMERGENCY: Any collision that involves vehicles or property, regardless of the amount of damage, requires an accident report, which may include a police report. The employee may be held liable for collision damage to a DISTRICT vehicle that is not supported by an accident report. 11 | P a g e

Instructions for emergency situations (accident, flat tire, etc.) are inside a folder in the glove box of the vehicle. DISTRICT CHECK OUT PROCEDURES: Vehicle will be parked at Lincoln School. Key to car, key to gate and gas card will be provided to employee at Business Office. Car keys must be picked up the day before if you are leaving prior to 7:30 am. The vehicle will need to remain parked at Lincoln, you are not permitted to take it home overnight without Superintendent or Designee's permission. Driver is responsible to record the odometer reading before and after trip, to keep all receipts for gas and fill up the car before returning it. DISTRICT RETURN PROCEDURES: Vehicle needs to be returned to the Lincoln parking lot with a full tank of gas. If, after hours you need to open and lock gates with vehicle securely inside gated lot. Return keys, gas card and receipts to Business Office. After business hours returns, place items in the door slot at Human Resource. Envelope will be in the glove box of vehicle. Vehicle must be returned on the date specified. Another employee may be leaving with vehicle the next morning. If there is any reason you can't return the vehicle on time, contact the Assistant Superintendent. II. Car Rental Guidance When the District deems use of a rental car is the most economical means of travel, arrangements will be made for the employee based off of the “District Vehicle Request Form.” Employees will provide reservation information by Business Services at least 48hrs. prior to departure for reservations. All Rules list above are applicable for car rentals. All rentals will be for intermediate size cars or smaller, unless 3 or more people are traveling together. Fuel card will be provided by Business Service. III. Personal Vehicle Guidance Employees may opt to take their personal vehicle but will forfeit mileage and/or gas reimbursement. Under special circumstances and with prior approval by the Superintendent, employees may be reimbursed for the use of one’s personal vehicle. To request approval employees must email the Superintendent requesting his approval. In order to process the mileage reimbursement, the email approval shall be attached to the travel reimbursement form submitted to accounts payable. Meals for Same Day Travel (Effective January 1, 2016) In order to be compliant with IRS Publication 463, the District must report meal reimbursements to employees for travel that does not require an overnight stay. According to the IRS, this type of reimbursement is considered taxable income and will be reported on 2017 W-2’s. Exemptions (https://www.irs.gov/pub/irs-pdf/p463.pdf): • Travel that requires overnight stay. • Meals provided as part of a meeting or conference. Employees may elect to decline same day travel meal reimbursements in order to avoid the tax adjustment. If employee declines the reimbursement, please make a note on the Travel Expense Claim Form.

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Purchase Orders Process: Purchase orders/requisitions shall be processed through the online financial system. As part of this manual, we have provided a flow chart of the process and instructions on how to use the system. If you need a new user added or have issues with your user id and/or password contact Carla Arguilez at ext. 8528. *ICSIS Financial System Guide is available on our website and will give you step by step instructions on requisition/purchase order processing.

Purchase Order Process Flow Chart

Purchase Order

•Teacher or other site personnel submit request for purchase order to designated Site ICSIS User (Secretary or Admin Clerk). Site ICSIS User(s) are determined by Principal/Director. •Interal Purchase request procedures to be determined by Site Principal/Director.

Request

Requistion Creation

Requistion Approval

Convert to Purchase Order

Payment

•Site ICSIS User enters Requisition into system and prints copy. •See the following detailed instructions on how to use the online system.

•Requistion goes through the proper approval process. •Principal/Directors need to sign Requistion. For Categorical Program purchases Ed Services needs to sign off on Requisition. Proper back-up needs to be with Requisition.

•The approved Requisiton form will be turned into Business Services. •Business Services will verify that it has the proper accounting and sufficient budget. •They will convert it to a Purchase Order and send to approriate contacts (ie. vendors, site).

•Upon receiving shipped items, check off all items and sign and date yellow purchase order •Forward all packing slips, invoices, or related documents along with yellow P.O. copy to accounts payable for payment processing.

Processing

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Budget – School Site Allocations A listing of account line codes for site specific Purchase Orders, Confirming Purchase Orders, Time Cards, and Teacher Substitute Slips can be found at the back of this packet. A site specific spreadsheet will be provided to Principals during management meetings at the beginning of the year and periodically throughout the school year. Below is a description of how to read this spreadsheet and a description of how the allocations are calculated. Description of Expenditures 1. Planned Expenditures: Include salaries on the sheet reflect current staffing levels and employee salary placement. These are classified as planned since the positions have already been filled at your site. Any potential changes that you would like should be discussed with the Superintendent. 2. Principal’s Discretionary Funds: These are the amounts you have direct control on how they are spent. We have budgeted your copier expenses based on prior year spending. However, it is up to you how much your site spends in this area. The remainder of your allocation has been budgeted to material & supplies. You can spend these on other areas such as travel, professional services, or computers. Carla Arguilez will work with you on moving your budgets to the proper objects depending on the expenditure type but, your total expenditures cannot exceed your allocation. For example, if you choose to spend $5,000 out of travel we will lower your materials & supplies budget by $5,000 and move it to travel. Description of Allocation 1. Title I Funds  Distribution: These funds are distributed based on the student’s counts from our annual CARS report. Due to timing and planning we will always use the prior year’s CARS numbers. Carry-over will not be allowed by site. Any site funds not used at the end of the fiscal year will be re-distributed in the subsequent fiscal year to all sites.  Allowable uses: These are Federal funds and must follow the allowable uses those program guidelines. The school site single plan for student achievement should include a detailed plan for these expenditures. References to your SPSA should be made on purchases from these funds. Educational Services will be reviewing these expenditures to ensure they are allowable. 2. LCFF Funds  Distribution: These funds are based on your school sites unduplicated pupil counts (Free and Reduced Priced Meals and English Learners). Due to timing and planning we will always use the prior year’s unduplicated numbers. The more free and reduced priced applications for your site the more your will receive. Make sure and push for 100% collection of meal applications. There will not be any carryover by site.  Allowable uses: The intent of these is to support education student services not administrative expenses. These funds should be used in a similar manner as Title I regulations. These will be reviewed by Educational Services. If you have questions on allowable expenditures, contact Linda Morse or Joy Ceasar. 3. Administrative Unrestricted Funds  Distribution: These funds are based on your prior year school site enrollment numbers at $10.00 per K6th student and $11.00 for 7th-8th.  Allowable uses: These are unrestricted funds for your office site.

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4. ASES  Distribution: Based on grant amount. Questions on this can be answered by Linda Morse, Director of Educational Services.  Allowable uses: These funds must follow the State guidelines. Education Services will be reviewing them to ensure they are appropriate.

Budget- Running Reports in ICSIS Step-by-Step Instructions ICSIS is available at http://www.icsis.icoe.org under ICSIS Applications link.

Log into ICSIS (if you forgot your user name and password contact Carla Arguilez). Login – User Name District Number- 24 Password- User Password Fiscal Year for 2017-18 – 2018

Go to Budget Report You have a couple of different options depending on what you would like to review. Your school site number is available on your school site allocation sheet provided. A copy of each report listed below is part of your packet. Title I Funds for your site- Enter Resource 3010 and your school Site Number.

Enter your specific site number

If you prefer to only see your discretionary funds add Goal 1200.

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LCFF Site Funds for your site- Enter Resource 0133 and your school Site Number.

Administrative Unrestricted Funds- Enter Goal 1200, Function 2700 and Site Number.

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Custodial Supplies Funds- Enter Goal 1200, Function 8200 and Site Number.

If you want to review all funds that you have discretion over their spending (excludes salaries) enter Goal 1200 and Site Number. This report is a great way to get a snapshot of all your site allocations.

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ASES Funds- Enter Resource 6010 and Site Number.

How to Read a Budget Report

Working- Is the Budgeted Amount for that account line. These amounts could change during the year.

Account Lines

Current- Is the amount spent within the time frame of the report. Note dates at top this report is 7/1/2014-7/21/2014.

Balance- Budget minus expenditures and encumbrances.

Current YTD- Is the amount spent as of July 1st to actual date the report is ran.

Encumb YTD- Are Purchase Orders that have been encumbered haven’t been paid. These funds should be looked at as “spent.”

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Payroll Classified (blue) Timecards  Must be completely filled in with school name, name of employee, social security number and work assignment  Budget Code to pay timecard must printed or it will be returned  Signatures (employee and supervisor)  Request to Employ form - Make certain yellow original is submitted to Betty Ann Jones (HR Dept.) and a copy is kept at your site. Certificated (pink) Timecards  Must be completely filled in with school name, name of employee, social security number and work assignment  Budget Code to pay timecard must printed or it will be returned  Signatures (employee and supervisor)  Stipend Request Form – Make certain original is submitted and a copy is kept at your site Classified & Management Absence (green) Form  Full legal name  Last (4) four of Social Security number  Reason for Absence/ i.e.: Sick Leave (01)  Two Signatures (Employee & Principal)  Workers’ Compensation related absences must have date and type of injury (Example: DOI: 08/13/14, Injury Left Shoulder) Certificated Employees Absence (white) Form  Full legal name  Last (4) four of Social Security number  Reason for Absence/ i.e.: Sick Leave (01)  Two Signatures (Employee & Principal) Workers’ Compensation related absences must have date and type of injury (Example: DOI: 08/13/14, Injury Left Shoulder)  If a certificated substitute is employed, a budget code will be required and Certification of Substitute Service section will need to be complete. If substitute is a classified employee, mark a “C” next by his/her name and attach the classified time card. Hourly Absence Form (Effective July 1, 2015)  Full legal name  Last (4) four of Social Security number  Position they are absent from  Budget Code DO NOT hold any payroll documents at your site (desk). Submit ALL timecards and absences on the designated deadlines. Penalties will be assessed and will be charged to the School Site’s budget.

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Payroll Deadlines Payroll documentation includes certificated and classified absences and timecards. Please be sure ALL payroll documents are in the payroll office by 4:00 p.m. on the deadline date to avoid any delays. PAYROLL PERIODS

DEADLINE DATE

ISSUE DATE

7/1/2017 - 7/30/2017

8/1/2017

8/31/2017

8/1/2017 - 8/31/2017

9/1/2017

9/29/2017

9/1/2017 - 9/30/2017

10/2/2017

10/31/2017

10/3/2017 - 10/31/2017

11/1/2017

11/30/2017

11/2/2017 - 11/30/2017

12/1/2017

CLASSIFIED

12/28/2017

12/1/2017

CERTIFICATED

01/02/2018

12/1/2017 - 12/30/2017

1/8/2018

1/31/2018

1/2/2018 - 1/31/2018

2/1/2018

2/28/2018

2/1/2018 - 2/28/2018

3/1/2018

3/29/2018

3/1/2018 - 3/31/2018

4/9/2018

4/30/2018

4/3/2018 - 4/28/2018 5/1/2018 – 5/31/2018

5/1/2018 6/1/2018 6/1/2018

**June 2018 All Absences Timecards ending 6/8/18 Timecards ending 6/29/18 Summer School Timecards to 6/29/18 Timecards after 6/29/18

5/31/2018 CLASSIFIED 6/28/2018 CERTIFICATED 6/8/2018

Daily 6/8/2018 6/29/2018

6/28/2018 7/10/2018

6/29/2018 End of Program

7/10/2018 7/31/2018

Public / Student Records Requests Guidelines for Student Records 1. Student Records Request Forms are available on our website www.ecesd.org under Depts/Assistant Superintendent of Administrative Services/ Records Request. 2. Authorized persons shall submit a request to the custodian of records to inspect, review, or obtain copies of student records. ONLY PARENTS / LEGAL GUARDIANS are able to obtain copies of student records who are under the age of 18. 3. If a student profile is needed: A Student Records Request Form needs to be completed. A photo identification is required for all student requests. 4. Attached copy of Identification to Student Records Request Form. 5. Review Student Records Request Form to verify all information is complete and legible. 6. Sign name and date received at the bottom of the form and forward to Marta Angie Santillan- DO#3 via district mail. 7. Notify individual requesting records that they will be contacted within 5 Business Days. 20 | P a g e

8.

Notify individual that records may only be delivered to authorized persons or if preferred, via email.

Guidelines for Student Records from Public Agencies Request for Department of Social Services from Parents 1. Parents may request forms or questionnaires from Social Services to be filled out at the school site. 2. School site secretaries are authorized to fulfill these requests. 3. If a parent doesn’t have a form/questionnaire, they need to be directed to complete an ECESD Student Records Request and to return it to District Office #3, Administrative Services, Marta Angie Santillan. Department of Social Services / Behavioral Health 1. A written notice is required from public agencies requesting student records and must be presented by an authorized personnel from the agency. 2. To verify authorization of individual, ask for agency specific identification (employee badge or business card with name and drivers license) make a copy to attach to the written request. 3. Make sure you are only providing the specific student information requested. IMPORTANT: Refer all legal subpoenas for student records to District Office #3, Kristy Curry, immediately upon receipt. These are time sensitive. Guidelines for Public Records • •

The District Administrative Services Department, Office #3, Kristy Curry and Marta Angie Santillan will handle all public records requests. School Site Responsibilities are as follows: o In person request or phone requests - Inform requesting individual that the District Office Administrative Services handles all public records requests. Marta Angie Santillan will be their immediate point of contact. o Requests received by email. Forward the email to Kristy Curry and Marta Angie Santillan upon receipt.

Records Retention (School Site) •

Attendance Rosters – Keep at your site four (4) fiscal years. At the end of the four years, box the records and label them DESTROY. Submit a request to the Warehouse to pick them up.

•

Associated Student Body Records (ASB) – Keep at your site four (4) fiscal years. At the end of the four years, box the records and label them DESTROY. Submit a request to the Warehouse to pick them up.

•

ASES (all documents) – Keep at your site five (5) fiscal years. On the sixth (6) year, box them up and label them ASES – (your school name) and (year). Submit a request to the Warehouse to pick them up.

•

Student Cumulative Files – See section in guide in Educational Services on Student Cumulation Files.

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Student Accident Reporting When a student is injured while in the custody of the District the following process shall be followed. 1. Triage the student and determine the extent of the injuries. If deemed life threatening or serious, call an ambulance. 2. Call the Parent to notify them of the injury (even minor injuries). 3. Complete a Student Accident Report (see attached form). 4. Student Accident Report should be promptly forwarded to the Assistant Superintendent’s Office. Important Tips and Reminders • Student Accident Reports are an internal District document. DO NOT give them to a parent or guardian. • The District DOES NOT cover medical bills incurred due to an accident at school. • If a parent/guardian is adamant about medical charges being paid by the District, do not argue with them. Refer them to the Assistant Superintendent’s office to process a claim. Our office will handle all claims against the District.

Student Extra-Curricular Participation •

Students who choose to participate in extra-curricular activities such as sports teams, band, orchestra, drill team, dance need to complete a ECESD Voluntary School Activities Participation Form. The form can be found on our website under departments – assistant superintendent – field trip & student activities form

•

These form is for liability purposes and to make sure parents/guardians and students are aware of district rules regarding eligibility to participate in extra-curricular activities.

Student Field Trips Please see attachment “Field Trip Flow Chart for Teachers” at the back of this guide. This has all of the information from start to finish for a field trip including all of the forms. The instructions below reflect the directions in the packet. 1st. Field Trip – Permission/Authorization Teachers must submit a “Field Trip Request Form” to the Principal for approval. This should be done prior to any parent notification or fundraising. 2nd. Field Trip – Transportation If transportation via school or charter bus is needed the following directions need followed; a. Field Trip Transportation for Local Trips i. Teacher should check with the Transportation Department (Martin Barajas) concerning available date(s) for field trip. (760) 353-9200 ext. 7014. ii. Prepared transportation request should be signed by site principal and sent to the Transportation Department two (2) weeks in advance of field trip date. Make sure you are using the latest Transportation Request Form – bottom left-hand date is 7/2017.

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iii. After field trip is approved by the Transportation Supervisor, the teacher will be notified of approval via fax with a confirmation number. If any changes need to be made (i.e. time of pick up/drop off, date of field trip, etc.) after field trip has been approved, a new request will have to be submitted and original request will be cancelled. iv. Special Instructions: 1. Staff may not request specific drivers. Drivers will be assigned at the discretion of the Transportation Supervisor. 2. If a trip is cancelled at any time, notify the Transportation Supervisor immediately. 3. All stops need to be included on request. DO NOT FAX REQUESTS or call to reserve a bus. Field trip requests faxed to transportation will not be honored. 4. No afternoon field trips will be approved on minimum days or Thursdays. v. Field Trip Fees: 1. Local Field Trip Fee $150.00 (i.e. IV Expo, Research Center, IVC, The Movies, Navy Base, Seeley, Holtville) • Out of Town Fee $300.00 (i.e. Within Valley – Brawley, Calexico, Calipatria, Westmorland, Salton Sea, Wetlands) • Free Local Field Trip for 2017-18 $0 (If included in the Local Control Accountability Plan Budget, each class shall be able to take one local field trip without a bus charge. Each class gets one trip but, must share a ride with another class at their site to qualify for the free trip). b. Field Trip Transportation Chartered Buses i. All charter bus requests MUST be processed through the Transportation Department. ii. Prepared transportation request must be signed and approved by site principal and sent to the Transportation Department at least one (1) month prior to the requested date of trip. Make sure you are using the latest Transportation Request Form – bottom left-hand date is Revised 7/2017. This time (1 month) is needed to obtain the check for the trip, and obtain documentation on the bus and driver. Trips requested for April or May should be submitted as early in the school year as possible in order to secure a reservation. iii. No School or Department may enter into a contract with a bus company. The Transportation Dept. will notify the school of the approved request and provide a confirmation number. iv. After the charter bus trip is scheduled, the Transportation Department will submit the appropriate documents (Purchase Order) to Fiscal Services to obtain the check for the charter company. You will receive a letter with copies of all appropriate documentation (approved Transportation Request, a copy of the Charter Confirmation, and directions regarding payment. Do not pay the Charter Company directly. A district check will be sent and you will reimburse the District. ALL CHARTER TRIP COSTS ARE TO BE PAID TO THE DISTRICT TWO WEEKS BEFORE THE TRIP OR THE TRIP WILL BE CANCELLED v. The Transportation Department is required to be present at the school site prior to the bus departing. No bus will leave their school site until the Transportation Department has officially cleared the Charter Bus for departure.

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The Transportation Department will be in charge of obtaining proper documentation from the Charter Company prior to the scheduled departure date. • Copy of S.P.A.B. Certificate (CHP292) • Copy of Certificate of Liability Insurance • Driver’s California Commercial Driver’s License (B)PS w/expiration date • School Bus, S.P.A.B. Certificate w/expiration date • Driver’s Medical Certificate Card w/expiration date (51A) • Driver’s First Aid Card w/expiration date 3rd.

Field Trip – Food Services Child Nutrition Services must receive written notification for all field trips regardless if meals are being requested. 1. The Field Trip Notification Form can be downloaded from the Child Nutrition webpage 2. Requests should be submitted at least 10 working days prior to field trip for approval. 3. Principal approval is required for all Field Trip Requests. Without a signature the request will be denied. 4. You MUST receive a confirmation number from the Central Kitchen prior to the field trip date. 5. The day of the trip Food Services will provide an ice chest with food and a meal roster. The meal roster must be completed when the meal is served and signed by the teacher. • School sites will be charged for the cost of lost or damaged ice chest, and for incomplete meals when rosters are not completed and returned.

4th. Field Trip – Parent Notification Parents should be receiving AT LEAST two forms of notification about a planned field trip. a. Parents should receive a note from the teacher at least 30 days prior to the field trip. This should explain the trip and that the parents have the option of driving their students back from a field trip but, not to a field trip location. This is a District Policy, only the Superintendent can approve a parent to bring their child to a field trip location. In order to pick up their child after a field trip parents must complete the “Release form for Transportation of Students by Parents/Guardians After Field Trips.” Parents need to be notified of this early because it can take two weeks to process the form. The form can be found at www.ecesd.org – under parents. b. Field trip permission slips (You must use the District form for liability reasons) and slips for chaperones (Adult Participation Form). These should be sent home at least two weeks in advance and must be collected in order for the student and/or chaperone to participate in the field trip. 5th. Field Trip – Day of Checklist Make sure you have these items the day of the trip! • Completed Student Permission Slips for all students attending. • Emergency Cards and any list of medications for students. • Food and meal rosters. • Completed Adult Participation Forms for chaperones.

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CHILD NUTRITION SERVICES CONTACTS: Molly Diaz, Dir. of Child Nutrition & Warehousing, (760) 353-9200 ext. 7011 Karen Larsen, Assistant Director of Child Nutrition, ext. 7010 Doug Dessert, Food Service Coordinator, ext. 7012 Marithza Pasaraba, Senior Admin. Clerk, ext. 7024 Breakfast in the Classroom • •

BIC will commence on August 28th. August 21st – August 25th breakfast will be served in the cafeteria as it has in the past. Students who would like breakfast can come in from 7:30 am - 8:00 am. If you feel your staff would benefit from a quick refresher on BIC service, please contact Molly to schedule.

BIC Procedures: 1. Meal Pick up -Teacher will send student to cafeteria/multi-purpose room to pick up meals. Breakfast period will be 8:00am to 9:00am. All breakfast boxes must be returned no later than 9:00am 2. Dissemination of Meal-Once in the classroom, meals will be distributed either by a monitor or each child will have the option to select items from wagon for consumption For assurance of proper dissemination – Have 2 monitors pre-plate meals (1 of each item in boat) prior to the start of meal service. 3. Meal Recording / Rosters- Teacher should then identify each child as having a complete meal and check them off. In order for the meal to be reimbursable, the child must have a minimum of 3 or maximum of 4 components, one must be a fruit or vegetable. Components are: dairy, grains, protein, fruit, & vegetable. Normally there will be 3 components no more than 4 offered: cereals, milk, and fruit. Prepare all boats with one of each item to ensure all students receive a reimbursable meal. All students are to be offered the meal but they are not required to take it or required to eat everything. Items taken by a student and not consumed can be set in designated area for other students to consume. Students are not allowed to obtain a second meal from boxes. The roster must be updated by the teacher each week. If a child drops please indicate with a line thru the name with a drop date. For a new child, please add them to the bottom of the roster. The Central Kitchen will then add the child to the roster for the following week. Indicate student that have eaten by placing a “Check Mark” in the box. If child is absent or doesn’t eat leave blank. 4. Return Meal Boxes -Once students have finished their meal, the breakfast boxes should be loaded with the remaining items: all food and shuttles must be returned to cafeteria. If roster is not returned at this time and meals are not accounted for, the classroom or school will be liable for payment of each meal not recorded. 5. Trash- Trash bag will be set outside the classroom door and will be picked up by the custodian. The ideal place would be on a grassy area if possible. 6. Allergies -Be advised that some children in your classrooms have allergies. By law and with a medical notice, the Child Nutrition department is responsible to substitute any food item for that child. Should one of your students have such allergies, it will be indicated with a red exclamation mark on your shuttle and

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with the student’s name highlighted on the roster. The type of allergy will be noted on roster and permanently listed on the front of the shuttle. The substituted item will be marked (in separate baggy). 7. Adult or Teacher Meals- No “cost free” meals will be served to teachers. All meals must be paid for in advance to the Food Service Department. All food must be consumed only by students enrolled in our district. No Adult should be eating meals. Reminders: • Please be advised that all information included in your shuttle is confidential. Please ensure that they are returned to the food service department in a timely manner. • Students must have a minimum of 3 components with a maximum of 4. One must be a fruit or a vegetable. • Teacher must visually see student’s meal and record on meal roster. •

• • • • •

Meals must be recorded on meal roster by indication of a in the box next to their name. If the student is absent or does not want a meal, leave box blank. Any class which fails to record meals properly will be charged the rate of $1.90 per meal. Meals that are not recorded properly cannot be claimed for reimbursement therefore must be paid for. This money will come from your school site budget. Meal rosters, food and wagons must be returned to cafeteria no later than 9:00 am. All food must be put back into bags and returned to cafeteria. No food is to be left in the classroom for later consumption. No teacher shall eat a breakfast meal without prepaying in the cafeteria. Look for meal substitutes for those children with allergies. Students who would like addition food item may not take it from the cart. Leftover items not eaten by other student may be redistributed for free.

CDE Breakfast Meal Components: • Students must take at least ½ cup of fruit for it to be considered a reimbursable meal. (minimum of ½ to maximum of 1 cup) • Students must take 3 meal items, one being the ½ cup of fruit. 1. Example: Oatmeal bar – Apple – Milk REIMBURSABLE! Oatmeal bar – Milk NOT REIMBURSABLE!

Lunch • • •

Lunch is served daily on regular days. Minimum days – meals will be available in the cafeteria on minimum days. Because of the minimum day unless requested prior to the minimum day, there will be a reduced number of meals available. If you would like your regular meal service on the minimum day, please advise us so accommodations can be made. Field Trips -See section on Student Field Trips.

CDE Lunch Meal Components: • Students must take 3 meal items and must include a ½ cup of fruit/vegetable for it to be considered a reimbursable meal. 1. Example: Burrito – Beans – Pear- Milk REIMBURSABLE! Burrito- Beans- Milk NOT REIMBURSABLE! 26 | P a g e

Special Events During Breakfast/Lunch • • •

All special meal services including lunch on the lawn, change in service time etc., must be submitted to the Child Nutrition Services on an FS-1 form and 10 working days prior to event. You must have a confirmation number prior to executing Special Meal Service from the Child Nutrition Department. Special Meal Service Form (FS-1) can be downloaded from the Child Nutrition Services webpage and is attached to this guide.

After School Snack • •

•

Students are offered snack at ASES. These snacks are delivered and distributed by the CN department. Sites participating in the reimbursement snack program must inform Karen Larsen ([email protected]) of their site’s program start date ASAP (please allow 1 week for the delivery of snacks prior to the start date any delay in notification will delay your snack start date). Sites participating in the reimbursement snack program will begin service on the first day the program is open, Child Nutrition staff will assume the distribution. Snacks will be distributed as early as immediately after school and no later than 2:45pm. Child Nutrition staff’s day ends at 3pm.

Classroom Parties • • • • •

Classroom parties, carnivals and other celebrations must be approved by the school principal. A maximum of three parties per classroom are allowed each school year, this includes birthday party celebrations. They should not be held during normal breakfast or lunch times. Schools are encouraged to serve items that meet the requirements listed in “Food & Beverages Sold on Campus” All food sold to students as part of an on campus classroom party, carnival or celebration during school hours, must comply with Food & Beverage Sales on Campus.

Rewards/Incentives/Additional Snacks (Food) •

All food and beverages offered to students, on school premises during school hours, as a reward, incentive or additional snack must meet the requirements listed in Food & Beverages Sold on Campus. If you have questions, contact Molly at Food Services (760) 353-9200 ext. 7011.

•

School funds shall not be used for snacks that do not comply with these regulations. Schools who submit for reimbursement of these will be denied. If they were charged to the District credit card, the school may be restricted from use of District credit card. This includes ice cream socials, popsicles, chips, soda, candy, etc. For questions regarding this policy, please contact the Assistant Superintendent, Kristy Curry.

Meal Application Distribution and Processing Procedures •

Distribution August 1st

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•

All student have prior year eligibility for the first 30 school days. These are for student which were in our district in the prior year. New students must complete and Meal Application upon registration for eligibility.

•

Parent will be able to fill out applications on –line through ECESD website @ ecesd.org under Child Nutrition

•

It is recommended that all households complete a Meal Application to ensure that the district as well as the Child Nutrition Department has accurate eligibility and students are maximizing their benefits. This is vital for school LCFF funding. Students who are Directly Certified (via state/county list) should not fill out an application.

•

Sites must distribute one application and one “Letter to the Household” to each student.

•

Items to review to ensure expedited Meal Application are: 1. Students Name / Names 2. Date of Birth 3. Grade 4. School 5. CAL FRESH – CASE NUMBER 6. Last 4 of their Social Security Number 7. Completion of section / step # 4 - including signature

In order to reduce the bad debt to the district, it is very important that students are given their meal benefits as soon as possible. Reminders are no longer distributed on the lunch line. Students are not to be the target of the financial responsibility of school lunches. The Child Nutrition Department will notify parent via mail and “Tell A Parent”. If parents have any questions or concerns please direct them to myself- Molly Diaz, Marithza Pasaraba or Karen Larsen in the Child Nutrition Department.

Food & Beverages Sold on Campus -Adults • •

Vending machines are permitted in areas where students do not have access such as teacher lounges. Adults may purchase meals through the cafeteria.

Food & Beverages Sold on Campus -Students All food and beverage sales on school premises during school hours are subject to the following rules and conditions. These are highly audited and regulated by CDE. See ASB Section on proper procedures for fundraising for paperwork requirements. Effective July 1, 2014 – all organizations selling food items and beverages sold and served on school premises including fundraisers, student stores, vending machines and foods offered free of charge as rewards or incentives must comply with all local, state and federal regulations with regards to minimal nutritional value. Criteria for approval will be based on the following: •

Rules for Food Sales on Elementary Campuses:

All foods sold to students during the school day on elementary school premises must be from the list of approved foods. The only foods that will be considered for approval are individual portions of nuts, nut butters, seeds, eggs, 28 | P a g e

individually packaged cheese, fruits and vegetables that have not been deep fried and legumes all of which do not exceed 175 calories per package. An individually packaged dairy or whole grain food item may be approved if it meets all of the following criteria: 1. Not more than 35 percent of total calories from fat 2. Not more than 10 percent of total calories from saturated fat 3. Not more than 35 percent of total weight shall be composed of sugar occurring naturally or added sugar 4. Single food items sold or served on an elementary school campus cannot contain more than 175 calories 5. Does not contain artificial trans fat. A food contains artificial trans fat if a food contains vegetable shortening, margarine, or any kind of partially hydrogenated vegetable oil, unless the manufacturer's documentation or the label required on the food, pursuant to applicable federal and state law, lists the trans fat content as less than 0.5 grams of trans fat per serving. •

Rules for Beverage Sales on Junior High and Middle School Campuses:

All foods sold to students during the school day on middle and junior high school premises must come from the list of approved foods. The only foods that will be considered for approval are individual portions of nuts, nut butters, seeds, eggs, individually packaged cheese, fruits and vegetables that have not been deep fried and legumes all of which do not exceed 250 calories per package. Other individually packaged snack food items may be approved if they meet all of the following criteria: 1. Not more than 35 percent of total calories from fat 2. Not more than 10 percent of total calories from saturated fat 3. Not more than 35 percent of total weight shall be composed of sugar occurring naturally or added sugar 4. Single food items sold or served on a middle or junior high school campus cannot contain more than 250 calories 5. Does not contain artificial trans-fat. A food contains artificial trans-fat if a food contains vegetable shortening, margarine, or any kind of partially hydrogenated vegetable oil, unless the manufacturer's documentation or the label required on the food, pursuant to applicable federal and state law, lists the trans-fat content as less than 0.5 grams of trans fat per serving. •

Rules for Beverage Sales on Elementary Campuses:

All beverages sold to students during the school day on any campus must come from the list of approved foods. Beverages must meet the following criteria for approval: 1. Fruit based drinks that are composed of no less than 50 percent fruit juice and have no added sweetener 2. Vegetable-based drinks that are composed of no less than 50 percent vegetable juice and have no added sweetener 3. Drinking water with no added sweetener 4. Milk that is 1% fat, 2% percent fat or non-fat

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5. For middle and junior high campuses, only, electrolyte replacement beverages may be approved if they contain no more than 42 grams of added sweetener per 200z serving. Other state and federal restrictions may also apply. Only foods and beverages which meet all state and federal standards will be placed on the approved list. Additional food and beverage items may be submitted for approval by forwarding the Nutritional Facts listed on the package to the Director of Child Nutrition Services. Nutrition facts may be sent via district mail, by email to [email protected] or by fax at 760-352-6811 . •

Conditions of Sales 1. Every food or beverage items offered for sale must meet the requirements delineated above. 2. A maximum of three (3) different items at Jr. High campuses and one (1) item at elementary campuses may be offered for sale per day. 3. Each student can purchase no more than one (1) food or beverage item per school day. 4. Food or beverage items sold on school premises during school hours may not be the same food or beverage items sold or served in the school meal program. (This includes variations of flavorings or package size) 5. Two Exceptions: Food and beverage sales are not required to meet the conditions listed above in the following two circumstances: • The sale occurs at least one-half hour after the final dismissal bell • The sale occurs off of and away from school premises

• Is Your Snack a Smart Snack? Take the guesswork out of nutrition guidelines with the new Alliance Product Calculator for Smart Snacks! Simply enter the product information, answer a few questions, and determine whether your beverage, snack, side or entrée item meets the new USDA Smart Snacks in School Guidelines. Go to: https://www.healthiergeneration.org/productcalculator

Use of Kitchen Equipment and Storage Areas •

Reminder – The kitchens are a permitted facility and subject to the California Food Code

•

The Kitchen Use Request Form can be downloaded from the Child Nutrition webpage.

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ASSOCIATE SUPERINTENDENT’S OFFICE CONTACTS: Ruben Castro, Associate Superintendent, (760) 352-5712 ext. 8523 Rosemary Martinez, Admin. Secretary, ext. 8522 Cumulative Student Files Cumulative File Order: 1. Cumulative File Insert 2. Test Data Insert 3. Residency/Enrollment Information/Enrollment Information a. Birth Certificate b. Proof of residency c. Intradistrict or lnterdistrict enrollment letter d. Restraining orders e. Custody assignment 4. Home Language Survey (EO) filled out during initial enrollment (Check for initial HLS from any district) 5. Parent Conference form (current and year prior) 6. Special Program Participation a. Special Ed- canary yellow half sheet (staple inside cover sheet) b. Student Study — blue half sheet (staple inside cover sheet) c. GATE- full page d. Parent/Teacher Compacts- (recent and year prior) full page 7. Report Cards — keep all (fold to fit) 8. Notification of Promotion/Retention Form/Retention Exception (recent and yr. prior) 9. Suspension/Expulsion Reports — red folder 10. Yellow folder — ELL students Yellow Packet a. HLS — initial enrollment b. Instructional Program Participation Form (2 years) c. Parental Exemption Waiver for Bil. Ed d. Transfer Placement Recommendation K through 8 (2 years) e. Initial English Prof. Test f. Primary Lang. Prof - LAS g. Parent Notification of Test Results K-8 (2 Years) h. Reclassification/Redesignation i. Spanish Normed Test (if applicable) most recent j. Annual CELDT Results K-8 (2 years) Green Packet - ELD profile Orange Packet — FEP form Blue Packet — Redesignation form 11. For students leaving school, insert Confidential Health Folder upon receiving request for student records 12. Files from another district 13. Optional: STAR Reports (most recent)

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Cumulative Folder Request/Retention Procedures: 1. When a student is transferred within our district (IE: Elementary to Jr High or School to School), all documents are to be sent with the cumulative file via district mail. 2. If cumulative file is being sent out of the district (IE: Junior High to High School) a. mark grades on insert file b. remove insert and retain at school site for two years, after that time send to Warehouse for permanent records retention. c. contact assigned high school of student for cumulative file pick up 3. If cumulative file is going out of the district within California for reasons other than promotions, you are required to have a written request from new district. a. remove insert from file b. attach written request to insert c. fax or mail original documents to new district d. retain for two years e. send to warehouse via district mail marked permanent files 4. If cumulative file is going out of the district outside of California, we are only required to send copies of files not originals. Forward file insert to Warehouse for Permeant Record

Worker’s Compensation – Employee Injury Reporting REPORTABLE INJURIES A. Report to Associate Superintendent, Ruben Castro, Rosemary Martinez, and appropriate Payroll Technician by e-mail as soon as possible. E-mail should contain employee’s name, injury, date of injury and last date of work. B. Give employee Workers’ Compensation Claim Form (DWC-1) and SISC Employee MPN Handbook (see attachments) to injured employee. C. The following documents must be submitted to Rosemary once completed. a. Workers’ Compensation Claim Form (DWC-1) – given out to employee when he/she is seeking medical treatment or misses at least 1 workday because of the work related injury. DO NOT give to employee if he/she tells you they will not be filing a worker’s compensation claim. Once employee fills out and returns to the school supervisor, fill out the bottom portion of the form. You will be responsible for submitting the form to the Associate Superintendent’s office within 24 hours. b. Supervisor’s Report of Work Related Injury & Illness – supervisor will fill out the information and sign the report. Once completed please forward report to the Associate Superintendent for approval. c. Employee Report of Injury – Employee will fill out this information and sign the report. Once completed please forward report to the Associate Superintendent. If employee refuses or fails to submit the DWC-1 form, e-mail Ruben, Rosemary and appropriate Payroll Technician a statement of their injury and failure to submit documents. The e-mail should state date of injury, 32 | P a g e

date supervisor or you were notified and date form (DWC-1) was given. Once you provide the Employee Claim form DWC-1 to the employee, it is his/her responsibility to return it to you. You are not responsible for reminding or requesting the employee to return the form. NON-REPORTABLE INJURIES If an employee is injured on the job and reports it to their supervisor, but does NOT want to seek medical attention due to the injury, the supervisor will fill out a Supervisor’s Report of Work Related Injury and Illness form ONLY noting on the form that it is “Non-Reportable.” This may assist the District in the future should an employee decide at a later date that they wish to see a doctor for the injury. Please send original copy to Associate Superintendent for approval.

Worker’s Compensation – Flow Chart

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HUMAN RESOURCES CONTACTS: Candice Ortiz, Director of Human Resources, (760) 352-5712 ext. 8549 Zarina Montano, Personnel Supervisor, ext. 8543 Arlene Jaime, HR Analyst, ext. 8551 Patti Dollente, Admin. Secretary, ext. 8513 Betty Ann Jones, Personnel Records, ext. 8511 Vivianna Morales, Personnel Records, ext. 8510 Carolina Arredondo, Personnel Records, ext. 8521 Enrollment Administrative Transfers Before the Administrative Transfer Process is used, it must have prior approval from the Associate Superintendent. The Administrative Transfer process will be used to transfer students to any special program (i.e., DI or STEM) or other extenuating circumstances. If parents visit the District Office, we are directing parents back to the resident school to speak with the principal about any concerns they might have about their resident school. This gives you an opportunity to resolve any problems and/or promote your school. It is important that you protect your school and advocate for your teachers and programs. If you exhaust all options and would like to pursue a transfer, you should contact the potential receiving principal to see if s/he would accept the transfer. If this is the case, you can contact Ruben Castro for an administrative transfer. If a student returns from a Charter School, either the sending or receiving principal in the District will initiate the transfer and obtain approval from the Associate Superintendent. Enrollment Reports Please email your enrollment (using the enrollment template) and overflow list to Ruben Castro and Patti Dollente no later than 1:00 p.m. on the first day of school. The overflow list should be by student name, address and grade. Thereafter, please email your enrollment reports using the enrollment template every day beginning Tuesday, August 22 through Friday, September 1 by 3:00 p.m. A memorandum will be sent to you specifying the dates to submit your reports for the remainder of the year. First Day of School On the first day of school, please place all overflow students on a waiting list. Unlike previous years where overflow students were to report to the multipurpose room or available classroom, overflow students must be placed in a classroom for the first day of school only. Please inform the parents that you will place students as soon as possible or they will be informed later that day of the school they will be attending. Please e-mail your enrollment and overflow list to Patti Dollente and Ruben Castro no later than 1:00 p.m. on the first day of school. The overflow list should be by student name, address, and grade. Interdistrict and Intradistrict – Reminder Please remind your staff not to disclose information regarding your space availability. We are advising parents of denied intra-district and inter-district petitions that did not get their school of choice to call Patti Dollente during the first week of school as to space availability at their requested school. 34 | P a g e

The application period for intra-district is April 1 – May 1. Students who move during the year and wish to stay at that school site may do so. However, the students must then apply for an intradistrict/interdistrict if they desire to remain at that school/District for the following year. However, all petitions are processed based on space availability. Mid-year Transitional Kindergarten and Kindergarten Enrollment Please be advised that it is District policy that students must be 5 years of age on or before September 2 in order to enroll in kindergarten. Proof of Residency Parents of students attending on a Declaration of Residency or Caregiver Affidavit are to provide a new proof of residency each year. Please call the parents as soon as possible so that the child can be placed at his/her school of residence prior to the beginning of the school year, if the address has changed. See Superintendent section on Proof of Residency for instructions.

Insurance Dependent Enrollment for Insurance Purposes Certificated – 30 days: Please advise your staff that they must enroll their new dependents within their first thirty days of birth or adoption. This thirty-day period also applies to new spouses, step children, etc. Classified/Confidential/Management – 60 days: Please advise your staff that they must enroll their new dependents within their first sixty days of birth or adoption. This sixty-day period also applies to new spouses, step children, etc. Health and Welfare Insurance Presentations Certificated: The health and welfare benefit presentation for all non-management certificated staff will be held at Wilson Jr. High on Thursday, August 17, 2017 after the Welcome Back meeting. Classified/Certificated Management:

Friday, August 25, 2017

9:00 a.m.

10:00 a.m.

Friday, August 25, 2017

3:00 p.m.

4:00 p.m.

ECESDWashington Elementary School, 223 E. First St., El Centro, CA 92243 ECESDLincoln Elementary School, th

Cafeteria

Cafeteria

200 North 12 St., El Centro, CA 92243 *Memorandums detailing information are forthcoming.

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Child Welfare Issues Removal of Child from the School Normally, when a child is removed from school by law enforcement officials, the principal or designee must notify the parents or guardian of the student regarding the release and the place where the child has been taken. However, when the cause of removal is child abuse, school officials must supply the peace officer with the address and telephone number of the minor pupil’s parent or guardian and the removing agency then has the obligation to immediately notify the parents. The law does not explain what the school official is supposed to do when an anxious parent calls regarding the whereabouts of the child. We suggest that you ask for the name and telephone number of the peace officer to give to an inquiring parent, as well as for instructions from the peace officer as to what to do or say regarding such inquiries. Interviewing Suspected Child Abuse Victims in School The Department of Social Services has the responsibility to investigate allegations of child abuse or neglect. In carrying out those duties, a social worker may take into temporary custody and maintain custody of a minor, without a warrant, when there is reasonable cause to believe that the minor is a person who has been neglected or abused in Welfare and Institutions Code Section 300. To determine whether a minor is such a person, the social worker, who may or may not be accompanied by a police officer, has a right to interview the minor, whether at school or at home. The school official is not required to notify the parent of the interview. Optional Presence of a Staff Member. The law affords the child who is being interviewed the option of being interviewed alone or of selecting an adult member of the staff of the school (including a volunteer aide) to be present at the interview to lend him or her moral support. The member selected to stand by the child may not participate in the interview and is required by Penal Code Section 11174.3 to keep all information confidential. Photographs of Students Suspected of Being Abused If you are taking photographs of a student’s injuries, please be advised that you should always have someone with you in the same office/room. Depending on the gender of the student and the location of the injury, you may want an individual that is the same gender of the student taking the photographs and also the witness being of the same gender. Student Searches by Staff To maintain discipline and order within the school environment, school officials may conduct searches without a warrant based on reasonable suspicion that the student is engaged in illegal activity or a violation of school rules. New Jersey v. T.L.O (1985) 469 U.S. 325. What is reasonable depends on the context within which a search takes place. The search must be: 1. Justified at its inception (i.e., there are reasonable grounds for suspecting the search will turn up evidence that the student is violating the law or school rules); and 2. Reasonable in scope (i.e., the measures adopted are reasonably related to the objectives of the search and not excessively intrusive in light of the age and sex of the student and the nature of the infraction). New Jersey v. T.L.O. (1985) 469 U.S. 325

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Employment Inquiries Regarding Employees (Former and Current) Any and all inquiries regarding employees, either from employers or others, are to be directed to the Office of Human Resources. Letters of Recommendation All letters of recommendation are to be cleared through the Associate Superintendent. All letters of recommendation should state at the bottom of the letter: This document was not prepared on behalf of the District and I have no authority on behalf of the District to comment on any matter related to the performance of a current or former employee. Letters of recommendation issued by co-workers are not to be issued on District or Site letterhead. Offers of Employment No offers of classified or certificated employment are to be made without authorization of the Associate Superintendent. Please make sure that you document your background reference checks in EdJoin prior to the scheduled second interview. A second interview will be conducted by the Associate Superintendent, Assistant Superintendent, HR Director and/or the Superintendent for all positions. Work Study/SER/ICOE/CalWORKs All agreements for services (employment/volunteer) are to go through and be approved by Associate Superintendent. The Office of Human Resources will arrange for fingerprinting. No individual is to report to work prior to having fingerprint clearance.

Certificated Employees Absence Forms All absence forms which state “Association Business” as the reason for absence shall be submitted to the Office of Human Resources to be signed by the Principal and Associate Superintendent. Principal will remain responsible for signing off on the bottom portion authorizing a substitute. Employees must receive prior approval from the Office of Human Resources. Principal will receive a copy of the written approval prior to date of requested absence. Assignments It is imperative that the certificated assignment list submitted to the Office of Human Resources be accurate. You are to list the assignment of the employee exactly. All job titles are to refer to official titles, i.e., School Resource/Reading Support Teacher rather than listing “Reading.” If an individual is employed in two positions, list both positions with official titles and their assigned percentage time for each assignment, e.g., 50%. If at any time, there is a change in assignments at your site, please send an updated certificated assignment list to this Office as soon as possible. If vacant position, please note grade level and that it is vacant. Please submit via email your most updated certificated assignment list in ALPHA order by teacher last name to Candice Ortiz (cc: Patti Dollente and Zarina Montaño) by Friday, August 25, 2017. 37 | P a g e

BTSA Support Providers The District is in great need of BTSA Support Providers. Please encourage your best teachers to become a BTSA Support Provider. For more information and applications, please contact Candice Ortiz. Evaluation List Certificated evaluation lists will be distributed by the end of the month. Once you receive your list, begin planning observations, conferences, etc. Evaluation Timelines Probationary 1: Preliminary Evaluation by November 13 Final Evaluation by April 13 Probationary 2: Preliminary Evaluation by November 13 Final Evaluation by February 9 Evaluations that are not submitted timely cannot be placed in the personnel file. All Day Kindergarten (ADK) Support All DISTRICT Kindergarten teachers shall receive the support of a teacher or instructional aide for a minimum of 90 minutes daily. NCLB Letters to Parents We will be preparing letters for you to send out to the parents of students who are being taught for more than four (4) consecutive weeks by a teacher who is not NCLB compliant. Off-site Staff Meetings There are to be no off-site staff meetings due to liability issues unless authorized by the Superintendent. Reassignments When reassigning teachers to a new grade or a different classroom, it is recommended that you do the following: • Meet personally with the affected teacher • Provide individual written assignment notices • Advise teacher of support available, such as Reading Coach and fellow teachers • Advise teacher of custodial support available to assist with moving items to new classroom nd Also, the CBA limits reassignment to a span of three grade levels, e.g., 2 grade to 5th grade. Release time is provided only for involuntary reassignments and transfers that occur during the school year.

Teacher/ Staff Meeting Cell Phones -- Cell Phones are to be turned off during instructional time and school meetings. (Bulletin 46-9) Jury Duty -- Employees receiving a summons for jury duty or as a witness must notify the school office so that appropriate arrangements can be made. A unit member required to report to jury duty or as a witness shall not be required to return to the school site if the court service is dismissed after 11:00 a.m. The employee is required to provide documentation for the Jury Commissioner’s Office regarding the time or their service. Meetings -- Grade level and staff meetings are part of each teacher’s required duties. Such meetings will be held every Thursday afternoon unless otherwise noted. Please remind your staff to not schedule appointments or other events during that time. Standards for Appropriate Dress -- Standards of dress within the professional and business community shall determine employee dress. The general standard for appropriate appearance for faculty members is that they be 38 | P a g e

neat and clean. Employees shall wear modes of dress that are conducive to the educational atmosphere that is desirable and necessary in schools. (B.P. 4017)

Substitute Teachers Automated Educational Substitute Operator (AESOP) The AESOP service is available 24 hours a day, 7 days a week and can be accessed via internet and phone. The substitute is able to accept, confirm or decline positions. All substitute teachers will be provided with a username and pin number at the time of hire. Performance If you have an ineffective substitute teacher, please speak with the sub teacher regarding the issues of concern. If the concerns are of a serious nature, after meeting with the teacher, please notify Candice Ortiz and send an email detailing the conduct.

Classified Employees ASES Employees/Other Program Tutors (Maximum of 3.75 Hour Work Limitation) Please be advised that all ASES employees need to meet one of the following requirements: (1) 48 units from an institution of higher education (including community college), (2) an A.A. degree or higher degree or (3) successfully pass a formal District assessment. (See also Use of Paraprofessionals – Bulletin 45-5.) Substitute Instructional Assistants In order for school site office staff or other classified employees to serve as substitute instructional assistants, they must to meet one of the following requirements: (1) 48 units from an institution of higher education (including community college), (2) an A.A. degree or higher degree or (3) successfully pass the ECESD Competency Exam. Hourly employees (non-bargaining unit members) are not to serve in a classroom in the absence of a teacher.

Hourly Employees Hourly Employees Three and Three Quarter (3.75) Hour Work Limitation Please do not exceed the three and three quarter (3.75) hour maximum per day work limitation for hourly employees who are not members of PERS. The only exception is for those hourly employees who are already members of PERS and must be pre-approved by Human Resources. If you have any questions as to who is a member of PERS, please contact Candice Ortiz. Pupil Supervisors Part-time classified bargaining unit members are not to be hired as pupil supervisors. Effective January 1, 2003, the law provides that the number of hours assigned to pupil supervision in addition to an employee’s regular assignment hours are combined for the offering of health and welfare benefits. For example, a 3-hour instructional assistant-general who works 2 hours’ pupil supervision would be eligible for 39 | P a g e

5 hours of District-paid health and welfare coverage. Thus, your budgets would be affected by now having to absorb your portion of the health and welfare costs. Release of Hourly Employees If you have an ineffective hourly employee, please speak with the employee regarding the issues of concern. If the concerns are of a serious nature, after meeting with the employee, please notify Candice Ortiz with an email detailing the conduct.

All Employees AB 1825/2053 Sexual Harassment/Discrimination Training & Prevention of Abusive Conduct – Supervisors All supervisors must receive 2 hours of training every 2 years. New supervisors must receive training within 6 months of hire and every 2 years thereafter. Absences – Management In order to comply with the FCMAT recommendations for management absences, managers are to continue to submit forms for their absences, including submitting absence forms for out-of-county school business activities. Child Abuse Mandated Reporter Training All employee will be required to complete the AB-1432 California Mandated Reporter Training at http://educators.mandatedreporterca.com/ no later than October 15th. The training takes between 90 – 180 minutes and at the conclusion of the training employees will take a final test that requires an 80% or higher score to pass. Upon passing the test, employees will be e-mailed verification of their completion of the training. Please schedule this training as soon as possible, collect a sign-in sheet, and submit a copy of the certificate of completion to the HR Office to form part of our files. Early Release of Employees Employees are not to be released early by the supervisor unless you have received prior authorization from the Associate Superintendent or Superintendent. Leaves: Medical, Maternity or Other Please advise the Office of Human Resources as soon as possible of any leaves of absences for employees that are medical, maternity or other (e.g., taking care of family members). The HR Office needs to send the FMLA letters, receive information regarding work restrictions, and also advise Payroll. Maternity leave forms are to be submitted to the Office of Human Resources at least two months prior to the anticipated date of leave so that we can provide the employee with proper notifications. Notice of Change of Address/Information Employees are to be reminded that they are to submit an updated Change of Address form if they have moved or changed telephone number, including cellular phone number. This includes hourly employees. Personal Business v. Personal Necessity An employee is eligible to take a maximum of 7 days’ personal necessity during the school year as long as he/she has available sick leave to use. Personal Necessity is to be used only for the following reasons specified in the collective bargaining agreements: death or serious illness of immediate family member or accident involving 40 | P a g e

his/her person or property or that of immediate family; and appearance in court on own behalf. In addition, effective the 2015-2016 school year eligible ECETA members will be able to take personal necessity due to court appearances or depositions; adoption or birth of a child; imminent danger to the unit member’s home or property; hazardous weather or road conditions causing unsafe travel to the unit member’s work site; death or impending death of a personal friend or relative not included in the definition of immediate family. Certificated absences will be updated to reflect the new Personal Necessity language. Unit members shall provide advance notification of 72 hours, whenever possible to their supervisor to take personal necessity leave for the reasons stated above. Updated Certificated absences have been ordered and will be distributed to all work sites as soon as received. In addition to the above reasons, an employee may use up to 4 days of accumulated sick leave giving 24 hours’ notice (certificated) or 48 hours’ notice (classified) to the Principal/Supervisor. These 4 days are referred to as Personal Business days and are included within the 7 days of Personal Necessity. Personnel File Language “I have reviewed this letter and understand that it will be placed in my personnel file at the end of ten (10) business days. I also understand that I possess the right to have a written response placed in my personnel file and attached to this letter, if I submit the written response within this ten (10) business day period.” Prohibition of Sexual Harassment/Discrimination Please review the Employee Handbook with your employees, specifically the sexual harassment/discrimination. Please have the employees sign off that they received the information and submit to the Office of Human Resources for our records. Use of Legal Names All District paperwork is to have the employee’s legal name as it appears on employee’s social security card. Please do not use nick names or other names that are not legal names.

Miscellaneous Calendars School District Monthly Calendar: School meetings, trainings, events, and deadlines will be posted on the School District Monthly Calendar. Please provide Vivianna Morales with the items you need posted by the 3rd Friday of the month. The calendars will be distributed to all management and board members at the end of each month. Incidents Any site incidents that may involve a criminal or liability matter or a matter that may be reported to the media are to be reported to the Office of the Superintendent immediately. Individuals Requesting Information Regarding District Employees Reminder: We are under no obligation to provide nor should we be providing information to spouses, family members or others regarding a District employee, this includes information regarding work schedules, overtime, lunch breaks, names of co-workers, etc. Tape Recording Do not allow yourself to be tape recorded by an employee, parent, etc. If you are asked whether you mind being tape recorded, the answer is that you do mind and you do not want to be tape recorded. 41 | P a g e

MAINTENTANCE, OPERATIONS AND TRANSPORTATION CONTACTS: Kim Dessert, Director MOT, (760) 353-9200 ext. 7033 Martin Barajas, Transportation Supervisor, ext. 7014 Doug Hisel, Custodial Supervisor, ext. 7013 Armando Valenzuela, Maintenance & Grounds Supervisor, ext. 7016 Delia Celaya, Senior Secretary, ext. 7032 Cathie Escalante, Senior Secretary, ext. 7015 After School Event Air Conditioner Scheduling The following procedures are to be followed to ensure that air conditioning is scheduled for all after-school events at school sites: 1.

One week prior to the event, send an e-mail to Delia Celaya at [email protected] with a cc to [email protected] , stating the date of the event; the start time and end time for air conditioning.

2.

Delia will provide a confirmation number (E-00000) for your records.

3.

If the event is cancelled, you will need to call Delia at (760) 353-9200 ext. 7032 as soon as possible.

Alarm Services – How to Report a False Alarm (Alarm set off by accident) The El Centro Elementary School District uses Advanced Electronics Solutions (AES) as the District’s alarm monitoring company. Important Note: In order to decrease the number of false alarms, staff must be trained on how to properly enter their school site and disarm the alarm. If the alarm does go off, staff should follow the proper procedures in notifying the alarm service company (AES) of a false alarm, immediately. Otherwise, AES will dispatch a security officer from Southwest Security to check out the alarm call and the District will incur a $25 charge. Procedures to notify AES of a false alarm are as follows: • • •

Call AES Alarm Services dispatch immediately once the alarm has been set off. The number to call is 1-888533-0029 (toll free). Once the dispatcher answers, tell them that they have just received a signal from your school site and that it is a false alarm. They will need your name and your individual school password (abort code) in order to cancel the dispatched security officer.

Your school site password (abort code) should be kept in a secure area. Please inform and train all school site staff affected by this procedure. If you have forgotten your site password (abort code), please call Kimberly Dessert at (760) 353-9200 ext. 7033.

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Appliances, Candles and Air Fresheners in Classrooms Please be advised that it is prohibited to have microwave ovens, coffee makers, crock pots, popcorn poppers, and other heat producing appliances in classrooms. Those appliances are restricted to the employee lounge, or school kitchen. Small refrigerators, under 3 cubic feet, are allowed. Large, full-size refrigerators (over 3 cubic feet) are restricted to the employee lounge area. In addition, candles are also prohibited in any district-owned facility. Air fresheners and deodorizers are also prohibited in District facilities. compounds) that can be harmful to building occupants and visitors.

They emit VOC (volatile organic

District Radios •

Each school has 2 District radios. Schools are to be on Channel A. This is the channel used for transportation and normal communications. School sites are to have their radios tuned into Admin A at all times.

•

In the event of an emergency, staff may be instructed to tune to a different channel.

•

All radios are to be placed in the charger at the end of each work day.

•

If you are having trouble with your radio, call Delia (760) 353-9200 ext 7032 at the Warehouse and she will send a loaner while yours is being repaired.

•

The MOT Department is “base” and is always on between 7:00 a.m. and 4:00 p.m.

Storage Spaces (Gas Blowers/Electrical Rooms) GAS BLOWERS: All gas blowers used by custodians are to be stored in the gardeners’ containers. They are not to be stored or placed, even for a short time, in the custodian’s closet located in a classroom building. In the past, blowers were found in electrical panel rooms, in air conditioner closets and other various locations. Arrangements can be made for custodians to store their gas blowers in the gardeners’ container, if needed. A key to the gardeners’ container will be issued to the site principal. The site principal will be responsible for securing the container and equipment from theft when the gardeners’ are not on site. No other custodial supplies, school supplies, obsolete equipment or other items will be allowed into the grounds container.

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ELECTRICAL ROOMS: The 2001 California Electrical Code requires that clear working spaces be provided around all electrical equipment, and specifically states that “Working space required by this section shall not be used for storage.” In the past, we have found several instances where these spaces are being used as additional storage. Please review this with your custodian and remove any stored items from this area.

Work Order Requests •

The District utilizes an electronic work order system called “School Dude”. School Dude is for routine work orders.

•

If you are new or have new staff, School Dude in-service training can be obtained by calling Delia Celaya, Warehouse Secretary at (760) 353-9200 ext. 7032 and she will set up a training time for you.

•

School secretary completes the Work Order and forwards to the Principal for review/approval. The Principal reviews/approves and forwards the Work Order to MOT Director for review/approval. Work order is then forwarded to the Maintenance Supervisor for assignment to the various trades workers.

•

Once the work is completed, you will receive a closed out work order.

Emergency Work Order Requests: Any emergency work repairs (air conditioning, water leaks, power outage) are to be called in to the Warehouse 353-9200 extension 7015 or 7032 for immediate attention. Those repairs do not need a follow-up work order. An Emergency Work Order Form will be completed by Maintenance staff.

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SUPERINTENDENT’S OFFICE CONTACTS: Kathy Lemos, Executive Secretary, (760) 352-5712 ext. 8515 Proof of Residency Forms A copy of this information is included as an attachment in this guide. You can print the one page sheet to share with parents. These forms should be used when a parent doesn’t have proof of residency in their name. There are two forms to choose from. Please read these instructions to determine which form best fits the student’s living situation. *Both of these forms require a notary. This service if provided, free of charge, for our students. The District Notary, Kathy Lemos, is located at District Office #8, 1256 Broadway, El Centro. For an appointment call (760) 352-5712 ext. 8515. Declaration of Residency with Another Family Use this form when the student(s) and their family live in another family’s home, or if the proof of residency documents are not under a parent’s name. Special Instructions: • The person filling out the form must have a proof of residency document (utility bill, home bill or apartment rental contract) in their name. • Do not fil out form below dotted line. • The person named on the proof of residency document must sign in front of Notary. • Person must bring his/her driver’s license, identification card or passport with the form to the Notary. Identification must be current and have a picture. • After completing form, it needs to be turned into the school site. They will ask for the proof of residency and the completed Declaration of Residency with Another Family form before enrolling the student. The same person’s name must be on both documents. Caregiver’s Authorization Affidavit Use this form when the student lives with you and not their parent(s). Special Instructions: • One form MUST be filled out for each student. • This is not a legal custody document. This is just confirmation of student’s main residence. • The person filling out the form must have a proof of residency document (utility bill, home bill or apartment rental contract) in their name. • Do not fill out form below dotted line. • The person named on the proof of residency document must sign in front of the Notary. • Person must bring his/her driver’s license, identification card or passport with the form to the Notary. Identification must be current and have a picture. • After completing form, it needs to be turned into the school site. They will ask for the proof of residency and the completed Caregiver’s Authorization Affidavit form before enrolling the student. The same person’s name must be on both documents 45 | P a g e

Conference Room Request When requesting the use of the Board Room, Milter Conference Room, Parent Center Meeting Room and/or Parent Center Conference Room, you MUST e-mail a request or call Kathy Lemos stating what room you want to reserve, date, time and the name of the meeting. Whoever reserves any of the rooms is required to do the following: 1. Unlock and lock up the room. Turn on and off the lights, set the alarm and close the gates. 2. Empty ALL trash/trash cans in the outside large trash can. 3. Clean and straighten out the room. Do not leave it in a mess. 4. Set up the tables and chairs or any other equipment you will be using. 5. If food is served, you need to throw the trash in the outside trash can. No food is to be left inside any of the rooms. Someone else may be using the room after you, so please clean up after your meeting. If you are using the room and the meeting is going to exceed the time period you requested, you need to contact Kathy immediately. She will let you know if you can continue there or not. Do NOT exceed the time period unless it's been approved. The room may be already reserved. Another reminder, just because the room is empty, does not give you the right to go in and use it without notifying Kathy. Please check with Kathy on its AVAILABLITY. It may be reserved already. REMINDER: It is YOUR RESPONSIBILITY to unlock and lock the door as well as turn on and off the lights and set the alarm. Do not leave the rooms unlocked or with the lights on. If the meeting ends after 3:30 p.m., it is your responsibility to lock the bathrooms also. The custodian is not responsible.

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SPECIAL EDUCATION DEPARTMENT CONTACTS: Janice Lau, Director of Special Education, (760) 352-5712 ext. 8534 Sylvia Hernandez, Senior Secretary, ext. 8533 Esperanza Moreno, Senior Admin. Clerk, ext. 8535 Rachel Fonseca, Admin. Clerk, ext. 8553

Discrimination, Harassment, Intimidation and Bullying Reporting and Investigating Process Flow Chart

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Bullying Logging into DTS Directions for Entering Bullying Investigation in Document Tracking System Logging In 1. Go to www.doc-tracking.com (click ''Client Login'') in the upper right of the screen 2. Enter your username and password ( example provided below) Username: Maria.Smith Password: SMaria 3. Click the ''Login'' button Updating Documents 1. Click on the number under the ''Edit by Sections'' column for the document you would like to edit 2. Click on the title of the section for which you would like to make updates 3. Make updates and click ''Save Data'' in the upper left of your screen 4. Return to the section list by clicking on the number in the ''Edit by Sections'' column 5. Return to the home screen by clicking on the ''Home'' button in the upper-right of the screen * Note: As you make your updates, click ''Save Data'' often Printing Documents/Sections PDF version (print from PDF) • From the Home Screen: Click on the red PDF button in the ''View Document'' column • From a Section Click ''View Current Document'' to see the entire document or, Click ''View Section'' to see the section you're working in

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WAREHOUSE CONTACTS: Molly Diaz, Dir. of Child Nutrition & Warehousing, (760) 353-9200 ext. 7011 Marithza Pasaraba, Senior Admin. Clerk, ext. 7024 Juan Abarca, Reprographics, ext. 7023 Instructional Supplies • • •

Instructional requisitions are required for order supplies from the warehouse. All requisitions must be signed by an administrator prior to the distribution of products. Absence of signature will result in a delay. Supplies will be delivered to your sites. You will be notified if you are awaiting any back order items. These items will be delivered upon their arrival.

WH-10/ WH-11 WH- 10 and WH-11 are used to move items within the district. These forms are found on the ECESD website. 1. Each item should be logged in its own line. 2. If an item is coming to the warehouse for temporary storage, be sure to note on WH-10. Otherwise this item may be given out to another site. 3. Please ensure that all items to be picked up are in a centralized location and location is specified. 4. Items which are broken (example – chair) can be tossed at your site in the waste container. 5. WH-11 is specifically for electronic equipment. Make sure that each item is logged line by line with the serial number and that all equipment are red tagged. Drivers will not pick up any item that is not listed or red tagged. 6. Reminder: In conjunction with WH-10/ WH-11, the warehouse staff has several deliveries throughout the day. On a daily basis they are responsible for food supplies and meal deliveries (3) plus (2) mail runs. Please keep this in mind, their schedules are planned accordingly and anything additional requests may interfere. If you need additional help please be sure to note it on the request otherwise you will need to submit an additional WH-10/WH-11.

Science Kits • • •

Science kits are delivered through the warehouse. A calendar and reminders will be sent out periodically Science Kit pick-ups and deliveries are scheduled in advance. Please have kits ready the day before pick up in the appropriate location. Science kit pick-ups commence at 6 am, if they are not ready your site will be responsible for delivering them to the Science Center to be replenished.

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Reprographics • • •

Complete a “Reprographics request form.” These are intended for large quality copies for your school site/department You may email/scan items to Reprographics for duplicating to [email protected] Please allow 2 weeks for delivery of product.

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LIST OF ATTACHED FORMS

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EL CENTRO ELEMENTARY SCHOOL DISTRICT DISTRICT VEHICLE REQUEST FORM (Revised 7-2017)

Driver's Name Event Name Driving Destination Departure Date

Departure Time

Return Date

Return Time

Budget Code If applicable, list any passengers. If passengers are not employees of ECESD, an Adult Waiver of Liability Form for Participation in School/District Sponsored Activities, needs to be submitted with this request. Non-employee passengers need to be pre-approved by the Assistant Superintendent or Superintendent. Passenger #1 (Name)

ECESD Employee

Yes

Passenger #2 (Name)

ECESD Employee

Yes

Passenger #3 (Name)

ECESD Employee

Yes

Passenger #4 (Name)

ECESD Employee

Yes

Passenger #5 (Name)

ECESD Employee

Yes

No

No

No

No

No

EMAIL OR SEND REQUEST TO DISTRICT OFFICE #3 - MARTA ANGIE SANTILLAN ([email protected]). You will be notified of the arrangements via email.

FOR OFFICE #3 USE ONLY:

Date Request Received

Driver on Approved District List

Yes

Assigned Vehicle

District Car

No (Can't Use Vehicle)

Enterprise Rental Car

Passengers- Are ECESD Employees or we have release forms Mileage or Confirmation #

JE # Yes No (Can't Use Vehicle)

EL CENTRO ELEMENTARY SCHOOL DISTRICT

El Centro Elementary School District

EL CENTRO ELEMENTARY SCHOOL DISTRICT STUDENT RECORDS REQUEST

Return form to ECESD Administrative Services (Office #3) 1256 Broadway, El Centro

In accordance with District Administrative Regulation 5125, authorized persons shall submit a request to the custodian of records to inspect, review or obtain copies of student records. Within five business days, following the date of request, you will be contacted. Please note: A photo ID is required for all records requests. The District charges five cents per copy. When available, electronic records can be delivered via e-mail, free of charge. Student's First Name

Middle Name

Last Name

Name of School Last Attended

Records Requested By (Full Name):

Date of Birth

Last Date Attended (Estimated)

Phone Number:

E-mail Address:

Requestor's Authority to Review Said Students Records (Please choose one): Self, I am over 18 years old. Self, I am a student under the age of 18 attending a postsecondary institution. Parent/Guardian of student who is younger than 18 years old (includes non-custodial parents). Parent/Guardian of an adult student with disabilities who is age 18 years or older and has been declared incompetent under state law. Parent/Guardian of an adult student who is a dependent, as defined in Section 152 of Title 26 United States Code. I hereby authorize El Centro Elementary School District to release all education, medical, social and/or psychological information that has been made a part of the school records regarding the student listed above. I further release ECESD from all liability and claims pertaining to disclosure of the information requested. Signature of Requestor:

I prefer: Hard Copies ($0.05 each) E-mail Delivery (free of charge)

ECESD Office Use Only: Received by: Verification of ID

Date Received Yes No

Date Completed

EL CENTRO ELEMENTARY SCHOOL DISTRICT PUBLIC RECORDS REQUEST

Return form to ECESD Administrative Services (Office #3) 1256 Broadway, El Centro

In accordance with Government Code 6253, any person may request a copy or inspection of any district record that is open to the public and not exempt from disclosure. The District requests that you complete the following form to aid in your request. You will be contacted within, ten business days ,following the receipt of your request. First Name

Last Name

Street Address

Date of Request

City

State

E-mail Address (If requesting electronic delivery of records)

Zip Code

Phone Number

Detailed Description of Records Being Requested:

Signature of Requestor:

I prefer: Hard Copies of Records ($0.05 each) On-site Inspection of Records E-mail Delivery of Records (free)

ECESD Office Use Only: Date Received

Received By: Date Completed

EL CENTRO ELEMENTARY SCHOOL DISTRICT FIELD TRIP INSTRUCTIONS FOR TEACHERS/STAFF 1st. PERMISSION -Teachers must submit a “Field Trip Request Form” to the Principal for approval. This should be done prior to any parent notification or fundraising. 2nd. TRANSPORTATION - If transportation via school or charter bus is needed the following directions need followed; a. Field Trip Transportation for Local Trips i. Teacher should check with the Transportation Department (Martin Barajas) concerning available date(s) for field trip. (760) 353-9200 ext. 7014. ii. Prepared transportation request should be signed by site principal and sent to the Transportation Department two (2) weeks in advance of field trip date. Make sure you are using the latest Transportation Request Form – bottom left-hand date is 7/2017. iii. After field trip is approved by the Transportation Supervisor, the teacher will be notified of approval via fax with a confirmation number. If any changes need to be made (i.e. time of pick up/drop off, date of field trip, etc.) after field trip has been approved, a new request will have to be submitted and original request will be cancelled. iv. Special Instructions: 1. Staff may not request specific drivers. Drivers will be assigned at the discretion of the Transportation Supervisor. 2. If a trip is cancelled at any time, notify the Transportation Supervisor immediately. 3. All stops need to be included on request. DO NOT FAX REQUESTS or call to reserve a bus. Field trip requests faxed to transportation will not be honored. 4. No afternoon field trips will be approved on minimum days or Thursdays. v. Field Trip Fees: 1. Local Field Trip Fee $150.00 (i.e. IV Expo, Research Center, IVC, The Movies, Navy Base, Seeley, Holtville) • Out of Town Fee $300.00 (i.e. Within Valley – Brawley, Calexico, Calipatria, Westmorland, Salton Sea, Wetlands) • Free Local Field Trip for 2017-18 $0 (If included in the Local Control Accountability Plan Budget, each class shall be able to take one local field trip without a bus charge. Each class gets one trip but, must share a ride with another class at their site to qualify for the free trip). b. Field Trip Transportation Chartered Buses i. All charter bus requests MUST be processed through the Transportation Department. ii. Prepared transportation request must be signed and approved by site principal and sent to the Transportation Department at least one (1) month prior to the requested date of trip. Make sure you are using the latest Transportation Request Form – bottom left-hand date is Revised 7/2017. This time (1 month) is needed to obtain the check for the trip, and obtain documentation on the bus and driver. Trips requested for April or May should be submitted as early in the school year as possible in order to secure a reservation. iii. No School or Department may enter into a contract with a bus company. The Transportation Dept. will notify the school of the approved request and provide a confirmation number.

iv. After the charter bus trip is scheduled, the Transportation Department will submit the appropriate documents (Purchase Order) to Fiscal Services to obtain the check for the charter company. You will receive a letter with copies of all appropriate documentation (approved Transportation Request, a copy of the Charter Confirmation, and directions regarding payment. Do not pay the Charter Company directly. A district check will be sent and you will reimburse the District. ALL CHARTER TRIP COSTS ARE TO BE PAID TO THE DISTRICT TWO WEEKS BEFORE THE TRIP OR THE TRIP WILL BE CANCELLED v. The Transportation Department is required to be present at the school site prior to the bus departing. No bus will leave their school site until the Transportation Department has officially cleared the Charter Bus for departure. The Transportation Department will be in charge of obtaining proper documentation from the Charter Company prior to the scheduled departure date. • Copy of S.P.A.B. Certificate (CHP292) • Copy of Certificate of Liability Insurance • Driver’s California Commercial Driver’s License (B)PS w/expiration date • School Bus, S.P.A.B. Certificate w/expiration date • Driver’s Medical Certificate Card w/expiration date (51A) • Driver’s First Aid Card w/expiration date 3rd. FOOD SERVICES – Child Nutrition Services must receive written notification for all field trips regardless if meals are being requested. 1. The Field Trip Notification Form (FS3) can be downloaded from the Child Nutrition webpage 2. Requests should be submitted at least 10 working days prior to field trip for approval. 3. Principal approval is required for all Field Trip Requests. Without a signature the request will be denied. 4. You MUST receive a confirmation number from the Central Kitchen prior to the field trip date. 5. The day of the trip Food Services will provide an ice chest with food and a meal roster. The meal roster must be completed when the meal is served and signed by the teacher. • School sites will be charged for the cost of lost or damaged ice chest, and for incomplete meals when rosters are not completed and returned. 4th. PARENT NOTIFICATION – Parents should be receiving AT LEAST two forms of notification about a planned field trip. a. Parents should receive a note from the teacher at least 30 days prior to the field trip. This should explain the trip and that the parents have the option of driving their students back from a field trip but, not to a field trip location. This is a District Policy, only the Superintendent can approve a parent to bring their child to a field trip location. In order to pick up their child after a field trip parents must complete the “Release form for Transportation of Students by Parents/Guardians After Field Trips.” Parents need to be notified of this early because it can take two weeks to process the form. The form can be found at www.ecesd.org – under parents. b. Field trip permission slips (You must use the District form for liability reasons) and slips for chaperones (Adult Participation Form). These should be sent home at least two weeks in advance and must be collected in order for the student and/or chaperone to participate in the field trip. 5th.

FIELD TRIP CHECKLIST - Make sure you have these items the day of the trip! • Completed Student Permission Slips for all students attending. • Emergency Cards and any list of medications for students. • Food and meal rosters. • Completed Adult Participation Forms for chaperones.

1st- Field Trip Request Submitted to Principal Use Field Trip Approval Form

2nd- Will you need Transportation (school bus or charter)?

Complete as soon as you If yes, there is a detailed are planning the trip. process. Review District directions (attached).

3rd- Is the field trip during breakfast and/or lunch time? 4th- Parent Notification

If yes, complete the Child Complete as soon as you Nutrition Field have a date to verify Notification Trip form. 1st Notice- Parents availability! Complete at least 2 should be notified 30 weeks in advance. days prior.

If Parents want to drive Review District directions their student AFTER the field trip, they need to on this (attached) complete the Release Form two weeks in advance. 2nd Notice- Field Trip Permission slips need to be sent home 2 wks in advance. If there are chapaones, they need to complete an Adult Participation Form. Created 7/2017

5th- Field Trip Check List Student Permission Slilps for all students attending. Emergency cards or list Medications Meal Rosters (if food is being taken) Completed Adult Waiver of Liability Form

Field Trip Approval Form Number of Students Attending:

Name of Teacher (s) Attending:

Field Trip Destination:

Anticipated Date of Field Trip:

City:

Will this be an overnight trip? (Requires Supt. Approval)

Yes

Will this trip be during meal times?

Yes

No

Will this be on a regular school day?

No How will this trip be funded (fundraising, grant, etc.)?

What educational purpose will this trip provide?

Planned source of transportation:

Principal's Signature Approved Additional Comments:

Denied

Yes No

El Centro Elementary School District - Transportation Request Submit requests for pupil transportation to the Transportation Supervisor. District Bus Requests will need to be submitted two weeks in advance and Charter Bus Requests will need to be submitted four weeks in advance of the day the bus is needed. DO NOT FAX REQUESTS. PART I - SCHOOL SITE School Site

Date

Date of Trip

Requested by:

Destination # to be Transported

# of Buses Needed

Request Type

For Charter Bus: Teacher Cell #

District Bus

Free Trip

Charter Bus

Chaperones

Departure Time

Departure Location

Return Time

Return Location

Pick-up Time from Destination

School Funding/Payment Source

Special Instructions (Additional stops will not be made unless indicated below):

Justification Principal's Signature of Approval

Date

Trans. Supervisor Signature

PART II - TRANSPORTATION DEPARTMENT USE ONLY

Revised 7/2017

Date

EL CENTRO ELEMENTARY SCHOOL DISTRICT PRE-TRIP SAFETY INSTRUCTIONS

Date: ______________________ Name and Location of School: ____________________________________________________ California Education Code Section 39831.5 states: Prior to departure on a school activity trip, all pupils riding on a school bus or school pupil activity bus shall receive safety instruction which includes, but is not limited to, location of emergency exits, and location and use of emergency equipment. Instruction also may include responsibilities of passengers seated next to an emergency exit. Names of supervising adults (Teachers/Others): _____________________________________________________ ______________________________________________________________________________ SUBJECTS COVERED: ___ Explanation on how to use emergency, rear and side exits, entrance doors, emergency windows, and roof hatches. ___ Explanation on how to use and location of the fire extinguisher, first-aid kit, and reflectors and purpose of each. ___ Explanation on how to turn ignition switch off, and how to set the emergency brake. ___ Other if any: ______________________________________________________________________________ ____________________________________________________________________________________________ Bus Driver Name: ______________________________________ Bus Number: __________________________________________ Number of students and grade level: _______________________ Further remarks if any: _________________________________________________________________________ ____________________________________________________________________________________________

FS 3 FORM

revised 08/04/15

FIELD TRIP NOTIFICATION FORM

DATE OF TRIP / /

THIS FORM MUST BE SUBMITTED EVEN IF NO MEALS ARE BEING REQUESTED THIS FORM IS ALSO AVAILABLE ON THE ECESD WEB PAGE MUST REQUEST 10 DAYS PRIOR

SCHOOL

TEACHER(S)

NUMBER OF STUDENTS ATTENDING FIELD TRIP : ARE YOU REQUESTING MEALS FOR THIS TRIP?

YES

NO

PRINT NAME OF PERSON COMPLETING REPORT :

STUDENT MEALS

*THE NUMBER OF MEALS OFFERED CANNOT EXCEED THE NUMBER OF STUDENTS ATTENDING FIELD TRIP

*TOTAL BREAKFASTS NEEDED:

*TOTAL LUNCHES NEEDED:

IMPORTANT NOTICE:

THE TEACHERS FOR EACH CLASS ARE RESPONSIBLE FOR POINT OF SERVICES MEAL COUNTS. A ROSTER THAT CONTAINS THE NAMES OF EVERY STUDENT WHO IS SERVED A BREAKFAST AND/OR LUNCH MUST BE SUBMITTED TO THE CENTRAL KITCHEN THE WORKDAY FOLLOWING THE TRIP. IF THE REQUIRED ROSTER IS NOT SUBMITTED, THE SCHOOL WILL BE BILLED $2.50 FOR EACH MEAL DELIVERED.

ADULT MEALS

IMPORTANT - ADULTS MAY NOT EAT MEALS PREPARED FOR STUDENTS.

NUMBER OF ADULT BREAKFASTS NEEDED:

AT $2.00 EACH =

$

NUMBER OF ADULT LUNCHES NEEDED:

AT $3.00 EACH =

$

TOTAL COST FOR ADULT MEALS:

$

PAYMENT FOR ADULT MEALS MUST BE MADE PRIOR TO THE DATE OF THE TRIP. CAFETERIA PERSONNEL WILL GLADLY ACCEPT PAYMENT FOR ADULT MEALS.

DELIVERY INSTRUCTIONS DELIVERY TIME:

AM PM

LOCATION:

SCHOOL KITCHEN

TEACHER SIGNATURE(S) EACH TEACHER ATTENDING MUST SIGN x ______________________________________________________________________ x ______________________________________________________________________ x ______________________________________________________________________ x ______________________________________________________________________ PRINCIPAL'S SIGNATURE x ______________________________________________________________________ IF YOU DO NOT RECEIVE A CONFIRMATION NUMBER , CALL 353-9617 EX 7012 OR 7010 TO CONFIRM RECEIPT

DATE _________________ DATE _________________ DATE _________________ DATE _________________

DATE _________________

CONFIRMATION #: DATE:

* There will be a service charge of $40 to school site per each lost or damaged ice chest _______________________________ _________________________________ _____________________ Teacher Signature Print Name Date I certifiy and acknowledge the process of the completing appropriate paper work (Rosters) for field trip meals.

EL CENTRO ELEMENTARY SCHOOL DISTRICT Parent Consent and Waiver Form for Field Trips

In accordance with District Administrative Regulation 6153. Before a student can participate in a school-sponsored trip, the teacher shall obtain parent/guardian permission for the trip. Whenever a trip involves water activities, the parent/guardian shall provide specific permission for his/her child to participate in water activities. The District shall provide an alternative educational experience for students whose parents/guardians do not wish them to participate in the trip. Donations may be requested for field trips to cover costs. Donations are voluntary and students shall not be excluded from trip based on receipt of donation. However, teachers have the discretion to cancel trips due to lack of funds.

School Name Certificated Person in Charge of Trip

Contact Information

Trip Destination Address Departure & Return Time

Date Donation Request: Trip Activities

Water Activities?

No Yes

Special Instructions (Dress or Items Recommended):

I grant permission for the student named below to attend the field trip described on this form. I understand, pursuant to Education Code 35330, all persons making the field trip, including students, shall be deemed to have waived all claims against the School District or State of California for injury, accident, illness or death occurring during or by reason of the field trip. Parents or guardians of pupils taking field trip shall sign below waiving such claims. *Upon parent/guardian request, a sack lunch can be provided to students for trips that occur during lunch. Charges for these lunches are based on the students meal application status of free, reduced or full price.

Student First Name My child needs a lunch provided: Emergency Contact Parent/Guardian Printed Name

Student Last Name No Yes

I am willing to chaperone. (If chaperones are needed, you will be contacted): Phone Number Parent/Guardian Signature

No Yes

EL CENTRO ELEMENTARY SCHOOL DISTRICT

Consentimiento de los padres y formulario de renuncia para viajes

De acuerdo con el Reglamento Administrativo del Distrito 6153, antes de que un estudiante pueda participar en una excursión patrocinada por la escuela, el maestro deberá obtener permiso del padre/tutor para la excursión. Cada vez que un viaje implique actividades de agua, el padre/tutor deberá presentar autorización específica para que su hijo/a participe en las actividades de agua. El distrito deberá proporcionar una experiencia de educación alternativa para los estudiantes cuyos padres no deseen que participen en la excursión.Donaciones pueden ser solicitadas para cubrir los costos de viajes de campo. Las donaciones son voluntarias y los estudiantes no seran excluidos del viaje basado en el recibo de la donacion.

Escuela Persona encargada de viaje

Informacion de contacto

Destino del viaje Dirreccion Hora de salida/regreso

Fecha Solicitud de donación Actividades

Actividades de agua?

No Si

Instrucciones especiales:

Yo doy permiso para que el estudiante nombrado arriba asista al viaje descrito en esta forma. Yo entiendo, de acuerdo con el Código de Educación 35330, que todas las personas que hacen la excursión, incluyendo a los estudiantes, se consideran haber renunciado a todo reclamo contra el Distrito Escolar o el Estado de California por lesión, accidente, enfermedad, o muerte que ocurra durante o por motivo de la excursión. Todos los adultos o padres tutores de los estudiantes tomando el viaje deberán firmar abajo renunciando a tales reclamos.

Nombre del estudiante Mi hijo necesita que se le proporcione almuerzo: Contacto de emergencia Nobre impreso del padre

Apellido del estudiante No Si

Estoy dispuesto a acompanarlos (si se necesitan acompanates, usted ser contactado):

Numero de telefono Firma del padre

No Yes

EL CENTRO ELEMENTARY SCHOOL DISTRICT Voluntary School Activities Participation Form

School Name Supervising Employee

Activity Contact Information

Beginning Date

Ending Date

Will student travel by District transportation during the course of activity? Yes, parent should be provided a copy of travel schedule No I understand and acknowledge the following: (1) These activities, by their very nature, pose the potential risk of serious injury/illness to individuals who participate in such activities. (2) That some injuries/illnesses that may result from participating in these activities include, but are not limited to the following: sprains, strains, fractured bones, unconsciousness, head and/or back injuries, paralysis, loss of eyesight, communicable diseases and death. (3) That participation in these activities is completely voluntary and as such is not required by the District. (4) That in order to participate in these activities, I agree to assume liability and responsibility for an and all potential risks that may be associated with participation in such activities. (5) I agree that the District, its employees, officers, agents or volunteers shall not be liable and I hereby waive, release, and discharge them from any future claims, demands, obligations, or causes of action for any injury/illness or property damage suffered by my child arising as a result of engaging or receiving instruction in said activity or any activity that is incidental thereto. (6) I have the option to purchase student insurance through Pacific Educators Insurance Services at www.peinsurance.com/ sign-up. Brochures are available on the District website www.ecesd.org under parents. (7) Parents who wish to pick up their child from an off-site event (game or performance) will need to complete the District's "Release Form for the Transportation of Students After Field Trips." This form can be found on the website www.ecesd.org under Parents. (8) ECESD prohibits discrimination based upon race, color, ancestry, national origin, ethnic group identification, age, religion, marital or parental status, physical or mental disability, sex (sexual harassment), sexual orientation, gender, gender identity or expression, or genetic information; the perception of one or more of such characteristics; or association with a person or group with one or more of these actual or perceived characteristics. Copies of policies can be obtained at the Office of Human Resources, 1256 Broadway, El Centro, CA. For questions, please contact the Associate Superintendent (Title IX Coordinator) at 1256 Broadway, (760) 352-5712 extension 8522. (9) The ECESD Board of Trustees's expects that students adhere strictly to all safety rules, regulations, and instructions, as well as rules and guidelines related to conduct and sportsmanship. (10) In accordance with Board Policy 6145, students in grades 7-8 must meet educational and behavioral expectations in order to participate in extracurricular activities. At a bare minimum students must have a 2.0 grade point average. Additional requirements, if any, shall be communicated with the student and parent in the "Student Athlete Agreement." I acknowledge that I have carefully read this form. I grant permission for my child to participate in this school activity and, if applicable, to travel by District transportation.

Student First Name

Student Last Name

Emergency Contact

Phone Number

Parent Printed Name

Parent Signature

EL CENTRO ELEMENTARY SCHOOL DISTRICT Escuela Voluntarias Actividades Solicitud de Participación

Nombre de Escuela

Empleado Supervisor

Actividad Fecha de Comienzo

Información del contacto

Fecha de Finalización

¿El estudiante viajara en el transporte del Distrito durante el curso de la actividad? Sí, padre debe proveersele una copia del itinerario de viaje No Entiendo y reconozco lo siguiente: (1) Estas actividades, por su propia naturaleza, plantean el riesgo potencial de lesión / enfermedad grave para las personas que participan en estas actividades. (2) Que algunas lesiones / enfermedades que pueden derivarse de la participación en estas actividades incluyen, pero no se limitan a lo siguiente: torceduras, esguinces, fracturas de huesos, pérdida del conocimiento, la cabeza y / o lesiones en la espalda, parálisis, pérdida de visión, enfermedades transmisibles y la muerte. (3) Que la participación en estas actividades es completamente voluntaria y, como tal, no es requerido por el Distrito. (4) Que con el fin de participar en estas actividades, estoy de acuerdo en asumir la responsabilidad y la responsabilidad de una y de todos los posibles riesgos que pueden estar asociados con la participación en este tipo de actividades. (5) Estoy de acuerdo en que el Distrito, sus empleados, funcionarios, agentes o voluntarios no será responsable y por la presente renuncia, liberación y descargarlos desde cualquier futuro reclamo, demanda, obligaciones, o causas de acción de cualquier lesión / enfermedad o daños materiales sufridos por mi hijo que surga como resultado de su participación o recibir instrucción en dicha actividad o cualquier actividad que conlleva de las mismas. (6) Tengo la opción de adquirir un seguro del estudiante a través del Pacífico Educadores Servicios de aseguramiento en www.peinsurance.com/sign-up. Los folletos están disponibles en el sitio web del Distrito de www.ecesd.org bajo padres. (7) Los padres que deseen recoger a sus hijos de un evento fuera de sitio (juego o el rendimiento) tendrá que completar el Distrito de "Formulario de Autorización para el transporte de los estudiantes después de los viajes de campo." Este formulario se puede encontrar en la página web bajo www.ecesd.org padres. (8) ECESD prohíbe la discriminación basada en la raza, color, ascendencia, origen nacional, identificación de grupo étnico, edad, religión, estado civil o de paternidad, incapacidad física o mental, el sexo (acoso sexual), orientación sexual, género, identidad de género o expresión , o información genética; la percepción de una o más de tales características; o asociación con una persona o grupo con una o más de estas características reales o percibidas. Las copias de las políticas pueden obtenerse en la Oficina de Recursos Humanos, 1256 Broadway, El Centro, CA. Si tiene alguna pregunta, por favor, póngase en contacto con el Superintendente Asociado (Coordinador del Título IX) en 1256 Broadway, (760) 352-5712 extensión 8522. (9) El Consejo de Administración de ECESD espera que los estudiantes se adhieran estrictamente a las normas de seguridad, reglamentos e instrucciones, así como las normas y directrices relacionadas con la conducta y deportividad. (10) De acuerdo con la Política de la Junta 6145, los estudiantes en los grados 7-8 deben cumplir con las expectativas educativas y de comportamiento con el fin de participar en actividades extracurriculares. En un mínimum las estudiantes deben tener un promedio de 2.0. Los requisitos adicionales, si los hubiere, se comunicarán con el estudiante y el padre en el "Acuerdo del estudiante atleta." Reconozco que he leído cuidadosamente este formulario. Doy permiso para que mi hijo participe en esta actividad escolar y, en su caso, para viajar en el transporte del Distrito.

Nombre del Estudiante

Apellido del Estudiante

Contacto de emergencia

Número de teléfono

Nombre del padre

Firma de los padres

EL CENTRO ELEMENTARY SCHOOL DISTRICT RELEASE FORM FOR THE TRANSPORTATION OF STUDENTS BY PARENTS/GUARDIANS AFTER FIELD TRIPS

In accordance with District Administrative Regulation 6153. These are the procedures for parental/guardian release for private transportation on school-sponsored field trips. * Student(s) must take District transportation TO the field trip in order to participate. * Student(s) may leave with parent after the field trip, if this release form been completed and approved. * The approval process is as follows: 1. The parent completes this form and turns it in with a valid driver's license and proof of insurance to their student's school site at least 5 days prior to the trip. 2. The school Principal or Designee will verify the required documents and sign the form. 3. A copy of the approved form will be given back to the parent. The parent will need to provide the copy to the teacher when picking up the student from the field trip. The Superintendent or Superintendent's Designee has the authority to override aspects of the field trip policy for extenuating circumstances.

Student Name School Name:

Teacher Name

Field Trip Location

Date

I hereby certify that I am the parent/guardian of the student mentioned above. I am voluntarily choosing to pick-up my child from the above mentioned field trip location. By signing this statement, I am releasing El Centro Elementary School District of any and all liability that may arise as a result of transporting my child. Parent/Guardian Name (Printed) Parent/Guardian Signature

Documentation to be verified by School Site Staff: Principal/Designee Signature

Date

Copy of Valid Driver's License Proof of Insurance Date Approved

*Provide a copy of the approval form to the parent/guardian prior to the field trip. This will need to be provided to the teacher before releasing the student.

EL CENTRO ELEMENTARY SCHOOL DISTRICT

FORMULARIO DE LIBERACIÓN PARA EL TRANSPORTE DE ESTUDIANTES POR LOS PADRES/TUTORES DESPUÉS DE EXCURSIONES

En conformidad con el Reglamento Administrativo del Distrito 6153. Estos son los procedimientos para la liberación de los padres/tutores para el transporte privado en las excursiones patrocinadas por la escuela. *El estudiante (s) debe tomar el transporte del distrito para el viaje de campo a fin de participar. *El estudiante (s) podrá regresar con los padres después de la visita de campo, si esta forma de liberación ha sido completada y aprobada. *El proceso de aprobación es el siguiente: 1. El padre completa este formulario y lo entrega con una licencia de conducir válida y comprobante de seguro a la escuela de sus hijos por lo menos 5 días antes del viaje. 2. El Director de la escuela o persona designada verificarán los documentos requeridos y firmarán el formulario. 3. Una copia del formulario aprobado será devuelto a los padres. El padre tendrá que proporcionar la copia al maestro al momento de recoger al estudiante de la excursión. El Superintendente o persona designada por el Superintendente tiene la autoridad para anular los aspectos de la política de excursión por circunstancias atenuantes.

Nombre Del Estudiante Nombre del Escuela:

Maestro/a

Lugar de la excusion

Fecha

Por la presente certifico que soy el padre/tutor del estudiante mencionado anteriormente. Estoy voluntariamente eligiendo recoger a mi hijo del lugar de la excursión mencionada. Al firmar esta declaración, estoy liberando al Distrito Escolar de El Centro de toda y cualquier responsabilidad que pueda surgir como consecuencia del transporte de mi hijo. Padre/Tutor (Nombre impreso) Padre/Tutor (Firma)

Documentación que deberá verificarse por la Escuela con el Administrador: Firma del director/ persona designada

Fecha

Copia de licencia de conducir valida Comprobante de seguro

Fecha Approbado

* Proporcionar una copia del formulario aprobado a los padres/tutores antes del viaje de excursión.

EL CENTRO ELEMENTARY SCHOOL DISTRICT Adult Waiver of Liability Form Participation in School/District Sponsored Activities

School Name ECESD Employee in Charge of Activity

Contact Information

Name of Activity Location of Activity Date of Activity

Departure & Return Time

I, the undersigned participant, am requesting participation in the activity listed above. In consideration of my participation in the activity, I hereby waive, release, hold harmless, and discharge the El Centro Elementary School District, its officers, directors, employees, and agents, all of which are collectively hereinafter referred to as “the District,” from all claims, causes of action, or liability against arising out of my participation in the activity, including for damage or injury to property or persons, attorney’s fees, and other related costs and expenses, and even though such claims may arise out of negligence or carelessness on the part of the District. Knowing, understanding, and fully appreciating all possible risks, I hereby expressly, voluntarily, and willingly assume all risks and dangers associated with my participation in this activity. Some of the risks and dangers are listed below. I understand this list is not exhaustive. Common risks include: Travel to and from home and activity meeting location, overnight stay, food poisoning, theft, car accident, pedestrian accident, tripping, slipping, falling, etc. I have read this waiver/release and understand the terms used in it and their legal significance. This waiver and release is freely and voluntarily given with the understanding that the right to legal recourse against the District is, knowingly, given up in return for allowing my participation in the activity. My signature on this document is intended to bind not only myself but also my successors, heirs, representatives, administrators, and assignees.

Participant's Full Name

Phone Number

Address (Street/City/Zip) Emergency Contact Participant's Signature

Phone Number Date

EL CENTRO ELEMENTARY SCHOOL DISTRICT

Adultos exención de responsabilidad forma participación en la Escuela/Distrito patrocinados por actividades

Nombre de la Escuela ECESD Empleado a cargo de la actividad

Información de contacto

Nombre de la actividad Ubicación de la actividad Fecha de la actividad

Salida y tiempo de retorno

Que, el participante abajo firmante, solicito la participación en la actividad mencionada anteriormente. En la consideración de mi participación en la actividad, por la presente renuncia, liberar, eximir y descarga el distrito escolar elemental del Centro, sus oficiales, directores, empleados y agentes, que son colectivamente en lo sucesivo denominado "el distrito", de todos los reclamos, causas de acción o responsabilidad contra que surja de mi participación en la actividad, incluyendo daños o lesiones a personas u , honorarios de abogados y otros relacionados con los costos y gastos, y aunque tales demandas pueden surgir por negligencia o descuido por parte del distrito. Conocer, entender y apreciar completamente todos los riesgos posibles, por la presente expresamente, voluntariamente y voluntariamente asumo todos los riesgos y peligros asociados con mi participación en esta actividad. Continuación se enumeran algunos de los riesgos y peligros. Entiendo que esta lista no es exhaustiva. Riesgos comunes incluyen: viajar a y del hogar y lugar de reunión de la actividad, permanecer durante la noche, intoxicación alimentaria, robo, accidente, accidente peatonal, tropezar, resbalar, caer, etc.. He leído esta renuncia/liberación y entender los términos utilizados y su significado jurídico. Esta renuncia y liberación es libre y voluntariamente dada con el entendimiento de que es el derecho a un recurso legal contra el distrito, a sabiendas, dado para arriba a cambio de permitir mi participación en la actividad. Mi firma en este documento se pretende enlazar no sólo yo sino también mis sucesores, herederos, representantes, administradores y cesionarios. Nombre completo del participante

Número de teléfono

Dirección (calle, ciudad, código postal) Contacto de emergencia Firma del participante

Número de teléfono Fecha

ECESD- ASB FUNDRAISER PROCESS

EL CENTRO ELEMENTARY SCHOOL DISTRICT ASB - FUNDRAISING EVENT REQUEST

School Name

Event Organizer

Proposed Event

Detailed Description

Proposed Date(s) of Event Location of Event Budget Plan for Event

*Attach Fundraising event flyer that will be sent to parents and/or the community. Signature of Organizer

Date Submitted

FOR OFFICE USE ONLY: Date Request Received Principal's Decision

Received By:

Approved Denied

Principal's Signature

Quicken Reference Guide 2017 - 2018

Adding Class Accounts….………..………….………………………..……………………………………………………...………2 Entering Payments…………….....……………………….………………..…….…………………………………….……………..5 Entering Deposits……………………………………………………..……………………………………………………………….7 Split Transaction…………………………………………………………………………………………………………………………8 Cancelling Checks……………………..…………………………………………………………………………………………………9 Reconciling Accounts…………………………………………………………………………………………………………………..10 Transferring Between Accounts….…………………………………………………………………………………………….…15 Closing Accounts…………………………………………………………………………………………………………………………16

1

Adding Class Accounts Setting up Teachers Accounts 1. Class Account Options (click on business then right click the following options open).

2

1. ENTER ACCOUNT NAME (TEACHERS NAME/GRADE ETC.)

3

2. Enter beginning balance

3. Click on NO- no loans on this account

4. Click NEXT when done

4

Entering a Payment 1. ENTERING A VENDOR PAYMENT CHOOSE THE MAIN BANKING ACCOUNT

2. *****ENTER IN LAST LINE HIGHLIGHTED IN YELLOW 3. NUM: Check #

5

4. PAYEE: Who is the check written to 5. CATEGORY: THERE WILL BE A POP-UP SCREEN CLASS ACOUNTS WILL BE UNDER CATEGORY – TRANSFERS

6. 7. 8. 9.

TAG: Leave Blank MEMO: Optional Text – Notes PAYMENT: Dollar Amount Click on ENTER when finished

6

Entering Deposits EXAMPLE OF HOW TO ENTER A DEPOSIT BY DELGADO AND A CHECK FOR DJ SERVICES PAID BY CALOCA.

1. 2. 3. 4. 5. 6.

Select Deposit Dated to match bank statement Enter Check # or Cash PAID BY: Who is the deposit from PAYMENT: Key in Check Amount or Cash CATEGORY: ENTER: when finished

7

Split Transaction

1. Click on SPLIT: 2. Drop down arrow

3. Pop-up window will display list of accounts

Ok …then SAVE 8

Canceling Checks 1. CANCEL A CHECK THAT IS STALE DATED OVER 6 MONTHS 2. FIND THE CHECK AND RIGHT CLICK CHOOSE VOID TRANSACTION. 3. OK when done.

9

Reconciling Accounts 1. Click on Account then Tranasctions Tab

2. To the right, click under the Account Actions drop down arrow, click Reconcile

1.

2.

10

3.

Key in Ending Balance from Statement. Dates should match as well.

*In this pop-up, you can add an service charges are interest earned which will reflect on your statement *Click OK when finished

11

4. Next, check on the left of the transactions which have cleared.

*Verify that difference. This should be ZERO

13,627.29 13,627.29 0.00

12

5. Once complete, click on YES to back up your files

6. Name report Site/Month/Year

Make sure date is same as bank statement then OK

13

7. Print your report as back-up and attach to your bank statement

14

Transferring between Accounts Carryover funds can be carried over for a project in a new year 1. Click on Business 2.

When initial balance is closed at zero, you can hide the existing accounts but DO NOT DELETE.

15

Closing Accounts

16

Chapter 14

Chapter 14 – Allowable and Questionable Expenses

Anything purchased by a district must be in compliance with the law and local board policy, and cannot be considered a gift of public funds. Because ASBs are part of the district, ASB organizations must follow the same laws and local policies, as well as ensure that the funds are spent appropriately. The principal/school administrator and ASB advisors are responsible for ensuring that ASB funds are used to purchase goods and services that promote the students’ general welfare, morale and educational experiences. In general, ASB expenses that meet these criteria are allowable if they are directly linked to the students’ benefit. With few exceptions (such as awards and scholarships, which are discussed later in this chapter), ASB expenditures will benefit a group of students rather than individuals. The expenditures must also be for goods and services other than those the school entity should provide from its own funding sources. Thus if the expenditure is the district’s responsibility, or the district has paid for the expenditure in the past, or the ASB is being asked to pay for the item or service because of district budget cuts, it is probably not an allowable ASB expenditure. The district is responsible for the curriculum of the class or program; ASBs are supposed to pay for extras, meaning items in addition to the regular curriculum. In high schools, middle schools and community colleges, the students should be the primary authority that decides how the ASB funds are spent. This helps ensure that the interests of the students are protected. In elementary schools, the students are often not involved in the decision-making and operations. Regardless of the school type, the principal/school administrator or designee is responsible for protecting the interests of the students and ensuring that the funds are spent for their benefit. Although the primary decision maker may vary depending on the type of ASB, the types of expenditures that should be made with ASB funds remain the same for all ASBs. Questions often come up about whether an item is an appropriate use of ASB funds. In these instances, the principal/school administrator or the ASB advisor should contact the appropriate staff in the district business office for guidance.

Examples of Allowable Purchases Following are some examples of the many types of items generally considered allowable expenses from ASB funds. These examples include frequently questioned items; they do not include obviously appropriate ones, such as supplies for a student store, school photos, or a disc jockey or decorations for a school dance. These and similar expenditures that enhance students’ educational experience and are directly linked to the students’ benefit are other than what the school entity must provide from its general funding sources. The following are examples of appropriate expenditures using ASB funds: • Magazines and newspaper subscriptions for student use • Playground equipment • Library books • Supplemental equipment for student use that is not normally provided by the school entity, such as telescopes and aquariums • Field trips/excursions and outdoor education/science camps • Extracurricular athletic costs, including costs for ticket sales, game officiating and security • Costs for student social events • Scholarships (under specific circumstances) • Awards, if there is a district policy allowing them



Chapter 14 – Allowable and Questionable Expenses

185

• Substitute teacher, if the teacher’s absence is due to an authorized ASB activity • Indirect charges

Examples of Prohibited Purchases Expenditure of student funds for the following items is not usually allowable because they do not directly promote the general welfare, morale or educational experience of the students, or are considered a district responsibility, or do not benefit a group of students (with some exceptions), or are a gift of public funds: • Salaries or supplies that are the responsibility of the district. Some examples are teachers’ salaries and negotiated stipends, curriculum supplies, and office supplies and equipment. However, substitute teachers’ pay may be allowed if they are substituting because of an ASB-related activity. • Repair and maintenance of district-owned facilities and equipment. An exception might exist for equipment that the ASB donated to the district and for which the donation agreement includes a provision that the ASB will maintain the donation in the future, including paying for any repair, maintenance or replacement. • Permanent buildings • Articles for the personal use of district employees • Expenses for staff meetings • Expenses for faculty meetings • Expenses for booster clubs, foundations, auxiliary organizations and other parent-teacher organizations • Large awards, unless board policy states otherwise • Gifts of any kind • Employee appreciation gifts or meals • Employee clothing/attire • Donations to other organizations, except in special circumstances • Donations to families or students in need • Cash awards to anyone, because internal controls cannot be established and documented, unless a district’s board policy allows such awards (FCMAT does not recommend this). Because student body funds are to benefit students as a group and not individuals, awards and scholarships generally are discouraged but are allowable as discussed later in this chapter. Questions often arise about the giving of gifts, which has a personal as opposed to public character. Contrary to what often occurs in the field, gifts are not allowable, even if the amount is small. Gift certificates are ordinarily characterized as gifts of public funds even when purchased for an event with a public purpose, because they confer a tangible private benefit on an individual. To avoid making a gift of public funds with gift certificates, ask merchants or individuals to donate gift certificates. Although some school administrators may feel that the school or district benefits from positive relationships established by sending gifts to students, parents, board members or others, the real public relations value is of primary benefit to the respective individual leaders involved, not to the school entity itself as an institution. If students want to give gifts, use private funds, not public funds. Discussions regarding gifts often conclude that trivial or insignificant gifts are acceptable. However, given modern governmental accounting practices and regulations, conflict of interest law and criminal law, FCMAT’s recommendation is that such expenditures of public funds or use of public funds in any amount 186

Associated Student Body Accounting Manual, Fraud Prevention Guide and Desk Reference

can never be considered trivial or insignificant. The law clearly regards the misappropriation of public funds as a criminal act, with no minimum monetary limit specified, so it is best to avoid gifts of any amount.

Donations Donations to nonprofit organizations and students or families in need usually are not allowable because they are considered a gift of public funds, no matter how worthy the cause. ASB funds are legally considered public funds because they are raised through the district’s tax identification number and under its nontaxable status. In general, fundraising that occurs on campus should be for the benefit of the ASB and not for other organizations. However, a student group may organize a fundraiser to support an outside organization such as a charity as long as the fundraising event is clearly identified as raising funds to donate to that charity. All donations should be in the form of checks made payable to the charity and should be picked up by or delivered directly to the charity so that funds are not deposited into the ASB account. If it is not possible to have the checks made directly to the outside organization, open a trust account within the ASB specifically for these donations (with district governing board approval), then write a check to the organization and close the account when the fundraiser is over. It is crucial to ensure that the district’s governing board (not its designee) approves this fundraiser and that all paperwork associated with the fundraiser clearly documents that the only funds donated to the outside organization were those raised for that specific purpose. No funds from other clubs, inactive accounts, or fundraisers not approved by the governing board should be donated to outside organizations. Another viable option is to work with a parent group that has its own tax identification number and sufficient internal controls and ask them to operate the fundraiser because groups such as this are not subject to the rules regarding gifts of public funds. Many schools, especially elementary schools, like to hold what is often called a penny drive, during which students put collected pennies or other coins in jars and the money is then given to a designated charity. These are allowable but should be limited in their frequency, and the coin jars must be kept secure. Rather than depositing coins directly into the ASB account, ask the bank to count and issue the money directly to the charity, or use a coin counting machine. If the funds will be deposited into the ASB account, ensure that the governing board has approved the fundraiser. This is because if the governing board has determined that a specific expenditure will benefit the education of students by approving it, they have justified the expenditure as serving a public purpose and thus the expenditure is not considered a gift of public funds in the eyes of most courts. The normal rules regarding prior approval apply to donation disbursements: as with all ASB expenditures, the approval should be documented using the expenditure approval form signed by the student representative, advisor and principal/school administrator, and noted in the club meeting minutes. Under no circumstance should student groups donate funds to an individual needy student or family, or use school equipment for a charity fundraising drive. Those donations are not tax-deductible unless a legal foundation has been established for that student or family. The issue of a gift of public funds arises when a check is written from ASB and given or donated to another organization. This is why a food or can drive is allowable: rather than money from the ASB being used for the charity, students bring food from home to donate to the charity.

Scholarships As discussed in Chapter 8, the student council may accept scholarships and trusts from outside donors (individuals or organizations) with the approval of the governing board or authorized designee. The acceptance should be made in writing and should clearly describe all the conditions the donor is requesting. These funds should be accounted for separately in a trust account within ASB and used specifically for scholarships. If the donor does not establish criteria for award of the scholarship, the principal/school administrator should work with a committee that includes at least one student representative to determine

Chapter 14 – Allowable and Questionable Expenses

187

the criteria for the scholarship. A donor may not donate toward a specific student’s scholarship. If a donor wishes to fund a specific student’s higher education, the donor should transact directly with the student; such donations are not tax-deductible. Scholarships paid from student body fundraisers rather than from outside donations are normally not allowable because they do not benefit a group of students. School district governing boards may sometimes approve fundraisers specifically to raise scholarship funds, or may approve a club whose sole purpose is to raise scholarship funds. If governing board approval has been received, a separate trust account should be opened within the ASB specifically for these donations, with board approval, and then closed after the scholarship(s) are paid. It is critical to ensure that the board approves this fundraising and to clearly document that the only funds raised for scholarships are those that were fundraised and paid out for that specific purpose. No funds from other clubs or accounts should be used for scholarships. If scholarships are to be allowed, the district should set guidelines regarding how many will be allowed annually. There should be established selection criteria for all scholarships. Cash awards are not allowed; rather, scholarship checks should be made payable to an institution of higher learning or a college bookstore, to be used toward tuition or books and supplies. The normal rules regarding prior approval also apply to scholarship disbursements: as is the case with all ASB expenditures, the approval should be documented on the expenditure approval form by the signatures of the student representative, advisor and principal/school administrator, and noted in the club meeting minutes.

Awards Education Code section 44015 authorizes school districts to make awards to employees for exceptional contributions and to students for excellence. If items are intended as some form of employee or student award, it also requires the governing board to adopt rules and regulations concerning such awards. Such awards shall not exceed $200 unless a larger award is expressly approved by the governing board. Awards to community members, parents or volunteers are not considered authorized because they are not included as allowable in the Education Code. To award to employees for exceptional contribution, the governing board of a school district must find that the employee did one or more of the following: • Proposed procedures or ideas that thereafter are adopted and effectuated, and that resulted in eliminating or reducing district expenditures or improving operations. • Performed special acts or special services in the public interest. • By their superior accomplishments, made exceptional contributions to the efficiency, economy, or other improvement in the operations of the school district. Because this manual’s subject is ASB, FCMAT recommends that ASB funds be used for awards to pupils for excellence, if approved and in accordance with board policy. Awards to employees for exceptional contributions are best made from district funds because the intent is that ASB funds are to be used for students. Thus, if a governing board adopts rules and regulations before any awards are made, a district or ASB can recognize superior accomplishments of any employee or student within the guidelines and provisions contained in the applicable district policies, rules and/or regulations. In the absence of applicable policies, rules and/or regulations, no district official can make the award and no one can legitimately purchase the award. Life transition events such as birthdays, weddings, funerals, holidays and other similar circumstances can happen to anyone and so cannot be considered superior accomplishments, or merit an award.

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Associated Student Body Accounting Manual, Fraud Prevention Guide and Desk Reference

Awards are often signified by letters of commendation, board resolutions, trophies, certificates, plaques, medals, badges, pins and the like. They may also be in the form of a gift certificate or a scholarship, within the statutory monetary limits, if the governing board has approved such items as allowable awards and if IRS reporting requirements are followed. The board may also approve an expenditure for flowers or candy as part of an award, which is appropriate only if the school district’s board policy on awards complies with the Education Code and IRS regulations. FCMAT recommends that the district’s board policy allowing awards specify what is considered an allowable award. Mugs, cards and similar items given to promote goodwill or positive relations between either the district and its employees or between staff and students are not considered awards. The expenditure of public funds to promote positive employer-employee and/or staff-student relations does not serve a direct and/or substantial public purpose, so would likely violate the gift of public funds provisions contained in the California Constitution. IRS Publication 15b provides guidance to employers regarding how to report awards (tangible personal property) given to an employee as an award for either length of service or safety achievements. Publication 525 provides guidance to employees regarding how to report awards received. Generally, cash or cash-equivalent awards to employees must be reported as taxable income. If the award is provided in the form of goods or services, the fair market value of the award is reportable. Tangible personal property awards (other than cash, gift certificates, other cash equivalents or certain intangible property) for certain service or safety achievements are excludable up to certain amounts. Refer to the IRS publications for more information on the topic of employee awards and reporting of the awards for tax purposes.

Employee Appreciation Meals A 1978 legal opinion issued by the California attorney general concluded that a governing board is not authorized by Education Code section 44032 to provide for the reimbursement to its employees for the cost of meals purchased for community leaders, including public officials, regardless of whether such acts are deemed to be in the best interest of the school district. The attorney general concluded that the foregoing expenditures were not “actual and necessary” expenses within the meaning of Education Code section 44032 and thus could not be reimbursed. Absent special circumstance, it is unlikely that a court would conclude that an expenditure for employee appreciation meals, which do not qualify as awards, would serve a direct and/or substantial public purpose. The same rule applies for employee appreciation gifts because they also do not serve a direct and/or substantial purpose, and do not qualify as awards.

Employee Clothing/Attire There is no specific statute or case authorizing the expenditure of public funds for items such as employee jackets, sweatshirts or T-shirts, because these items benefit an individual and could be considered a gift of public funds. The only possible exceptions might arise when the clothing or equipment is necessary or required for the employee (e.g. athletic coach, club advisor) to perform his or her duties in that capacity, or where the clothing or equipment is properly given as an award under Education Code section 44015. However, FCMAT does not believe that it is appropriate to charge employee expenditures or awards to ASB funds and recommends that they be charged to district funds because the intent is that ASB funds be used for students.

Indirect Charges The question sometimes arises concerning whether a district may charge ASB funds an indirect cost rate as it does with certain local, state and federal programs. Indirect costs include services that support but are not directly attributable to ASB, such as insurance, utilities, management and supplies. Although it is allowable to charge the ASB an indirect charge, this should be discussed with the schools so that they can plan for that expenditure and understand what that charge pays for. Ensure that the board policy regarding ASB includes this information. As with all ASB expenditures, any such charge would need to be approved in advance.

Chapter 14 – Allowable and Questionable Expenses

189

Good Business Practices Because the distinction between allowable and prohibited expenses can be confusing, what guidelines or practices should an ASB consider? As with many business situations, the use of common sense is important. The ASB can also ask the rhetorical question, “If this situation were to be published on the front page of the local newspaper, would the same action still be recommended?” Questions to ask when deciding whether or not an expense would be allowable include the following: • Will the expenditure be used to promote the general welfare, morale and educational experience of the students? • Have the students agreed to the expenditure before it occurs? • Is this expenditure a responsibility of the district? • Has the ASB or the district paid for this in the past? • Is the ASB being asked to pay for this because the district is making a budget cut? • Is this something the district should provide, or is it an extra that the students want? • Who will use the item? • Will a group of students benefit? Here is more specific advice on recommended good business practices. The district should: • Establish board policy or administrative regulations with guidelines regarding allowable and prohibited expenditures. • Establish board policy or administrative regulations regarding procedures to follow if questionable expenditures arise. • Conduct regular reviews and updates of governing board policies and administrative regulations on this and all ASB matters. • Include a statement in the ASB constitution setting parameters for determining the appropriateness of expenditures. • Assign an employee position in the district’s business office to provide assistance when questions arise. • Provide annual training on expenditure guidelines, sponsored by the business office, for all staff members and students with ASB management responsibilities.

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TEACHERS ABSENCE FORMS This section will be helpful for the principal when he/she is completing the "Absence of Certificated Employees" form. The account code line must be completed before being submitted to the District Business Office. Generally it is the policy of the District that when a teacher is out of the classroom for School Business that the school site or a specific resource pays the cost of the substitute. There are a few exceptions to this rule. Examples would be a special education teacher who is out for an IEP, a teacher being out for negotiations, or a teacher on an interview panel. When the school site completes the account line, it will help ensure that substitutes are being charged to the appropriate resource.

Use when the District Pays for a "school business" absence. Teachers Out For Negotiations, CTA, ECETA, & Interview Panels Fund 010

Res 0000

Yr. 0

Goal 1550

Funct 1000

Object 1160

Site ??

Description/Example Use your school-site stamp for these absences

Object 1160

Site ??

Description/Example Use your special education stamp for these

Special Education Teachers (IEP's Etc.) Fund 010

Res 6500

Yr. 0

Goal 5770

Funct 1120

THE FOLLOWING ARE ALLOWABLE DISTRICT DEFINED ABSENCES Accident To Person/Property Personal Business w/o pay Sick Leave Personal Business (24 hr notice) Serious Illness Bereavement Leave Apperance in Court (own behalf) Labor Code 233 Apperance in Court (Jury Duty) One Extra Day Industrial Accident (On the Job) The District has provided account line stamps to sites for the ABOVE ABSENCES. If your stamp is lost contact Payroll.

ASES Fund 010 010

Res 6010 6010

Yr. 0 0

Goal 1110 1110

Funct 1000 1000

Object 1170 2900

Site ?? ??

Example Certificated Stipends (Time Cards) Classified Time Cards

Res 0000 0000

Yr. 0 0

Goal 1550 0000

Funct 1000 2100

Object 1160 1170

Site ?? 50

Example BTSA Substitutes BTSA Time Cards & Support Providers (flat rate)

Yr. 0

Goal 1200

Funct 1000

Object 1160

Site ??

Example Certificated Substitutes (Site expensed)

Goal 1545

Funct 1000

Object 1170

Site 50

Example Certificated Time Cards

BTSA Fund 010 010

LCFF Site Fund Fund 010

Res 0133

Science Program Fund 010

Res 0133

Yr. 1

Parent Center (PACE) Fund 010

Res 0133

Yr. 4

Goal 1110

Funct 1000

Object 4300

Site 66

Example

Yr. 0

Goal 1200

Funct 1000

Object 1160

Site 50

Example Certificated Substitutes (Site expensed)

No. 58 59 60 61 63 64 66 50

Definition St. Mary's King Kennedy Wilson Sunflower Christ Community Parent Center (PACE) IVHS - Fund 090, Resource 0000

Consumable materials & supplies used by students and employees

Title 1, Part A Fund 010

Res 3010

SITE IDENTIFIERS No. 50 51 52 53 54 55 56 57

Definition District Wide De Anza Desert Gardens Harding Hedrick Lincoln Mc Kinley Washington

GENERAL EXPENDITURES ASES Fd 010 010 010 010 010 010

Res 6010 6010 6010 6010 6010 6010

Yr 0 0 0 0 0 0

Goal 1110 1110 1110 1110 1110 1110

Object 1160 1170 2900 4300 4400 5800

Site ?? ?? ?? ?? ?? ??

Description Certificated Substitutes (Teacher Absence Slips) Certificated Stipends (Time Cards) Classified Time Cards Consumable materials & supplies used by students & employees Equipment individually costing between $500.00 and $5,000.00 Services rendered by persons (contractors) who aren't employees of the District

LCFF Site Fund - (To be used as previous EIA) Fund Res Yr Goal Funct Object 010 0133 0 1200 1000 1160 010 0133 0 1200 1000 1170 010 0133 0 1200 1000 2900 010 0133 0 1200 1000 4300 010 0133 0 1200 1000 4400 010 0133 0 1200 1000 5200 010 0133 0 1200 1000 5600 010 0133 0 1200 1000 5800 *Can be used for School-wide Plan

Site ?? ?? ?? ?? ?? ?? ?? ??

Description Certificated Substitutes (Teacher Absence Slips) *Certificated Stipends (Time Cards) *Classified Time Cards Consumable materials & supplies used by students & employees Equipment individually costing between $500.00 and $5,000.00 Travel & conference expense traveling outside the County Rents, leases without option to purchase; Repairs or maint. (agreements) with vendors Services rendered by persons (contractors) who aren't employees of the District

School Site Unrestricted Funds Fund Res Yr Goal 010 0000 0 1200 010 0000 0 1200 010 0000 0 1200 010 0000 0 1200

Funct 1000 1000 1000 1000 1000 1000

Funct 2700 2700 2700 2700

Object 4300 4400 5200 5901

Site ?? ?? ?? ??

This will not carryover Description Consumable materials & supplies used by students & employees Equipment individually costing between $500.00 and $5,000.00 Travel & conference expense traveling outside the County Postage stamps and "refill" of postage meters; Fed Ex

Title I, Basic - Site Allocations Fund Res Yr Goal Funct 010 3010 0 1200 1000 010 3010 0 1200 1000 010 3010 0 1200 1000 010 3010 0 1200 1000 010 3010 0 1200 1000 010 3010 0 1200 1000 010 3010 0 1200 1000 010 3010 0 1200 1000 010 3010 0 1200 2700 *Can be used for School-wide Plan

Object 1160 1170 2900 4300 4400 5200 5600 5800 5901

Site ?? ?? ?? ?? ?? ?? ?? ?? ??

Description Certificated Substitutes (Teacher Absence Slips) *Certificated Stipends (Time Cards) *Classified Time Cards Consumable materials & supplies used by students & employees Equipment individually costing between $500.00 and $5,000.00 Travel & conference expense traveling outside the County Rents, leases without option to purchase; Repairs or maint. (agreements) with vendors Services rendered by persons (contractors) who aren't employees of the District Postage stamps and "refill" of postage meters; Fed Ex

Title I, (Parental Involvement) Fund Res Yr Goal Funct 010 3010 0 9000 2490 010 3010 0 9000 2490 010 3010 0 9000 2490 010 3010 0 9000 1000 010 3010 0 9000 2490 010 3010 0 9000 2490 *Can be used for School-wide Plan

Object 2900 4300 5200 5600 5800 5901

Site ?? ?? ?? ?? ?? ??

Description *Classified Time Cards Consumable materials & supplies used by students & employees Travel & conference expense traveling outside the County Rents, leases without option to purchase; Repairs or maint. (agreements) with vendors Services rendered by persons (contractors) who aren't employees of the District Postage stamps and "refill" of postage meters; Fed Ex; UPS

INSTRUCTIONAL SUPERVISION - TIMECARDS/STIPEND REQUESTS Pupil Supervision Fund Res Yr 010 0133 3

Goal 1550

Funct 1000

Object 2900

Site Example 50 Classified time cards for pupil supervisors

Instructional Assistant (Substituting for ANY teacher in the classroom) EXCEPT READING COACHES Fund 010

Res 0000

Yr 0

Goal 1550

Funct 1000

Object 2160

Site Example ?? Instructional Supervision for regular education.

Instructional Assistant (Substituting for an instructional assistant) Fund Res Yr Goal Funct Object Site Example 010 ???? 0 ???? 1000 2160 ?? Use the code of the person they substituting.

CLERICAL STAFF - TIMECARDS/STIPEND REQUESTS School Site Secretary - Substitute Fund Res Yr Goal Funct 010 0000 0 1110 2700

Object 2460

Site Example ?? Classified Time Cards

School Site Administrative Clerk - Substitute Fund Res Yr Goal Funct Object 010 ???? 0 1110 2700 2460

Site Description ?? Classified Time Cards for Substitutes

OTHER RESTRICTED FUNDS - TIMECARDS/STIPEND REQUESTS Lottery Prop 20 - Instructional Materials (Science Center Only) Fund Res Yr Goal Funct Object Site Description 010 6300 0 1110 1000 4300 ?? Instructional supplies used in the classrooms Education Code Section 60010(h) states that "Instructional materials" means "all materials that are designed for use by pupils and their teachers as a learning Res and help Summer School (Special Ed) Fund Res Yr Goal 010 6500 0 5770 010 6500 0 5770 010 6500 0 5770

Funct 1130 1130 1130

Object 1170 2900 4300

Site 50 50 50

Description *Certificated Stipends (Time Cards) *Classified Time Cards Consumable materials & supplies used by students & employees

Coaches - Athletics Fund Res Yr 010 1100 0 010 1100 0 010 0000 0 010 0000 0 010 0000 0

Goal 1300 1300 1300 1300 1300

Funct 1000 1000 4000 4000 4000

Object 1170 2170 1900 2900 5800

Site 50 50 50 50 50

Description Certificated $800 Stipends for Coach Classified $800 Stipend for Coach Certificated Referee for Athletics (De Anza, KMS, & WJH only) Classified Referee for Athletics (De Anza, KMS, & WJH only) Sport, Referee (non-employee) & Tournament registration fees

Board Members Fund Res Yr 010 0000 0

Goal 0000

Funct 7100

Object 2300

Site Description 50 Paid Monthly (Time Card)

CUSTODIANS, GROUNDSKEEPERS, TRANSPORTATION, & MAINTENANCE TIMECARDS/STIPEND REQUESTS Custodian - (Substitute) Fund Res Yr Goal 010 0000 0 0000 010 0000 0 0000 010 0000 0 1200

Funct 8200 8200 8200

Object 2230 2260 4300

Site ?? 50 ??

Description Classified Overtime - Need to attach to OT/Comp Request Form Classified Time Cards for Substitutes Custodial supplies ordered from the District warehouse

Ongoing & Major Maintenance (Skilled Trades Substitutes) Object Site Description Fund Res Yr Goal Funct 2230 50 Classified Overtime - Need to attach to OT/Comp Request Form 010 8150 0 0000 8110 010 8150 0 0000 8110 2260 50 Classified Time Cards for Substitutes Grounds (Groundskeepers Substitutes) Fund Res Yr Goal Funct 010 0000 0 0000 8400 010 0000 0 0000 8400

Object 2230 2260

Site Description 50 Classified Overtime - Need to attach to OT/Comp Request Form 50 Classified Time Cards for Substitutes

Transportation (Bus Drivers, Bus Aides, & Mechanics) Fund Res Yr Goal Funct Object 2230 010 0131 0 0000 3600 010 0131 0 0000 3600 2260

Site Description 50 Classified Overtime - Need to attach to OT/Comp Request Form 50 Classified Time Cards for Substitutes

BILINGUAL EDUCATION Res - TIMECARDS/STIPEND REQUESTS Migrant Education Fund Res Yr 010 3060 0 010 3060 0 010 3060 0 010 3060 0

Goal 7110 7110 7110 7110

Funct 1000 3110 1000 2100

Object 1170 1900 2900 2430

Site 50 50 50 50

Migrant Education (summer school) Fund Res Yr Goal Funct 010 3061 0 7110 1000 010 3061 0 7110 1000

Object 1170 2900

Site Description 50 Certificated Stipend (Time Card) 50 Classified Time Card

Description Certificated Stipend (Time Card) Certificated Stipend (Time Card) Classified Time Card Classified Overtime

PROFESSIONAL DEVELOPMENT Res - TIMECARDS/STIPEND REQUESTS Title II, Part A, Teacher Quality Fund Res Yr Goal 010 4035 0 1110 010 4035 0 1110

Funct 2100 1000

Object 1170 2900

Site Description 50 Certificated Stipend (Time Card) 50 Classified Time Card

TITLE III, LEP Fund Res 010 4203 010 4203

Funct 1000 1000

Object 1170 2900

Site Description 50 Certificated Stipend (Time Card) 50 Classified Time Card

Yr 0 0

Goal 4760 4760

PUPIL SERVICES - TIMECARDS/STIPEND REQUESTS MAA Fund 010 010

Res 9080 9080

Yr 0 0

Goal 0000 0000

Funct 3140 3140

Object 1170 2900

Site Description 50 Certificated Stipend (Time Card) 50 Classified Time Card

Children and Families First (FACT) Fund Res Yr Goal Funct 010 9029 0 0000 3140

Object 2900

Site Description 50 Classified Time Card CAFETERIA- FOOD SERVICES - TIMECARDS/STIPEND REQUESTS

Food Services (Classified Employees) Fund Res Yr Goal Funct 130 5310 0 0000 3700 130 5310 0 0000 3700 130 5310 0 0000 3700

Object 2200 2230 4300

Site 50 50 50

Description Classified Time Card Classified Overtime - Need to attach to OT/Comp Request Form Consumable materials & supplies used by students and employees

Object Classification Code

Definition

4000-4999

Books and Supplies

4300

be used by students, teachers, and other LEA personnel. Instructional materials and supplies are those used in the classroom by students and teachers. Other materials and supplies included in Object 4300 are those used in services and auxiliary programs, such as custodial supplies; gardening and maintenance supplies; supplies for operations; transportation supplies, including gasoline; supplies for repair and upkeep of equipment or buildings and grounds; and medical and office supplies. Expenditures for food for staff meetings and similar situations are recorded in Object 4300 and the appropriate function.

4400

Noncapitalized Equipment. Record expenditures for movable personal property of a relatively permanent nature that has an estimated useful life greater than one year and an acquisition cost less than $5,000 and greater than $500 per Education Code Section 35168 or local policy.

5000-5999

Services and Other Operating Expenditures

5200

Travel and Conferences. Record actual and necessary expenditures incurred by and/or for employees and other representatives of the LEA for travel and conferences outside the County. Object code 5200 is designed to capture travel expenses of employees and other representatives of the LEA, which may include travel costs to conferences or fees paid for

5300

Dues and Memberships. Record the membership fees of an LEA in any society, association, or organization. Object 5300 may be sued for the dues of an employee if is deemed that the LEA is represented and benefits from the membership.

5600

Rentals, Leases, Repairs. Record expenditures for rentals, leases without option to purchase, and repairs or maintenance (including maintenance agreements) of sites, buildings, and equipment by outside vendors. Include incidental materials and supplies included in the cost of repairs.

5800

Professional/Consulting Services and Operating Expenditures. Record the expenditures for personal services rendered by personnel who are not on the payroll of the LEA. Professional/consulting services are delivered by an independent contractor (individual, entity, or firm) that offers its services to the public. Such services are paid on a fee basis for specialized services that are usually considered to be temporary or short term in nature, normally in areas that supplement the expertise of the LEA. This includes all related expenditures covered by the personal services contract.

ICSIS Requisition Process (Purchase Orders)

How to Login to ICSIS 1. ICSIS is available at http://www.icsis.icoe.org under ICSIS Applications link.

2. Log into ICSIS (if you forgot your user name and password contact Carla Arguilez). a. b. c. d.

Login – User Name District Number- 24 Password- User Password Fiscal Year for 2017-18 2018

3. From the Accounts Payable menu, select Requisition by double clicking.

4. This is the Requisition Screen.

IMPORTANT TIPS:  Status ranges are as follows: o New - A requisition that has not yet been saved o Open - A requisition that has been saved but not converted into a purchase order. NOTE: For all Open requisitions the PO No box will be blank o Closed - Requisition has been converted into a purchase order. All Closed requisitions will have a PO No assigned and changes can no longer be made  The following fields are for display information only: o Status, PO No, Date Created, Requestor, Detail Total, Distributions Total & Total    

Use the TAB key to move between the different areas of the requisition Use SHIFT+TAB key to move backward between the different areas of the requisition. Use the mouse to move to the desired item in the window The budget encumbrance balance of the accounts on each requisition will be verified when you create the requisition but it will not be updated until you convert a requisition into a purchase order.

Entering a New Requisition 1. Click New Requisition button on bottom of screen. Req # - By default the system automatically assigns the next requisition number available within the fiscal year selected.

2. Vendor - Enter the vendor number, name or a partial name and press the ENTER key. When a partial name is entered the following window will appear to select the vendor *If the vendor you need isn’t listed. Contact Nadia Velazquez at Accounts Payable ([email protected] or ext. 8542). She can verify if a vendor exists or not. If a vendor needs to be added, you will be requesting a W-9 form from the vendor. Submit the completed W-9 form to Nadia to add as a vendor. Once the vendor is established she will provide you the vendor number.  

Move within the window using the scroll bars or the arrow keys Select a vendor from the list either by o Pressing the ENTER key or o Clicking twice with the mouse over selection o Once finished, press the TAB key to move to the next field

3. Comments – Enter comments. A maximum of 200 Characters can be entered. o For purchases using Categorical funding please list why this is an allowable expense. This will assist Education Services when they review the requisition. 4. Detail Lines & Destination - Enter the line item details for the requisition. To move within this grid, use o Arrow keys or o Press the ENTER key to move to the next cell

a. Qty - Enter the Quantity. The Quantity column allows digits 1.0 to 999,999.9 b. Units - Select the Unit from the drop down menu. Make the selection as follows: o Click the arrow button with the mouse, then click over selection o Enter the first letter of the unit desired and press the ENTER key o Press the ENTER key, move with the arrow key down and press ENTER over selection c. Unit Price - Enter the Unit Price d. Discount - Enter the Discount e. Description - Type item description. Up to 200 characters can be entered. i. If quote has more than 10 lines of information description can be “see attached” and you would enter the total of the invoice as amount. ii. If less than 10 lines, please enter each line. This will allow the purchase order to reflect what you are purchasing and become a permanent record in our financial system. iii. Example, if quote is for office furniture for the principal, you do not need to enter each item (desk, file cabinet, and chair) you can enter the description as office furniture. f. Tax - The program automatically calculates the tax amount, but the user has the ability to overwrite. To overwrite do the following: o Press the ENTER key to move to the Tax cell and enter new amount or o Use mouse to click over Tax cell and enter new amount g. Amount – This cell is the total per line item and is for display information only h. Del – This column allows the user to delete line item(s). To delete a line item do as follows: o Use the mouse to click over the X in the Del cell of the line item 5. Shipping/Freight - Enter the shipping or freight charges 6. Confirmation Code – This field is for additional instruction to the vendor to be printed on the requisition under the vendor address. To select: o Using the mouse, click the arrow button , then click over selection or o Use arrow key and press ENTER over selection o NOTE: AA- will not print any code 7. Shipping Address – Select the address in which the order is to be shipped. NOTE: By default the District’s primary address will be selected. To change the selection do the following:

Using the mouse, click the arrow button , then click over selection or Use arrow key and press ENTER over selection IMPORTANT: Additional shipping addresses for schools, departments, etc. can be created please contact Nadia Velazquez at Accounts Payable if you need to modify your shipping addresses. o Once finished, press the TAB key to open the Account Distributions tab. Or using the mouse, click over the Accounts Distributions tab. 8. Account Distributions – Enter the account line(s) in this grid. To move through this grid use: o Arrow keys or o Press ENTER to move to the next cell o o o

a. Account - Enter the account line. Do not enter dashes; by default the system places the dashes between the codes. Once the account line is typed in, press the ENTER key. The system will validate the account line. NOTE: If the account line is invalid the following message will appear. The system will not save the requisition if any account lines are invalid. Click OK and modify the entry.

If you have problems with account lines please contact Carla Arguilez at ([email protected] or ext. 8528). To modify entry within this cell: o o o

Use the Arrow keys or Using the mouse, click twice to modify any section of account line Use the Backspace or Delete keys

b. Dist. Amount – Enter the distribution amount for this account line. The system will verify the account balance of the account line entered. The following warning will appear if the distribution amount is over the account balance. The District Business will be verifying that you have adequate budget before converting a requisition to a Purchase Order. If you receive this error, the account line you are using doesn’t have sufficient funds. If you need funds moved from another account line where you have funds, contact Carla Arguilez ([email protected] or ext. 5828). Note: You can “overwrite” the error in order to save your work if you know you will be having funds transferred from another account. o Yes – Overwrites the balance and moves curser to next line for entry o No – Automatically returns to the Dist. Amount cell for entry adjustment c. Dist. Balance – This cell is the amount to be encumbered for the entered account line and is for display information only d. Acct. Balance – This cell is the balance of the account line entered and is for display only. IMPORTANT: All requisitions entered in the system that have not been converted into a purchase order are NOT encumbered and are NOT reflected in the Acct. Balance amount listed. e. Del – This column allows the user to delete the line(s). To delete a line do as follows: o Use the mouse to click over the X in the Del cell of the desired line

9. Save Requisition – The Detail Total and the Distribution Total must be in balance for the system to save the requisition. To save requisition use one of the following options “a”, “b” or “c” (below): a. Update – Using the mouse, click on the Update button o The requisition will be saved and the following message will appear. Click OK. The screen will remain the same. Close the requisition by clicking the Exit button or clicking the on the top right of the window

b. New Requisition – Using the mouse, click on the New Requisition button. o The following message will appear.

  c.

Yes – Saves the requisition, then opens a new requisition screen No – Does NOT save the requisition, then opens a new requisition screen

Exit – Using the mouse, click on the Exit button o The following message will appear

 

Yes – Saves the requisition, then opens a new requisition screen No – Does NOT save the requisition, then closes Requisition module

NOTE: Users have the ability to reopen requisitions to view. If the Status is Open users have access to modify or delete a requisition. If the Status is Closed the user no longer has the ability to make changes because the requisition has been converted into a purchase order.

Copying a Prior Requisition The Copy Prior Requisition menu option allows users to import information from existing requisitions in the system. o The number of the requisition that is to be copied is required. If the requisition number is not known, use the Search Requisitions button. See the Search Requisitions section of this user guide for searching instruction. o Requisitions can be copied from up to 4 years prior to the selected fiscal year

1.

Using the mouse, click on File located in the top menu bar, then select Copy prior Requisition. The following window will appear:

2.

Enter the desired requisition number to copy

3.

The system will populate all the prior requisition information into a new requisition screen. NOTE: By default the system automatically assigns the next requisition available within the fiscal year selected.

4. 5.

Enter any necessary modifications and/or additions to the new requisition Save requisition. For direction on saving, see page 6 of this user guide

Modifying an Existing Requisition Users have the ability to make modifications to an existing requisition that has the status Open (have not yet been converted into a purchase order) o

o

The following fields are for display information only and cannot be modified: Req#, Status, PO No, Date Created, Requestor, Detail Total, Distributions Total, Total, Amount, Dist. Balance and Acct. Balance If the Status is Closed the user no longer has the ability to make changes because the requisition has been converted into a purchase order.

1. If the desired requisition is not already open, do the following: o Open the requisition application o Enter the requisition number in the Req # cell, then press the ENTER key If the requisition is already open, go to step 2.

2. Modify - Make any necessary modifications and/or additions to any open requisition fields: Vendor, Comments, Qty, Units, Unit Price, Discount, Description, Tax, Shipping/Freight, Confirmation Code, Shipping Address, Account and Dist. Amount 3. Delete – Delete any Detail Lines or Account Distributions by using the Del column o Using the mouse, click over the X in the Del cell of the line 4. Update - Once done with modifications, update the requisition as follows: o Using the mouse, click on the Update button, the requisition will be saved and the following message will appear. Click OK. The requisition screen will remain open.

IMPORTANT: If modifications are made to an existing requisition, Update MUST be selected before printing. If the update is not done, the modifications will not appear on the printed document

5. Exit without Saving – To close requisition without saving do as follows: o Using the mouse, click on the Exit button, the following message will appear

Using the mouse, click on the No button – Does NOT save the requisition, then closes the Requisition module 6. Close or print requisition as needed. For printing instruction see the Print Requisition section of this user guide o

Printing a Requisition Requisitions can be printed only when the status shows as Open or Closed. NOTE: If the requisition status is Open, the PO number will not be included since it is not yet assigned. 1. If the desired requisition is not already open, do the following: o Open the requisition application o Enter the requisition number in the Req # cell, then press the ENTER key If the requisition is already open, go to step 2.

2. The system provides two formats for printing requisitions. Use the Blank Page Option – Prints entire requisition document format. Using the mouse, click on File in the top menu bar, then select Print, and click on On blank page.

IMPORTANT: o The system will not print a requisition that is not saved. If print is selected and the requisition has not been saved, the system will prompt user to save requisition o If modifications are made to an already existing requisition, Update MUST be selected before printing. If the update is not done, the modifications will not appear on the printed document o The Print Preview screen will appear as follows:

3. Using the mouse, click on the printer

icon on the top menu bar. The following window will appear:

4. Select the printer by using the drop down menu as follows:  Using the mouse, click the arrow button , then click over printer selection or  Use arrow key and press ENTER over printer selection 5. Close Print Preview window by clicking the on the top right corner of the screen 6. Once a requisition is printed it needs to have the proper signatures (same process as in the past, for example: Principal for site funds, Ed Services for categorical program funds) and back-up documentation. Once it has the proper signatures and documentation it needs to be turned into Alicia Diaz at Business Services who will then convert it to a Purchase Order. She will provide you with the copies needed to make the purchase.

Deleting a Requisition Before deleting a requisition take note of the following information: o o

A requisition can ONLY be deleted if the status shows as Open Once a requisition is deleted the number can be reused for a new requisition

1. Open the requisition to delete as follows: o Open the requisition application o Enter the requisition number in the Reg # cell, then press the ENTER key o The following window will appear

2. Using the mouse, click on File in the top menu bar, then select Delete

o

The following message will appear:

Searching for a Requisition 1. Open the requisition application

2. Using the mouse, click on the Search Requisitions button located on the lower left corner of the screen. 3. In the Vendor cell, enter the vendor number, name (or partial name), then press the ENTER key o The system will list all requisitions that match the entered criteria as follows:

4. Select the desired requisition o Move within the window using the scroll bars or the arrow keys o Select a requisition from the list either by  Pressing the ENTER key over selection or  Clicking twice with the mouse over selection 5. The system will then display the chosen requisition

W-9

Form (Rev. December 2014) Department of the Treasury Internal Revenue Service

Request for Taxpayer Identification Number and Certification

Give Form to the requester. Do not send to the IRS.

Print or type See Specific Instructions on page 2.

1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. 2 Business name/disregarded entity name, if different from above

3 Check appropriate box for federal tax classification; check only one of the following seven boxes: C Corporation S Corporation Partnership Trust/estate Individual/sole proprietor or single-member LLC Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ▶ Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for the tax classification of the single-member owner.

4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Exempt payee code (if any) Exemption from FATCA reporting code (if any) (Applies to accounts maintained outside the U.S.)

Other (see instructions) ▶ 5 Address (number, street, and apt. or suite no.)

Requester’s name and address (optional)

6 City, state, and ZIP code 7 List account number(s) here (optional)

Part I

Taxpayer Identification Number (TIN)

Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter.

Part II

Social security number

–

–

or Employer identification number

–

Certification

Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3.

Sign Here

Signature of U.S. person ▶

Date ▶

General Instructions

• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition)

Section references are to the Internal Revenue Code unless otherwise noted.

• Form 1099-C (canceled debt)

Future developments. Information about developments affecting Form W-9 (such as legislation enacted after we release it) is at www.irs.gov/fw9.

Purpose of Form

• Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.

An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following:

If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding? on page 2.

• Form 1099-INT (interest earned or paid)

3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and

• Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions)

By signing the filled-out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or

4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting? on page 2 for further information.

• Form 1099-K (merchant card and third party network transactions) Cat. No. 10231X

Form W-9 (Rev. 12-2014)

EL CENTRO ELEMENTARY SCHOOL DISTRICT

______FY

Request To Employ For Classified Personnel

EMPLOYEE NAME: ______________________________________________ SOC. SEC. #: ____________ JOB TITLE: _____________________________________________________________________________ Please mark appropriate boxes: New Hire

Regular

Substitute

ASES

Short-Term

Hourly

Re-Hire

If above employee is currently employed in any other position/program within ECESD, please list the following: M T W TH F ___________________________

________

_________

___________________________

________

_________

___________________________

________

_________

Site

# of Hours

Title of Position

Weekly Breakdown of Hours

Start Date: _________________ End Date: _________________ Work Site: ________________________ Number of Hours Per Day: __________

Weekly Breakdown of Hours:

M

T

W

TH

F

Remarks: _______________________________________________________________________________ Authorized Signature: ____________________________________________________________________ Principal/Director, or other Authorized Signature FOR DISTRICT OFFICE USE ONLY Full-Time Rate: $___________ X _________% = Salary: $__________________ per ________________ 3.5%: $___________

3.5% Salary: $__________________

Mo/Year: ____________________ Days/Year: ____________________ Class/Step: __________________ % Of Time

Coding

__________

____________________________________________________

__________

____________________________________________________

Authorized Signature: ____________________________________________________________________ Director of Human Resources AGENDA Revised 07/17 zm

____________________________

NOE

_________________________

Workers’ Compensation Claim Form (DWC 1) & Notice of Potential Eligibility Formulario de Reclamo de Compensación de Trabajadores (DWC 1) y Notificación de Posible Elegibilidad If you are injured or become ill, either physically or mentally, because of your job, including injuries resulting from a workplace crime, you may be entitled to workers’ compensation benefits. Attached is the form for filing a workers’ compensation claim with your employer. You should read all of the information below. Keep this sheet and all other papers for your records. You may be eligible for some or all of the benefits listed depending on the nature of your claim. If required you will be notified by the claims administrator, who is responsible for handling your claim, about your eligibility for benefits. To file a claim, complete the “Employee” section of the form, keep one copy and give the rest to your employer. Your employer will then complete the “Employer” section, give you a dated copy, keep one copy and send one to the claims administrator. Benefits can’t start until the claims administrator knows of the injury, so complete the form as soon as possible. Medical Care: Your claims administrator will pay all reasonable and necessary medical care for your work injury or illness. Medical benefits may include treatment by a doctor, hospital services, physical therapy, lab tests, x-rays, and medicines. Your claims administrator will pay the costs directly so you should never see a bill. There is a limit on some medical services. The Primary Treating Physician (PTP) is the doctor with the overall responsibility for treatment of your injury or illness. Generally your employer selects the PTP you will see for the first 30 days, however, in specified conditions, you may be treated by your predesignated doctor or medical group. If a doctor says you still need treatment after 30 days, you may be able to switch to the doctor of your choice. Different rules apply if your employer is using a Health Care Organization (HCO) or a Medical Provider Network (MPN). A MPN is a selected network of health care providers to provide treatment to workers injured on the job. You should receive information from your employer if you are covered by an HCO or a MPN. Contact your employer for more information. If your employer has not put up a poster describing your rights to workers’ compensation, you may choose your own doctor immediately. Within one working day after you file a claim form, your employer shall authorize the provision of all treatment, consistent with the applicable treating guidelines, for the alleged injury and shall continue to be liable for up to $10,000 in treatment until the claim is accepted or rejected. Disclosure of Medical Records: After you make a claim for workers' compensation benefits, your medical records will not have the same level of privacy that you usually expect. If you don’t agree to voluntarily release medical records, a workers’ compensation judge may decide what records will be released. If you request privacy, the judge may "seal" (keep private) certain medical records. Payment for Temporary Disability (Lost Wages): If you can't work while you are recovering from a job injury or illness, for most injuries you will receive temporary disability payments for a limited period of time. These payments may change or stop when your doctor says you are able to return to work. These benefits are tax-free. Temporary disability payments are two-thirds of your average weekly pay, within minimums and maximums set by state law. Payments are not made for the first three days you are off the job unless you are hospitalized overnight or cannot work for more than 14 days. Return to Work: To help you to return to work as soon as possible, you should actively communicate with your treating doctor, claims administrator, and employer about the kinds of work you can do while recovering. They may coordinate efforts to return you to modified duty or other work that is medically appropriate. This modified or other duty may Rev. 6/10

Si Ud. se lesiona o se enferma, ya sea físicamente o mentalmente, debido a su trabajo, incluyendo lesiones que resulten de un crimen en el lugar de trabajo, es posible que Ud. tenga derecho a beneficios de compensación de trabajadores. Se adjunta el formulario para presentar un reclamo de compensación de trabajadores con su empleador. Ud. debe leer toda la información a continuación. Guarde esta hoja y todos los demás documentos para sus archivos. Es posible que usted reúna los requisitos para todos los beneficios, o parte de éstos, que se enumeran, dependiendo de la índole de su reclamo. Si se requiere, el administrador de reclamos, quien es responsable por el manejo de su reclamo, le notificará sobre su elegibilidad para beneficios. Para presentar un reclamo, llene la sección del formulario designada para el “Empleado,” guarde una copia, y déle el resto a su empleador. Entonces, su empleador completará la sección designada para el “Empleador,” le dará a Ud. una copia fechada, guardará una copia, y enviará una al administrador de reclamos. Los beneficios no pueden comenzar hasta, que el administrador de reclamos se entere de la lesión, así que complete el formulario lo antes posible. Atención Médica: Su administrador de reclamos pagará toda la atención médica razonable y necesaria, para su lesión o enfermedad relacionada con el trabajo. Es posible que los beneficios médicos incluyan el tratamiento por parte de un médico, los servicios de hospital, la terapia física, los análisis de laboratorio y las medicinas. Su administrador de reclamos pagará directamente los costos, de manera que usted nunca verá un cobro. Hay un límite para ciertos servicios médicos. El Médico Primario que le Atiende-Primary Treating Physician PTP es el médico con la responsabilidad total para tratar su lesión o enfermedad. Generalmente, su empleador selecciona al PTP que Ud. verá durante los primeros 30 días. Sin embargo, en condiciones específicas, es posible que usted pueda ser tratado por su médico o grupo médico previamente designado. Si el doctor dice que usted aún necesita tratamiento después de 30 días, es posible que Ud. pueda cambiar al médico de su preferencia. Hay reglas differentes que se aplican cuando su empleador usa una Organización de Cuidado Médico (HCO) o una Red de Proveedores Médicos (MPN). Una MPN es una red de proveedores de asistencia médica seleccionados para dar tratamiento a los trabajadores lesionados en el trabajo. Usted debe recibir información de su empleador si su tratamiento es cubierto por una HCO o una MPN. Hable con su empleador para más información. Si su empleador no ha colocado un cartel describiendo sus derechos para la compensación de trabajadores, Ud. puede seleccionar a su propio médico inmediatamente. Dentro de un día después de que Ud. Presente un formulario de reclamo, su empleador autorizará todo tratamiento médico de acuerdo con las pautas de tratamiento aplicables a la presunta lesión y será responsable por $10,000 en tratamiento hasta que el reclamo sea aceptado o rechazado. Divulgación de Expedientes Médicos: Después de que Ud. presente un reclamo para beneficios de compensación de trabajadores, sus expedientes médicos no tendrán el mismo nivel de privacidad que usted normalmente espera. Si Ud. no está de acuerdo en divulgar voluntariamente los expedientes médicos, un juez de compensación de trabajadores posiblemente decida qué expedientes se revelarán. Si Ud. solicita privacidad, es posible que el juez “selle” (mantenga privados) ciertos expedientes médicos. Pago por Incapacidad Temporal (Sueldos Perdidos): Si Ud. no puede trabajar, mientras se está recuperando de una lesión o enfermedad relacionada con el trabajo, Ud. recibirá pagos por incapacidad temporal para la mayoría de las lesions por un period limitado. Es posible que estos pagos cambien o paren, cuando su médico diga que Ud. está en condiciones de regresar a trabajar. Estos beneficios son libres de impuestos. Los pagos

Workers’ Compensation Claim Form (DWC 1) & Notice of Potential Eligibility Formulario de Reclamo de Compensación de Trabajadores (DWC 1) y Notificación de Posible Elegibilidad be temporary or may be extended depending on the nature of your injury or illness. Payment for Permanent Disability: If a doctor says your injury or illness results in a permanent disability, you may receive additional payments. The amount will depend on the type of injury, your age, occupation, and date of injury. Supplemental Job Displacement Benefit (SJDB): If you were injured after 1/1/04 and you have a permanent disability that prevents you from returning to work within 60 days after your temporary disability ends, and your employer does not offer modified or alternative work, you may qualify for a nontransferable voucher payable to a school for retraining and/or skill enhancement. If you qualify, the claims administrator will pay the costs up to the maximum set by state law based on your percentage of permanent disability. Death Benefits: If the injury or illness causes death, payments may be made to relatives or household members who were financially dependent on the deceased worker. It is illegal for your employer to punish or fire you for having a job injury or illness, for filing a claim, or testifying in another person's workers' compensation case (Labor Code 132a). If proven, you may receive lost wages, job reinstatement, increased benefits, and costs and expenses up to limits set by the state. You have the right to disagree with decisions affecting your claim. If you have a disagreement, contact your claims administrator first to see if you can resolve it. If you are not receiving benefits, you may be able to get State Disability Insurance (SDI) benefits. Call State Employment Development Department at (800) 480-3287. You can obtain free information from an information and assistance officer of the State Division of Workers' Compensation (DWC), or you can hear recorded information and a list of local offices by calling (800) 736-7401. You may also go to the DWC website at www.dwc.ca.gov. You can consult with an attorney. Most attorneys offer one free consultation. If you decide to hire an attorney, his or her fee will be taken out of some of your benefits. For names of workers' compensation attorneys, call the State Bar of California at (415) 538-2120 or go to their web site at www.californiaspecialist.org.

por incapacidad temporal son dos tercios de su pago semanal promedio, con cantidades mínimas y máximas establecidas por las leyes estatales. Los pagos no se hacen durante los primeros tres días en que Ud. no trabaje, a menos que Ud. sea hospitalizado una noche o no pueda trabajar durante más de 14 días. Regreso al Trabajo: Para ayudarle a regresar a trabajar lo antes posible, Ud. debe comunicarse de manera activa con el médico que le atienda, el administrador de reclamos y el empleador, con respecto a las clases de trabajo que Ud. puede hacer mientras se recupera. Es posible que ellos coordinen esfuerzos para regresarle a un trabajo modificado, o a otro trabajo, que sea apropiado desde el punto de vista médico. Este trabajo modificado u otro trabajo podría ser temporal o podría extenderse dependiendo de la índole de su lesión o enfermedad. Pago por Incapacidad Permanente: Si el doctor dice que su lesión o enfermedad resulta en una incapacidad permanente, es posible que Ud. reciba pagos adicionales. La cantidad dependerá de la clase de lesión, su edad, su ocupación y la fecha de la lesión. Beneficio Suplementario por Desplazamiento de Trabajo: Si Ud. Se lesionó después del 1/1/04 y tiene una incapacidad permanente que le impide regresar al trabajo dentro de 60 días después de que los pagos por incapacidad temporal terminen, y su empleador no ofrece un trabajo modificado o alternativo, es posible que usted reúna los requisitos para recibir un vale no-transferible pagadero a una escuela para recibir un nuevo entrenamiento y/o mejorar su habilidad. Si Ud. reúne los requisitios, el administrador de reclamos pagará los gastos hasta un máximo establecido por las leyes estatales basado en su porcentaje de incapacidad permanente. Beneficios por Muerte: Si la lesión o enfermedad causa la muerte, es posible que los pagos se hagan a los parientes o a las personas que viven en el hogar y que dependían económicamente del trabajador difunto. Es ilegal que su empleador le castigue o despida, por sufrir una lesión o enfermedad en el trabajo, por presentar un reclamo o por testificar en el caso de compensación de trabajadores de otra persona. (El Codigo Laboral sección 132a.) De ser probado, usted puede recibir pagos por pérdida de sueldos, reposición del trabajo, aumento de beneficios y gastos hasta los límites establecidos por el estado. Ud. tiene derecho a no estar de acuerdo con las decisiones que afecten su reclamo. Si Ud. tiene un desacuerdo, primero comuníquese con su administrador de reclamos para ver si usted puede resolverlo. Si usted no está recibiendo beneficios, es posible que Ud. pueda obtener beneficios del Seguro Estatal de Incapacidad (SDI). Llame al Departamento Estatal del Desarrollo del Empleo (EDD) al (800) 480-3287. Ud. puede obtener información gratis, de un oficial de información y asistencia, de la División Estatal de Compensación de Trabajadores (Division of Workers’ Compensation – DWC) o puede escuchar información grabada, así como una lista de oficinas locales llamando al (800) 736-7401. Ud. también puede consultar con la pagína Web de la DWC en www.dwc.ca.gov. Ud. puede consultar con un abogado. La mayoría de los abogados ofrecen una consulta gratis. Si Ud. decide contratar a un abogado, los honorarios serán tomados de algunos de sus beneficios. Para obtener nombres de abogados de compensación de trabajadores, llame a la Asociación Estatal de Abogados de California (State Bar) al (415) 5382120, ó consulte con la pagína Web en www.californiaspecialist.org.

Rev. 6/10

State of California Department of Industrial Relations DIVISION OF WORKERS’ COMPENSATION

Estado de California Departamento de Relaciones Industriales DIVISION DE COMPENSACIÓN AL TRABAJADOR

WORKERS’ COMPENSATION CLAIM FORM (DWC 1) Employee: Complete the “Employee” section and give the form to your employer. Keep a copy and mark it “Employee’s Temporary Receipt” until you receive the signed and dated copy from your em ployer. You may call the Division of Workers’ Compensation and hear recorded information at (800) 736-7401. An explanation of workers' compensation benefits is included as the cover sheet of this form. You should also have received a pamphlet from your employer describing workers’ compensation benefits and the procedures to obtain them. Any person who makes or causes to be made any knowingly false or fraudulent material statement or material representation for the purpose of obtaining or denying workers’ compensation benefits or payments is guilty of a felony. Employee—complete this section and see note above

PETITION DEL EMPLEADO PARA DE COMPENSACIÓN DEL TRABAJADOR (DWC 1)

Empleado: Complete la sección “Empleado” y entregue la forma a su empleador. Quédese con la copia designada “Recibo Temporal del Empleado” hasta que Ud. reciba la copia firmada y fechada de su empleador. Ud. puede llamar a la Division de Compensación al Trabajador al (800) 7367401 para oir información gravada. En la hoja cubierta de esta forma esta la explicatión de los beneficios de compensación al trabajador. Ud. también debería haber recibido de su empleador un folleto describiendo los benficios de compensación al trabajador lesionado y los procedimientos para obtenerlos. Toda aquella persona que a propósito haga o cause que se produzca cualquier declaración o representación material falsa o fraudulenta con el fin de obtener o negar beneficios o pagos de compensación a trabajadores lesionados es culpable de un crimen mayor “felonia”.

Empleado—complete esta sección y note la notación arriba.

1.

Name. Nombre. _____________________________________________Today’s Date. Fecha de Hoy.

2.

Home Address. Dirección Residencial. _______________________________________________________________________________________

3.

City. Ciudad. _______________________________________ State. Estado. __________________

4.

Date of Injury. Fecha de la lesión (accidente). ________________________ Time of Injury. Hora en que ocurrió. _________a.m. ________p.m.

5.

Address and description of where injury happened. Dirección/lugar dónde occurió el accidente. _________________________________________

___________________________________

Zip. Código Postal. ___________________

_______________________________________________________________________________________________________________________ 6.

Describe injury and part of body affected. Describa la lesión y parte del cuerpo afectada. _______________________________________________ _______________________________________________________________________________________________________________________

7.

Social Security Number. Número de Seguro Social del Empleado.

8.

Signature of employee. Firma del empleado.

_______________________________________________________________

_________________________________________________________________________________

Employer—complete this section and see note below. Empleador—complete esta sección y note la notación abajo. 9.

Name of employer. Nombre del empleador. ___________________________________________________________________________________

10. Address. Dirección. _____________________________________________________________________________________________________ 11. Date employer first knew of injury. Fecha en que el empleador supo por primera vez de la lesión o accidente. _____________________________ 12. Date claim form was provided to employee. Fecha en que se le entregó al empleado la petición. _________________________________________ 13. Date employer received claim form. Fecha en que el empleado devolvió la petición al empleador. _______________________________________ 14. Name and address of insurance carrier or adjusting agency. Nombre y dirección de la compañía de seguros o agencia adminstradora de seguros. SISC, PO Box 1847, Bakersfield, CA 93303-1847 _______________________________________________________________________________________________________________________ 15. Insurance Policy Number. El número de la póliza de Seguro. _____________________________________________________________________ 16. Signature of employer representative. Firma del representante del empleador. _______________________________________________________ 17. Title. Título. _____________________________________ 18. Telephone. Teléfono. _______________________________________________ Employer: You are required to date this form and provide copies to your insurer or claims administrator and to the employee, dependent or representative who filed the claim within one working day of receipt of the form from the employee.

Empleador: Se requiere que Ud. feche esta forma y que provéa copias a su compañía de seguros, administrador de reclamos, o dependiente/representante de reclamos y al empleado que hayan presentado esta petición dentro del plazo de un día hábil desde el momento de haber sido recibida la forma del empleado.

SIGNING THIS FORM IS NOT AN ADMISSION OF LIABILITY

EL FIRMAR ESTA FORMA NO SIGNIFICA ADMISION DE RESPONSABILIDAD

❑ Employer copy/Copia del Empleador 6/10 Rev.

❑ Employee copy/ Copia del Empleado

❑ Claims Administrator/Administrador de Reclamos

❑ Temporary Receipt/Recibo del Empleado

SELF-INSURED SCHOOLS OF CALIFORNIA MEDICAL PROVIDER NETWORK

EMPLOYEE HANDBOOK

1

Effective: October 1, 2007 To All Employees: Your employer is committed to your well-being and safety at the workplace. Keeping injuries from happening is our first concern. However, if you do have a work injury, it is our goal to help you recover and return to useful employment as soon as it is medically possible. Your employer has chosen the Self-Insured Schools of California (SISC)/California Foundation for Medical Care, Medical Provider Network (MPN) as the network of medical providers in the case of a work injury. The MPN is a Workers’ Compensation Provider Network built around Occupational Care Providers. Unless you predesignate a physician or medical group, your new work injuries arising on or after October 1, 2007 will be treated by providers in our SISC Medical Provider Network. If you have an existing injury, you may be required to change to a provider in the new SISC MPN. Check with your claims adjuster. You may obtain more information about the MPN from the Workers’ Compensation Poster or from your employer. The MPN will be delivered through SISC’s network of medical providers and facilities. Your employer is self-insured and SISC (a Joint Powers Authority) functions as its Third Party Administrator. The California Foundation for Medical Care provides a comprehensive medical network to serve the needs of SISC and their medical providers. The MPN includes occupational health clinics and doctors who will provide you with medical treatment. The occupational doctor will also manage your return-to-work with your employer. Existing work injuries may be transferred into the new MPN, employees should check with their claims adjuster for more information. Under the MPN Program, you will be provided: A primary care physician Other occupational health services and specialists Emergency health care services and Medical care if you are working or traveling outside of the Geographic services area This network has been built to provide you with timely and quality medical care. The MPN is easy to access and is here to provide you with quality medical care and to assist you to return to health and a productive life. Employees will be notified of the MPN Implementation by mail or included on or with an employee’s pay stub, paycheck or distributed through electronic means, including e-mail, if the employee has regular electronic access to e-mail at work to receive this notice. If the employee cannot receive this notice electronically at work, then the employer shall ensure this information is provided to the employee in writing. This MPN Employee Handbook will provide you with the information to help you through your workrelated injury or illness, additional information regarding the MPN may also be obtained from the Workers’ Compensation poster, asking your employer, www.cfmcnet.org/SISC, or by calling the toll free number of 1-877-222-4946. Please refer to page 10 for MPN Contact Information.

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MPN EMPLOYEE HANDBOOK TABLE OF CONTENTS PAGE THE PURPOSE OF THE MEDICAL PROVIDER NETWORK (MPN) Workers’ Compensation Injuries and Illnesses Only

4

HOW TO ACCESS THE MPN Description of Services Report Your Injury Immediately Definition of “Emergency Health Care Services” Selecting a Medical Provider What To Do If You Have Trouble Getting an Appointment

5 5 5 6 7

CHANGING PROVIDERS & SECOND/THIRD OPINIONS Changing Your Provider How To Obtain A Referral To A Specialist How To Use the Second and Third Opinion Process How To Obtain An Independent Medical Review

7 7 7 8

MEDICAL BILLS

9

DISPUTES What If My Employer Disputes My Injury

9

CONTINUITY OF CARE What Happens If Your Provider Is Terminated From the MPN

9

TRANSFER OF ONGOING CARE What Happens When You Are Being Treated For An Injury Or Illness Prior To the Coverage Of the MPN

10

MPN CONTACT INFORMATION

10

Attachment A: Continuity of Care Policy Attachment B: Transfer of Care Policy Attachment C: Access Standards

3

THE PURPOSE OF THE MEDICAL PROVIDER NETWORK California law requires your employer to provide and pay for medical treatment if you are injured at work. Your employer has chosen to provide this medical care by using a Workers’ Compensation physician network called a Medical Provider Network (MPN). This MPN is administered by the California Foundation for Medical Care. Your employer’s workers’ compensation administrator is Self-Insured Schools of California (SISC). This notification tells you what you need to know about the MPN program and describes your rights in choosing medical care for work-related injuries and illnesses. Injured workers deserve timely, quality medical care. The Medical Provider Network (MPN) is a network of doctors and hospitals who understand how to diagnose and treat work-related injuries. These providers are committed to improving your physical wellbeing and returning you to useful employment. The MPN is not just for medical treatment. It will also help you to return to work after an injury or illness. The MPN’s main purpose is to help employees who are injured or become ill on the job to return to work safely and as soon as possible. You may be assigned a telephonic nurse case manager to work with you, your employer, your insurance carrier and your doctor to help you recover from your injury or illness and help you return to work. Your MPN should be used only for injuries and illnesses covered under your employer’s workers’ compensation plan. If you are injured at work, you must use the doctors, clinics, hospitals and other medical providers who are part of the MPN. Please refer to the information below for specific instructions on how to access the MPN. HOW TO ACCESS THE MPN Your employer has designated a Site Coordinator to help you use the MPN if you are injured or ill on the job. This person should be your first contact if you have questions about the MPN or your workers’ compensation coverage. You may also refer to the MPN Poster and State posting notice for additional information. Access Standards For answers to the below please see See Attachment C How to access treatment if (a) the employee is authorized by the employer to temporarily work or travel for work outside the MPN’s geographical area; (b) a former employee whose employer has ongoing workers’ compensation obligations permanently resides outside the MPN geographical service area; and (c) an injured employee decides to temorpairly reside outside the MPN geographic service area during recovery pursuant to 9767.12.a.5 How to obtain a referral to a specialist outside the MPN pursuant to 9767.12.a.9

4

Description of Services Your employer is responsible for providing medical care including: -

A Primary Care Physician within 30 minutes or 15 miles of your residence or work place Other occupational health services and specialists within 60 minutes or 30 miles of your residence or work place Access to medical care in rural areas Emergency health care services, and Medical care if you are working or traveling outside of the geographic services area

IMPORTANT: REPORT YOUR INJURY IMMEDIATELY In the event of an emergency (defined below on this page), or if urgent care is needed, please call 911 or seek medical attention from the nearest hospital or Urgent Care Center. Once you have received care, let your Site Coordinator know as soon as possible. If your job-related injury or illness is not an emergency, please let your immediate supervisor and/or the Site Coordinator know before seeing a doctor. If you are treated away from your home or work place, upon your return to your geographic location, you must let your Site Coordinator know. Your Site Coordinator will provide you with a listing of the MPN doctors if you require additional medical care. Definition of “Emergency Health Care Services” “Emergency Health Care Services” or “Urgent Care” is defined as health care services for a medical condition manifesting itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to place the patient’s health in serious jeopardy. The MPN is ONLY for work-related injuries or illnesses. You should not seek medical treatment from the MPN without telling your Site Coordinator. Remember, if you need emergency treatment call 911 or go to the nearest hospital. Never delay seeking medical treatment if you are seriously injured or ill.

5

VERY IMPORTANT: IF YOU HAVE PRE-DESIGNATED YOUR PERSONAL PHYSICIAN PRIOR TO AN INJURY If you have pre-designated your personal physician prior to an injury, you may seek care from this physician. IMPORTANT: You may only pre-designate your personal physician prior to the injury if: 1) Your employer offers a non-occupational group health plan or insurance; 2) You have received care with the physician prior to the injury; 3) The physician retains your medical records; 4) the physician agrees to be your primary treating physician; and 5) The physician must be either a physician who has limited her or her practice of medicine to general practice, or who is a board-certified internist, pediatrician, obstetrician-gynecologist, or family practitioner. If your physician does not agree to participate in this capacity, you will be required to seek care with an MPN provider. This pre-designation must be in writing and on file with the employer. You will be given an “Employee Physician Pre-Designation Form” at the time of the effective date of the MPN (or upon hire, if you are hired after the MPN effective date). Should you decide to pre-designate at a later time and require another form, request it from your employer. Selecting a Medical Provider Your employer must arrange for an initial medical evaluation and begin treatment, if appropriate. However, you have a right to be treated by a MPN physician of your choice after the first visit. As a patient in the MPN, you have the right to see a doctor close to your home or work place. If you have to travel more than 15 miles or 30 minutes to see your treating doctor or 30 miles or 60 minutes to see a specialist, you should advise your SISC claims adjuster. If you live in a rural area, the travel distance and/or travel time may be greater than the timeframes listed previously. The instructions that follow will help you choose a doctor. For an emergency, or urgent care situation, call 911 or go directly to the nearest emergency room. For non-urgent care, do the following: After reporting your injury to your Site Coordinator, your Site Coordinator will provide you with a DWC-1 Claim Form, a copy of the MPN handbook as required by law, and will give you the name of a doctor for an initial medical evaluation and you may begin treatment, if necessary. You may continue using this designated doctor after the initial evaluation or you may choose another MPN doctor. You can get the list of MPN providers by calling the MPN contact or by going to our website at www.cfmcnet.org/SISC. You also have the right to a complete listing of all of the MPN providers upon request.

6

What To Do If You Have Trouble Getting an Appointment If you have trouble getting an appointment for non-emergency services with a MPN doctor within 3 business days or an MPN specialist doctor within 20 business days of your employer’s receipt of a request, you should seek assistance from your SISC claims adjuster at 800-972-1727, or contact your attorney if you are represented. Your SISC claims adjuster will work with the MPN to assist you in getting an appointment in a timely manner. If you require further assistance, you may contact the MPN call center at (877) 222-4946 for any network questions. CHANGING PROVIDERS & SECOND /THIRD OPINIONS Changing Your Provider Your employer has selected an initial medical provider to treat you for your work injury. However, you have the right to change your doctor if you are not happy with the doctor treating your work-related injury or illness, but even so, medical treatment must still be provided inside the MPN. To get a listing of MPN doctors in your area, you may consult with your MPN Site Coordinator, consult the MPN website at www.cfmcnet.org/SISC, or contact the MPN call center at (877) 222-4946. If you decide to change doctors, it is your responsibility to advise the SISC claims adjuster immediately. How To Obtain A Referral To A Specialist If your treating physician cannot provide you the care needed for recovery, he or she will refer you to an MPN specialist that is appropriate to address your particular injury or illness. If you need assistance locating an MPN specialist near your workplace or home, you may consult with your MPN Site Coordinator, consult the MPN website at www.cfmcnet.org/SISC, or contact the MPN call center at (877) 222-4946. How To Use the Second and Third Opinion Process If you dispute either the diagnosis or the treatment that is recommended by the treating physician, you may obtain a second and third opinion from physicians within the MPN. During this process, you must continue your treatment with your treating physician or another physician of your choice within the MPN. For obtaining a second opinion, it is your responsibility to: 1. 2. 3. 4.

Inform the SISC Claims Examiner either orally or in writing that you dispute the treating physician’s opinion and you are requesting a second opinion. Select a physician or specialist from a regional area listing of available MPN providers. Make an appointment with the second physician within 60 days. Inform the SISC Claims Examiner of the appointment date.

7

For obtaining a second opinion, it is SISC’s responsibility to: 1. 2. 3. 4. 5.

Provide a regional area listing of MPN providers and/or specialists for you to select a second opinion physician based on the specialty or recognized expertise in treating your injury or condition in question. Contact your treating physician. Provide a copy of the medical records or send the necessary medical records to the opinion physician prior to the appointment. Provide a copy of the records to you upon request. Notify the second opinion physician in writing that he or she has been selected to provide a second opinion and the nature of the dispute.

If you do not make an appointment with a second opinion physician within 60 days of receiving the list of available MPN providers, then you will not be able to obtain a second opinion regarding the diagnosis or treatment in dispute. If, after your second opinion physician reviews your medical records, he or she determines that your injury is outside the scope of his or her practice, the second opinion physician will notify you and SISC so that SISC can provide a new list of MPN providers. If you disagree with either the diagnosis or treatment prescribed by the second opinion physician, you may seek the opinion of a third physician within the MPN, following the same procedure as above for requesting a second opinion physician. The second and third opinion physicians must provide his/her opinion of the disputed diagnosis or treatment in writing and offer alternative diagnosis or treatment recommendations, if applicable. These physicians may order diagnostic testing if medically necessary. A copy of the written report must be given to you and your employer within 20 days of the date of your appointment or receipt of the results of the diagnostic tests, whichever is later. If you disagree with either the diagnosis or treatment prescribed by the third opinion physician, you may file with the Administrative Director a request for an Independent Medical Review. A copy of the second and/or third opinion report will be sent to the employee’s treating physician pursuant to 9767.7f. HOW TO OBTAIN AN INDEPENDENT MEDICAL REVIEW You must obtain a second and third opinion before you can request an Independent Medical Review (IMR). If you disagree with either the diagnosis or treatment prescribed by the third opinion physician, you may file with the Administrative Director a request for an Independent Medical Review. You may obtain an IMR by submitting an application to the Administrative Director. Upon notice of your selection of a third opinion physician, the SISC Claims Examiner will provide you with the IMR application and instructions form by which you would request an IMR in the event you dispute the findings of the third opinion physician. The

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Administrative Director will assign the Independent Medical Reviewer, who may, at your request, conduct a medical examination during the review. SISC will provide the Independent Medical Reviewer with a copy of all relevant medical records, and will send you a copy of the documents sent to the IMR. You may also furnish any relevant medical records or additional materials to the IMR, with a copy to SISC. The Independent Medical Reviewer must issue a report to the Administrative Director, in writing, that includes his/her analysis and determination whether the disputed health care service met the State’s treatment guidelines. The report must be issued within 20 days of the examination, or within less time upon request of the Administrative Director. However, if the Reviewer certifies the disputed health care service is a serious threat to your health, the report must be provided within three days of the examination. If the Independent Medical Reviewer does not agree with the disputed diagnosis, diagnostic service or medical treatment prescribed by the treating physician, you have the right to receive this treatment from any doctor you choose, inside or outside the MPN and SISC will pay for approved treatment. If you choose to receive medical treatment with a physician outside the MPN, the treatment is limited to the treatment or the diagnostic service recommended by the IMR. MEDICAL BILLS All medical bills resulting from your work-related injury or illness should be sent directly to SISC who will review the charges to make sure they are correct. SISC will pay the provider(s). Your lost wage compensation and any other benefits you are entitled to under the California State Workers’ Compensation Act will be paid by SISC. You can direct any questions regarding your benefits to your employer. DISPUTES What If My Employer Disputes My Injury You may be entitled to receive treatment even if your employer initially disputes your injury. The injury is presumed to be work-related if the claim is not denied within 90 days of the date the claim form is filed. Until the date that liability for the claim is accepted or rejected, the employer’s liability for the claim is limited to $10,000. Please note this does not guarantee that you will receive medical care up to this $10,000 limit. Treatment can continue until the employer makes a decision to deny your claim. This treatment must be provided from an MPN doctor unless it is an emergency situation, or if you predesignated a treating physician. CONTINUITY OF CARE What Happens If Your Provider Is Terminated From the MPN Attachment A is a copy of your employer’s Continuity of Care Policy. This Policy provides for the completion of treatment by a doctor who has been terminated from the MPN for certain medical conditions.

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TRANSFER OF ONGOING CARE What Happens if You Already Have a Workers’ Compensation Claim Prior to the Effective Date of the MPN Until you are transferred into the MPN, your physician may make referrals to providers within or outside of the MPN pursuant to 9767.9.b. If you are being treated for an injury or illness prior to the coverage of the MPN, your employer will provide for the completion of your treatment with your doctor under certain circumstances. Attachment B is your employer’s Transfer of Ongoing Care Policy. MPN CONTACT INFORMATION The following is the contact information for the SISC MPN: MPN Call Center: 1-877-222-4946 The contact for your MPN is: Name: Provider Relations Department/SISC MPN Representative Address: 5701 Truxtun Avenue, Suite 100, Bakersfield, CA 93309 Telephone Number: 1-877-222-4946 Email: [email protected] Website address: www.cfmcnet.org/SISC

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Attachment A

Continuity of Care Policy Completion of Treatment by a Terminated Provider SISC will comply with the provisions set forth in California Labor Code Sections 4616.2(d) and (e) when the covered employee requests completion of treatment by a terminated provider. SISC will provide to all employees entering the workers’ compensation system notice of its written Continuity of Care policy and information regarding the process for an employee to request a review under the policy and will provide, upon request, a copy of the written policy to the employee pursuant to 9767.12.a.12. SISC will comply with the requirements of LC §4616.2(d) and (e) as follows: •

SISC/CFMC will provide either verbal or written notice to the injured employee of the termination from the MPN of his or her treating provider.

•

SISC will arrange for transfer of care to another MPN provider or will provide for the completion of treatment with the terminated provider according to LC §4616.2(d).

•

If the injured employee requests completion of treatment with the terminated provider, the SISC claim adjuster will review the claim for compliance to LC §4616.2(d).

•

If the injured employee meets the criteria as defined by LC §4616.2(d), SISC will provide: •

•

•

•

Completion of care for up to 90 days of treatment for an “acute condition” as defined in LC §4616.2(d)(3)(A) as “a medical condition that involves a sudden onset of symptoms due to an illness, injury or other medical problem that requires prompt medical attention and that has a limited duration”. Completion of treatment shall be provided for the duration of the acute condition. Completion of care for the period of time necessary to complete a course of treatment for a “serious chronic condition” up to one year from the date of determination that the injured employee has a “serious chronic condition” defined in LC 4616.2(d)(3)(B) as “a medical condition due to a disease, illness, or other medical problem or medical disorder that is serious in nature and that persists without full cure or worsens over an extended period of time or requires ongoing treatment to maintain remission or prevent deterioration”. Completion of care shall be provided for a period of time necessary to complete a course of treatment and to arrange for a safe transfer to another provider, as determined in consultation with the employee and the terminated provider and consistent with good professional practice. Completion of treatment shall not exceed 12 months from the contract termination date. Completion of care for the duration of a “terminal illness” as defined in LC §4616.2(d)(3)(C) as “an incurable or irreversible condition that has a high probability of causing death within one year or less. Performance of surgery or other procedure that has been authorized as part of a documented course of treatment and will occur within 180 days from the MPN coverage effective date as discussed in LC §4616.2(d)(3)(D).

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•

•

SISC/CFMC will notify terminated providers whose services are continued beyond the contract termination date pursuant to LC §4616.2(d)(4)(A) that they must agree in writing to be subject to the same contractual terms and conditions that were imposed upon the provider prior to termination. The SISC claim adjuster may direct the injured employee to an MPN provider if the terminated provider does not agree to comply with the prior contractual terms and conditions. Unless otherwise agreed by the terminated provider and SISC/CFMC, the services rendered pursuant to this section shall be compensated at rates and methods of payment similar to those used by SISC/CFMC for currently contracting providers providing similar services who are practicing in the same or a similar geographic area as the terminated provider. The SISC claims adjuster may direct the injured employee to an MPN provider if the terminated provider does not accept the payment rates provided for in this paragraph.

•

If the terminated provider was terminated for cause, fraud, or other criminal activity, the injured employee shall be transferred to an MPN provider.

•

Nothing stated above prohibits SISC from agreeing to provide continuity of care with a terminated provider should SISC determine that it is in the best interest of the injured employee to continue treatment with the terminated provider.

A copy of SISC’s determination of the employee’s medical condition will be sent to the employee’s primary treating physician pursuant to 9767.10.d.1. •

Dispute Resolutions:

•

After SISC makes a determination of the employee’s medical condition, SISC will notify the employee (with a letter written in English and in Spanish sent to the employee’s residence, using layperson’s terms to the maximum extent possible), advising whether or not he or she will be required to select a new provider from within the MPN.

•

If the terminated provider wishes to continue to treat and if the injured employee disputes the medical determination, he or she will be required to request a report from the treating physician that addresses whether his or her medical determination falls into any of the four conditions referenced above (as set forth in Labor Code 4616.2(d)(3). The treating physician will be required to provide this report within 20 calendar days from the request. If the treating physician fails to issue the report, then SISC’s determination shall apply.

•

If SISC disputes the medical determination by the treating physician, the dispute will be resolved using the QME process pursuant to Labor Code section 4062.

•

If the treating physician agrees with SISC’s determination that the injured employee’s medical condition does not meet the conditions set forth in Labor Code section 4616.2(d)(3), the employee will be required to select a new provider from within the MPN during the dispute resolution process.

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•

If the treating physician does not agree with SISC’s determination that the injured employee’s medical condition does not meet the conditions set forth in Labor Code section 4616.2(d)(3), the injured employee shall continue to treat with the terminated provider until the dispute is resolved.

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Attachment B Transfer of Care Policy SISC will comply with the provisions set forth in California Code of Regulations, Title 8, §9767.9 regarding Transfer of Ongoing Care into the MPN. Until the injured covered employee is transferred into the MPN, the employee’s physician may make referrals to providers within or outside of the MPN pursuant to 9767.9b. If a provider delivering ongoing care for a covered injured employee is already participating in the newly implemented MPN, SISC will notify the injured employee if his or her treatment is being provided under the MPN provisions. If a provider delivering ongoing care for a covered injured employee prior to the inception of the MPN is not a provider under the SISC/CFMC MPN, SISC as the claims administrator will provide: •

Completion of care for up to 90 days of treatment for an “acute condition” as defined in 8 CCR §9767.9(e)(1) as “a medical condition that involves a sudden onset of symptoms due to an illness, injury or other medical problem that requires prompt medical attention and that has a duration of less than 90 days”. Completion of treatment shall be provided for the duration of the acute condition.

•

Completion of care for the period of time necessary to complete a course of treatment for a “serious chronic condition” up to one year from the date of determination that the injured employee has a “serious chronic condition” as defined in 8 CCR §9767.9(e)(2) as “a medical condition due to a disease, illness, catastrophic injury, or other medical problem or medical disorder that is serious in nature and that persists without full cure or worsens over 90 days and requires ongoing treatment to maintain remission or prevent deterioration”. Completion of care shall be provided for a period of time necessary, up to one year: (A) to complete a course of treatment approved by SISC; and (B) to arrange for transfer to another provider within the MPN, as determined by SISC. The one year period of completion of treatment starts from the date of the injured employee’s receipt of the notification of the determination that the employee has a serious chronic condition.

•

Completion of care for the duration of a “terminal illness” as defined in 8 CCR 9767.9(e)(3) as “an incurable or irreversible condition that has a high probability of causing death within one year or less”.

•

Performance of surgery or other procedure that has been authorized as part of a documented course of treatment and will occur within 180 days from the MPN coverage effective date as discussed in 8 CCR 9767.9(e)(4).

•

Until the injured covered employee is transferred into the MPN, the employee’s physician may make referrals to providers within or outside of the MPN pursuant to 9767.9.b.

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SISC will conduct an assessment of the injured employee’s medical condition prior to any determination that the ongoing care does not meet any of the above criteria and therefore could be eligible for a transfer into the MPN. This assessment may involve the guidance of a TMC nurse case manager. SISC will send notification of the determination of the transfer of care to the injured employee’s residence and to the injured employee’s primary treating physician. The notification will be provided in English and Spanish and will use layperson’s terms to the maximum extent possible. If the injured employee disputes the medical determination that transfer of care into the MPN is appropriate, he or she must request a report from the primary treating physician addressing whether the ongoing care falls within any of the conditions identified above. The treating physician must provide the report to the employee within 20 calendar days of the request. If the treating physician fails to issue the report, then SISC’s determination regarding completion of treatment shall apply. If the primary treating physician agrees with SISC’s determination that the injured employee’s medical condition does not meet the conditions identified above (as set forth in 8 CCR 9767.9(e)(1) through (4), the transfer of care shall proceed during the dispute resolution process. If the primary treating physician disagrees with SISC’s determination that the injured employee’s medical condition does not meet the conditions identified above (as set forth in 8 CCR 9767.9(e)(1) through (4), the transfer of care shall not proceed until the dispute is resolved. Any dispute concerning the medical determination made by the primary treating physician concerning transfer of care will be resolved by the QME process pursuant to LC §4062. Referrals made to providers subsequent to the implementation of the MPN are to be made to a provider within the MPN. Nothing stated above prohibits SISC from agreeing to provide care outside the MPN should SISC determine that it is within the best interest of the injured employee to continue treatment with the non-MPN provider.

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Attachment C Access Standards (a) A MPN must have at least three physicians of each specialty expected to treat common injuries experienced by injured employees based on the type of occupation or industry in which the employee is engaged and within the access standards set forth in (b) and (c). (b) A MPN must have a primary treating physician and a hospital for emergency health care services, or if separate from such hospital a provider of all emergency health care services within 30 minutes or 15 miles of each covered employee’s residence or workplace. (c) A MPN must have providers of occupational health services and specialists within 60 minutes or 30 miles of a covered employee’s residence or workplace. (d) If a MPN applicant believes that, given the facts and circumstances with regard to a portion of its service area, specifically rural areas including those in which health facilities are located at least 30 miles apart, the accessibility standards set forth in subdivision (b) and/or (c) are unreasonably restrictive, the MPN applicant may propose alternative standards of accessibility for that portion of its service area. The MPN applicant shall do so by including the proposed alternative standards in writing in its plan approval or in a notice of MPN plan modification. The alternative standards shall provide that all services shall be available and accessible at reasonable times to all covered employees. (e) (1) The MPN applicant shall have a written policy for arranging or approving non-emergency medical care for: (A) a covered employee authorized by the employer to temporarily work or travel for work outside the MPN geographic area when the need for medical care arises; (B) a former employee whose employer has ongoing workers’ compensation obligations and who permanently resides outside the MPN geographic service area; and (C) an injured employee who decides to temporally reside outside the MPN geographic service area during recovery. (2) The written policy shall provide the employees described in subdivision (e)(1) above with the choice of at least three physicians outside the MPN geographic service area who either have been referred by the employee’s primary treating physician within the MPN or have been selected by the MPN applicant. In addition to physicians within the MPN, the employee may change physicians among the referred physicians and may obtain a second and third opinion from the referred physicians. (3) The referred physicians shall be located within the access standards described in paragraphs (c) and (d) of this section. (4) Nothing in this section precludes a MPN applicant from having a written policy that allows a covered employee outside the MPN geographic service area to choose his or her own provider for nonemergency medical care. (f) For non-emergency services, the MPN applicant shall ensure that an appointment for initial treatment is available within 3 business days of the MPN applicant’s receipt of a request for treatment within the MPN

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(g) For non-emergency specialist services to treat common injuries experienced by the covered employees based on the type of occupation or industry in which the employee is engaged, the MPN applicant shall ensure that an appointment is available within 20 business days of the MPN applicant’s receipt of a referral to a specialist within the MPN. (h) If the primary treating physician refers the covered employee to a type of specialist not included in the MPN, the covered employee may select a specialist from outside the MPN. (i) The MPN applicant shall have a written policy to allow an injured worker to receive emergency health care services from a medical service or hospital provider who is not a member of the MPN.

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ESCUELAS AUTO-ASEGURADAS DE CALIFORNIA (SELFINSURED SCHOOLS OF CALIFORNIA) RED DE PRESENTADORES MÉDICOS

MANUAL DEL EMPLEADO

Fecha de Vigencia: 10 de Oct. De 2007 A todos los empleados: Su empleador está comprometido a brindarle bienestar y seguridad en su lugar de trabajo. Nuestra preocupación más importante es evitar las lesiones. Sin embargo, si se lesionó en el trabajo, nuestro objetivo es ayudarlo a recuperarse y regresar al empleo útil tan pronto como sea médicamente posible. Su empleador ha elegido la asociación Escuelas Auto-Aseguradas de California (SISC), la Fundación de California para la Red de Atención Médica (MPN), como la red de prestadores médicos en caso de que sufra una lesión en el trabajo. La MPN es una Red de Prestadores en casos de Compensación por Accidentes en el Trabajo, constituida utilizando Prestadores de Servicios de Atención Ocupacionales. A menos que usted predesigne a un médico o un grupo de prestaciones de servicios médicos, las nuevas lesiones que ocurran el primero de octubre de 2007, o después, serán atendidas por prestadores en nuestra Red de Atención Médica SISC. Si usted tiene una lesión o herida existente, es posible que usted tenga que cambiarse a un proveedor en la nueva SISC MPN. Averigüe con su mediador de reclamos. Usted podrá obtener más información acerca de la MPN a través del cartel sobre Compensación por Accidentes en el Trabajo, o por medio de su empleador. La MPN será provista a través de la red de prestadores médicos y centros de SISC. Su empleador está autoasegurado a través de un Joint Powers Authority, (un Poder Conjunto), y SISC, que actúa como su administradora de reclamos, como parte tercera. SISC, como una Joint Powers Authority, presta servicios a varios distritos escolares en todo el Estado de California. La Fundación de Atención Médica de California provee una red médica amplia para atender las necesidades de SISC y su red de prestadores médicos. La MPN incluye clínicas de salud ocupacional y médicos que le prestarán atención médica. El médico ocupacional a su vez tratará el tema de su regreso al trabajo con su empleador. Daños existentes que se sufrieron en el trabajo podrán ser transferidos al nuevo plan MPN. Los empleados deben consultar con su Mediador de Reclamos si desea más información. Según el Programa MPN, usted recibirá: -Un médico primario -Otros servicios de salud ocupacional y especialistas -Servicios de atención médica de emergencia y -Atención médica si usted trabaja o viaja fuera del área geográfica de servicios Esta red ha sido desarrollada para brindarle atención médica oportuna y de calidad. La MPN es de fácil acceso y tiene como objetivo brindarle atención médica de calidad y ayudarlo a regresar a una vida productiva y saludable.

A los empleados se les notificará de la implementación del programa MPN a través del correo, o incluida en o con el talón del cheque de pago de sueldo del empleado, el cheque mismo, o distribuida por algún medio electrónico, incluyendo “e-mail”, si el empleado tiene acceso electrónico regular al “e-mail” en el trabajo para poder recibir esta notificación. Si el empleado no puede recibir esta notificación electrónicamente en el trabajo, entonces el empleador asegurará que tal información se le entregue al empleado por escrito. Este Manual del Empleado de la MPN le brindará la información para ayudarlo en caso de enfermedad o lesión relacionada con el trabajo. Información adicional relativa a la MPN también estará disponible a través del cartel sobre Compensación por Accidentes en el Trabajo, por consulta con su empleador, por medio del Internet: www.cfmcnet.org/SISC o llamando al número sin costo: 1-877-222-4946. Favor de referirse a la página 11 para obtener información de contacto de MPN.

MANUAL DEL EMPLEADO DE LA MPN ÍNDICE PÁG. EL OBJETIVO DE LA RED DE PRESTADORES MÉDICOS (MPN) 5 Sólo enfermedades y lesiones por accidentes de trabajo CÓMO ACCEDER A LA MPN Descripción de servicios 5 Informe su lesión inmediatamente 5 Definición de “Servicios de Atención Médica de Emergencia” 5 Elección de un prestador médico 7 Qué hacer si tiene problemas para obtener una cita 8

CAMBIO DE PRESTADORES Y SEGUNDAS/TERCERAS OPINIONES Cambio de su prestador 8 Cómo obtener una referencia para un especialista 8 Cómo usar el precedimiento de segundas y terceras opciones 8 Cómo obtener una revisión médica independiente 10 FACTURAS MÉDICAS 10 CONFLICTOS Qué sucede si su prestador no pertenece más a la MPN 11 TRANSFERENCIA DE LA ATENCIÓN CONTÍNUA Qué sucede si ya tiene un reclamo por accidente de trabajo de fecha anterior a la fecha de entrada en vigencia de la MPN 11 INFORMACIÓN DE CONTACTO DE LA MPN 11 Anexo A: Política de Continuidad de la Atención Anexo B: Política de Transferencia de la Atención Anexo C: Estándares de Acceso EL OBJETIVO DE LA RED DE PRESTADORES MÉDICOS

La legislación de California exige que su empleador le brinde y pague el tratamiento médico si se lesiona en el trabajo. Su empleador ha elegido prestarle esta atención médica a través de una red de médicos de Accidentes de Trabajo llamada Red de Prestadores Médicos (MPN). La administración de esta MPN se encuentra a cargo de la Fundación de Atención Médica de California (California Foundation for Medical Care). La asociación administradora de accidentes de trabajo de su empleador Escuelas Auto-Aseguradas de California (SISC). Esta notificación le informa lo que necesita saber sobre el programa de la MPN y describe sus derechos al elegir la atención médica por enfermedades o lesiones relacionadas con el trabajo. Los trabajadores lesionados merecen atención médica oportuna y de calidad. La Red de Prestadores Médicos (MPN) es una red de médicos y hospitales que saben cómo diagnosticar y tratar las lesiones relacionadas con el trabajo. Estos prestadores están comprometidos a mejorar su bienestar físico y ayudarlo a regresar a su empleo útil. La MPN no sólo presta tratamientos médicos. También le ayudará a regresar al trabajo luego de una lesión o enfermedad. El objetivo principal de la MPN es ayudar a los empleados que sufren lesiones o se enferman en el trabajo a regresar a trabajar en forma segura y tan pronto como sea possible. Puede que le asignen un administrador telefónico del caso (nurse case manager) para que trabaje con usted, su empleador, la aseguradora y su médico para ayudarle a recuperarse de su lesión o enfermedad y también a regresar al trabajo. Su MPN debe utilizarse solamente para lesiones o enfermedades cubiertas según el plan de compensaciones por accidentes de trabajo de su empleador. Si se lesiona en el trabajo, debe usar los médicos, clínicas, hospitales y otros prestadores médicos que sean parte de la MPN. Por favor, utilice la información que aparece a continuación para obtener instrucciones específicas sobre cómo acceder a la MPN. CÓMO ACCEDER A LA MPN Su empleador ha designado un Coordinador del Lugar (Site Coordinator) para ayudarle a usar la MPN si se lesiona o se enferma en el trabajo. Esta persona debe ser su primer contacto si tiene dudas sobre la MPN o la cobertura de accidentes de trabajo. También puede referirse al cartel sobre la MPN y el tablero de avisos del Estado para más información. Estándares de Acceso Para obtener respuestas relacionadas con los siguientes temas, lea el Anexo C. Cómo acceder al tratamiento si (a) el empleador autoriza al empleado a trabajar o viajar por trabajo temporalmente fuera del área geográfica de la MPN; (b) un ex-empleado cuyo empleador tiene obligaciones actuales relacionadas con un ambiente de trabajo reside en forma permanente fuera del área geográfica de la MPN; y (c) un empleado lesiónado decide residir temporalmente fuera del área geográfica de servicios de la MPN durante la recuperación de acuerdo con el artítuclo 9767.12.a.5

Cómo obtener una referencia para un especialista fuera de la MPN de acuerdo con el artículo 9767.12.a.9 Descripción de Servicios Su empleador es responsable de prestarle atención médica, incluidos los siguientes conceptos:

IMPORTANTE: INFORME SU LESIÓN INMEDIATAMENTE - Un Médico Primario dentro de los 30 minutos o las 15 millas de su hogaro lugar de trabajo - Otros servicios de salud ocupacional y especialistas dentro de los 60 minutos o las 30 millas de su hogar o lugar de trabajo - Acceso a la atención médica en áreas rurales - Servicios de atención médica si trabaja o viaja fuera del área geográfica de servicios

En caso de emergencia (como se define más adelante en esta página) , o si se requieren cuidados de urgencia, por favor llame al 911 o busque atención médica en el hospital o Centro de Cuidados de Urgencia más cercano. Una vez que haya recibido los cuidados, infórmele a su Coordinador del Lugar tan pronto como sea posible. Si su lesión o enfermedad relacionada con el trabajo no es una emergencia, por favor infórmele al Coordinador del Lugar o su supervisor inmediato antes de ver a un médico. Si recibe tratamiento lejos de su hogar o lugar de trabajo, al regresar a su lugar geográfico, debe informárselo al Coordinador del Lugar. El Coordinador del Lugar le dará un listado de médicos de la MPN si necesita atención médica adicional. Definición de “Servicios de Atención Médica de Emergencia” Los “Servicios de Atención Médica de Emergencia” o los “Cuidados de Urgencia” se definen como servicios de atención médica por un estado médico que se manifiesta a través de síntomas agudos de suficiente gravedad de forma tal que se podría esperar en forma razonable que la ausencia de atención médica coloque a la salud del paciente en grave peligro. La MPN es SÓLO para enfermedades o lesiones relacionadas con el trabajo. No debe solicitar tratamiento médico de la MPN sin informarle al Coordinador del Lugar. Recuerde, si necesita atención de emergencia llame al 911 o diríjase al hospital más cercano. No demore nunca la búsqueda de atención médica si se encuentra gravemente enfermo o lesionado.

MUY IMPORTANTE: SI HA PRE-DESIGNADO A SU MÉDICO PERSONAL EN FORMA PREVIA A UNA LESIÓN Si ha pre-designado a su médico personal en forma previa a una lesión, usted puede solicitar la atención de este médico. IMPORTANTE: Sólo puede pre-designar a su médico personal en forma previa a la lesión si: 1) Su empleador le ofrece un seguro o plan de salud grupal no ocupacional; 2) Ha recibido atención del médico antes de la lesión; 3) El médico conserva su registros médicos; 4) El médico conviene en ser su médico primario; y 5) El médico es un médico que sólo practica medicina general, o un médico internista certificado, un médico pediatra, un obstetra-ginecólogo o un médico familiar. Si su médico no está de acuerdo en participar en este carácter, deberá buscar la atención médica de un prestador de la MPN. Esta designación previa debe realizarse por escrito y estar registrada en los archivos del empleador. Se le entregará un “Formulario de Designación Previa del Médico por parte del Empleado” a la fecha de entrada en vigencia de la MPN (o al momento de la contratación, si lo contratan después de la fecha de entrada en vigencia de la MPN). En caso de que decida realizar la designación previa más adelante y necesite otro formulario, solicítelo a su empleador.

Elección de un Prestador de Servicios Médicos Su empleador debe programar una evaluación médica inicial y comenzar un tratamiento, si fuera necesario. Sin embargo, tiene derecho a ser tratado por un médico de la MPN de su elección luego de su primera visita. Como paciente de la MPN, tiene derecho a ver a un médico cercano a su hogar o lugar de trabajo. Si tiene que viajar más de 15 millas o 30 minutos para ver a su médico o 30 millas o 60 minutos para ver a un especialista, debe informárselo a su mediador de reclamos de la SISC. Si vive en un área rural, la distancia de viaje y/o tiempo de viaje pueden ser mayores que los marcos de tiempo descritos anteriormente. Las instrucciones que aparecen a continuación le ayudarán a elegir un médico. En caso de emergencia o una situación que requiera cuidados de urgencia, llame al 911 o diríjase directamente a la sala de emergencias más cercana. Para recibir cuidados que no sean de urgencia, haga lo siguiente: Luego de informarle su lesión al Coordinador del Lugar, él mismo le proporcionará un Formulario de Reclamo DWC-1, una copia del Manual de la MPN según lo exige la ley, y le dará el nombre de un médico para la evaluación médica inicial, luego podrá comenzar un tratamiento, de ser necesario. Podrá seguir atendiéndose con este médico designado de la evaluación inicial o podrá elegir otro médico de la MPN. Puede conseguir el listado de prestadores de la MPN llamando al contacto de la MPN o visitando nuestro sitio Web www.cfmcnet.org/SISC.

Asimismo, tiene derecho a recibir un listado completo de todos los prestadores de la MPN si así lo solicita. Qué hacer si tiene problemas para hacer una cita Si tiene problemas para hacer una cita para servicios que no sean de emergencia con un médico de la MPN dentro de 3 días hábiles o un especialista de la MPN dentro de los 20 días hábiles de la fecha de recepción por parte de su empleador de una solicitud, debe solicar la asistencia del mediador de reclamos de SISC al 800972-1727 o contactar a su abogado si tiene representación. Su mediador de reclamos de la SISC trabajará con la MPN para ayudarlo a conseguir una cita oportunamente. Si necesita más ayuda, puede contactar al centro de recepción de llamados de la MPN al (877) 222-4946 para que le respondan cualquier duda sobre la red. CAMBIO DE PRESTADORES Y SEGUNDAS/TERCERAS OPINIONES Cambio de su Prestador Su empleador ha elegido un prestador médico inicial para tratar su lesión de trabajo. Sin embargo, usted tiene derecho a cambiar de médico si no está conforme con el médico que está tratando su enfermedad o lesión relacionada con el trabajo, pero aún así, el tratamiento médico deberá prestarse dentro de la MPN. Para obtener un listado de los médicos de la MPN en su área, puede consultar con su Coordinador del Lugar de la MPN, consultar el sitio Web de la MPN www.cfmcnet.org/SISC o contactarse con el centro de recepción de llamados de la MPN al (877) 222-4946. Si decide cambiar de médico, es su responsabilidad informarle al mediador de reclamos de SISC inmediatamente. Cómo obtener una referencia para un especialista Si el médico que lo está tratando no puede prestarle la atención que necesita para su recuperación, le dará una referencia a un especialista de la MPN que sea adecuado para tratar su enfermedad o lesión particular. Si necesita ayuda para localizar a un especialista de la MPN cerca de su hogar o lugar de trabajo, puede consultar con el Coordinador del Lugar de la MPN, consultar el sitio Web de la MPN www.cfmcnet.org/SISC o contactarse con el centro de recepción de llamados de la MPN al (877) 222-4946. Cómo usar el procedimiento de segundas y terceras opiniones Si cuestiona el diagnóstico o el tratamiento recomendado por el médico que lo está tratando, podrá obtener una segunda y una tercera opinión de otros médicos dentro de la MPN. Durante este procedimiento, debe continuar su tratamiento con el médico que lo esté tratando u otro médico de su elección de la MPN.

Para obtener una segunda opinión, es su responsabilidad: 1. Informarle al Mediador de Reclamos de SISC en forma oral o por escrito que usted cuestiona la opinión del médico que lo está tratando y que solicita una segunda opinión. 2. Elegir un médico o un especialista de un listado de la región de prestadores disponibles de la MPN. 3. Programar una cita con el segundo médico dentro de los 60 días. 4. Informarle al Mediador de Reclamos de SISC la fecha de la cita. Para obtener una segunda opinión, es responsabilidad de SISC: 1 Proporcionar un listado regional de prestadores de la MPN y/o especialistas para que elija un médico que emita una segunda opinión basado en la especialidad o su reconocida experiencia en el tratamiento de su lesión o del estado en cuestión. 2 Contactar al médico que lo está tratando. 3 Proporcionar una copia de los registros médicos o enviarle los registros médicos necesarios al médico que emitirá la opinión con anterioridad a la cita. 4 Proporcionarle a usted una copia de los registros cuando lo solicite. 5 Notificarle al médico que emitirá la segunda opinión por escrito que ha sido seleccionado para emitir una segunda opinión y la naturaleza del conflicto. Si usted no hace una cita con un médico para que emita una segunda opinión dentro de los 60 días de haber recibido el listado de prestadores disponibles de la MPN, entonces no podrá obtener una segunda opinión con relación al diagnóstico o el tratamiento que se cuestiona. Si, luego de que el médico que va a emitir la segunda opinión analice sus registros médicos, él o ella determina que su lesión no está dentro del alcance de su práctica, dicho médico se lo notificará a usted y a SISC para que SISC le proporcione un nuevo listado de prestadores de la MPN. Si no está de acuerdo con el diagnóstico o el tratamiento prescrito por el médico que emitió la segunda opinión, podrá solicitar la opinión de un tercer médico dentro de la MPN, siguiendo el mismo procedimiento descrito anteriormente para la solicitud de un médico que emita una segunda opinión. Los médicos que emiten segundas y terceras opiniones deben proporcionar su opinión con relación al diagnóstico o el tratamiento cuestinado por escrito y ofrecer recomendaciones de diagnóstico y tratamiento alternativos, si corresponde. Estos médicos podrán ordenar pruebas diganósticas si fuera médicamente necesario. Usted y su empleador deberán recibir una copia del informe por escrito dento de los 20 días contados a partir de la fecha de su cita o de la recepción de los resultados de las pruebas diagnósticas, cualquier fecha que sea posterior. Si no está de acuerdo con el diagnóstico o el tratamiento prescrito por el médico que emitió la tercera opinión, podrá presentar una solicitud de Revisión Médica Independiente ante el Director Administrativo.

Se le enviará una copia del informe de la segunda y/o tercera opinión al médico que esté tratando al empleado de acuerdo con el artículo 9767.7f. CÓMO OBTENER UNA REVISIÓN MÉDICA INDEPENDIENTE Usted debe obtener una segunda y una tercera opinión antes de poder solicitar una Revisión Médica Independiente (IMR). Si no está de acuerdo con el diagnóstico o el tratamiento prescrito por el médico que emitió la tercera opinión, podrá presentar una solicitud de Revisión Médica Independiente ante el Director Administrativo. Podrá obtener una IMR presentando una solicitud ante el Director Administrativo. Recibida la notificación sobre la elección de un médico para que emita una tercera opinión, el Mediador de Reclamos de SISC le proporcionará un formulario de solicitud de IMR y de instrucciones por medio del cual usted puede solicitar una IMR en caso de que cuestione el informe del médico que emita la tercera opinión. El Director Administrativo le asignará el Revisor Médico Independiente, quien podrá realizar un examen médico durante la revisión si usted así lo solicita. SISC le entregará una copia de todos los registros médicos relevantes al Revisor Médico Independiente y le enviará una copia a usted de los documentos enviados al IMR. Asimismo, usted podrá proporcinarle al IMR todo registro médico u otro material adicional, con copia para SISC. El Revisor Médico Independiente debe emitir un Informe al Director Administrativo, por escrito, que incluya su análisis y la determinación que manifieste si el servicio de atención médica cuestionado cumplió con las pautas de tratamiento del Estado. El informe debe emitirse dentro de los 20 días de la realización del examen, o dentro de un plazo menor a pedido del Director Administrativo. Sin embargo, si el Revisor certifica que el servicio de atención médica cuestionado representa una amenaza grave para su salud, el informe debe emitirse dentro de los tres días de la realización del examen. Si el Revisor Médico Independiente no está de acuerdo con el diagnóstico cuestionado, el servicio de diagnóstico o el tratamiento médico prescrito por el médico que lo está tratando, usted tiene derecho a recibir este tratamiento de un médico que elija, dentro o fuera de la MPN, y SISC se hará cargo del tratamiento aprobado. Si elige recibir un tratamiento médico de un médico fuera de la MPN, el tratamiento se limitará al servicio de diagnóstico o al tratamiento recomendado por el IMR. FÁCTURAS MÉDICAS Todas las facturas médicas derivadas de su enfermedad o lesión relacionada con el trabajo deben enviarse directamente a SISC donde le analizarán los cargos para asegurarse de que estén correctos. SISC les pagará a los prestadores. SISC pagará la remuneración que hubiera perdido y los demás beneficios a los que tenga derecho según la Ley de Compensaciones por Accidentes de Trabajo (Worker’s Compensation Act) del Estado de California. Usted puede hacerle a su empleador todas las preguntas relacionadas con sus beneficios.

CONFLICTOS Qué sucede si mi empleador cuestiona mi lesión Usted podrá tener derecho a recibir tratamiento aún si su empleador cuestiona su lesión en un principio. Se presume que la lesión se relaciona con el trabajo si el reclamo no es rechazado dentro de los 90 días contados a partir de la fecha de presentación del reclamo. Hasta la fecha de aceptación o rechazo de reponsabilidad por el reclamo, la responsabilidad del empleador por el mismo se limiita a $10,000. Por favor observe que esto no garantiza que usted vaya a recibir atención médica por esta suma de hasta $10,000. El tratamiento puede continuar hasta que el empleador tome la decisión de rechazar su reclamo. Este tratamiento debe brindarlo un médico de la MPN a menos que se trate de una situación de emergencia, o si usted designó previamente a un médico para que lo trate. CONTINUIDAD DE LA ATENCIÓN MÉDICA Qué sucede si su prestador no pertenece más a la MPN El Anexo A es una copia de la de la Política de Continuidad de la Atención Médica de su empleador. Esta Política contempla la finalización del tratamiento por parte de un médico que ya no pertenece a la MPN para ciertos estados médicos. TRANSFERENCIA DE LA ATENCIÓN CONTINÚA Qué sucede si ya tiene un reclamo por accidente de trabajo de fecha anterior a la fecha de entrada en vigencia de la MPN Hasta que usted sea transferido a la MPN, su médico podrá remitirlo a prestadores dentro o fuera de la MPN de acuerdo con el artículo 9767.9.b. Si está recibiendo tratamiento por una lesión o enfermedad previa a la cobertura de la MPN, su empleador hará los arreglos para la finalización de su tratamiento con su médico bajo ciertas circunstancias. El Anexo B es la Política de Transferencia de la Atención Continua. INFORMACIÓN DE CONTACTO DE LA MPN Esta es la información para contacto con la MPN de SISC: Centro de Recepción de LLamados de la MPN: 1-877-222-4946 El contacto de su MPN es Nombre: Provider Relations Department/Representante-SISC MPN Dirección: 5701 Truxton Avenue, Suite 100, Bakersfield, CA 93309 Número de teléfono: 1-877-2224946 E-mail: [email protected] Dirección de internet: www.cfmcnet.org/SISC

Anexo A Política de Continuidad de la Atención Médica Finalización del tratamiento por parte de un prestador que ya no pretence a la red SISC cumplirá con las disposiciones del artículo 4616.2(d) y (e) del Código de Trabajo de California cuando el empleado cubierto solicite la finalización del tratamiento por parte de un prestador que ya no pertenece a la red. SISC brindará todos los empleados que ingresen al sistema de compensaciones por accidentes de trabajo una notificiación de su política de Continuidad de la Atención por escrito e información sobre el procedimiento por el que un empleado puede solicitar una revisión según la política y brindará, a solicitud, una copia de la política por escrito al empleado según el artículo 9767.12.a.12. SISC cumplirá con los requisitos del artículo 4616.2(d) y (e) del Código de Trabajo, de la siguiente manera: • SISC/CFMC notificará en forma oral o por escrito al empleado lesionado sobre la no pertenencia a la MPN del prestador que lo está tratando. • SISC coordinará la transferencia de la atención a otro prestador de la MPN o dispondrá la finalización del tratamiento con el prestador que ya no pertenezca a la red según el artículo 4616.2(d) del Código de Trabajo. • Si el empleado lesionado solicita la finalización del tratamiento con el prestador que ya no pertenezca a la red, el mediador de reclamos de SISC verificará que el reclamo cumpla con el artículo 4616.2(d) del Código de Trabajo. • • Si el empleado lesionado cumple con los criterios según el artículo 4616.2(d) del Código de Trabajo, SISC brindará: • Conclusión de la atención por hasta 90 días de tratamiento por un “estado agudo” definido en el artículo 4616.2(d)(3)(A) del Código de Trabajo como “un estado médico que involucra la aparición súbita de síntomas debido a una enfermedad, una lesión u otro problema médico que require la atención médica inmediata y que tiene una duración limitada”. La finalización del tratamiento se brindará por la duración del estado agudo. • • Conclusión de la atención por el tiempo necesario para teminar un tratamiento por un “estado crónico serio” hasta un año desde la fecha de la decisión de que el empleado lesionado tiene un “estado crónico serio” definido en el artículo 4616.2(d)(3)(B) del Código de Trabajo como un “estado médico debido a una enfermendad u otro problema médico o un trastorno médico que es serio por naturaleza y que persiste sin cura total o empeora durante un período prolongado o que require tratamiento continuo para mantener la remisión o evitar el deterioro”. La conclusión de la atención se brindará por el tiempo necesario para completar un tratamiento y para coordinar la transferencia segura a otro prestador, según se decida en la consulta con el empleado y el prestador que ya no pertenezca al plan y sea coherente con la buena práctica profesional. La finalización del tratamiento no deberá exceder los 12 meses desde la fecha de finalización del contrato. • • La conclusión de la atención por la duración de una “enfermedad terminal” según la define el artículo 4616.2(d)(3)(C) del Código de Trabajo, como “un estado incurable o irreversible que tiene una alta probabilidad de causar la muerte dentro del año o un tiempo menor. • Cirugía u otro procedimiento que hubiera sido autorizado como parte de un tratamiento documentado y que ocurrirá dentro de los 180 días desde la fecha de entrada en vigencia de la cobertura de la MPN según el artículo 4616.2(d)(3)(D) del Código de Trabajo. • SISC/CFMC notificará a los prestadores que ya no pertenezcan al plan cuyos servicios continúen más allá de la fecha de finalización del contrato conforme el artículo 4616.2(d)(4)A) del Código de Trabajo que ellos deben acordar por escrito estar sujetos a los mismos términos y condiciones contractuales impuestos al prestador antes de la finalización. El Mediador de Reclamos de SISC puede referir al

empleado lesionado a un prestador de la MPN si el prestador que ya no pertenece a la misma no acuerda cumplir con los términos y condiciones contractuales previos. • A menos que el prestador que ya no pertenece a la red y SISC/CFMC convengan de otra manera, los servicios prestados conforme este apartado serán remunerados a tarifas y métodos de pago similares a los usados por SISC/CFMC para los prestadores actuales que brindan servicios similares y que ejercen en la misma área geográfica que el prestador que ya pertenece a la red o en un área similar. El Mediador de Reclamos de SISC puede referir al empleado lesionado a un prestador de la MPN si el prestador que ya no pertenece a la misma no acepta las tarifas de pago previstas en este párrafo. • Si el prestador ya no pertenece a la red por alguna causa justificada, u otra actividad delictiva, el empleado lesionado deberá ser referido a un prestador de la MPN. • Nada de lo estipulado anteriormente prohíbe a SISC acordar la continuidad de la atención con un prestador que ya no pertenezca a la red, si SISC decide que conviene que el empleado lesionado continúe el tratamiento con el prestador que ya no pertenece a la red.

Una copia de la decisión de SISC sobre el estado médico del empleado será enviada al médico primario que está tratando el empleado según el artículo 9767.10.d.1. Resolución de conflictos:

• Luego de que SISC tome una decisión sobre el estado médio del empleado, SISC notificará al empleado (con una carta escrita en inglés y en español enviada al domicilio del empleado, usando términos de una persona llana en la medida máxima de lo posible), avisando si el mismo deberá seleccionar un nuevo prestador de la MPN. • • Si el prestador que no pertenezca más a la red deseara continuar tratando al empleado lesionado y si éste cuestionara la decisión médica, se le pedirá solicitar un informe del médico que lo está tratando que diga si su decisión médica recae dentro de alguna de las cuatro condiciones mencionadas anteriormente (según lo establecido en el artículo 4616.2(d)(3) del Código de Trabajo). Al médico que lo esté tratando se le pedirá brindar este informe dentro de los 20 días corridos desde la solicitud. Si el médico que lo esté tratando no emite el informe, entonces se aplicará la decisión de SISC. • Si SISC cuestiona la decisión médica por parte del médico que trate al empleado, el conflicto se resolverá usando el proceso QME conforme el artículo 4062 del Código de Trabajo. • Si el médico que trate al empleado está de acuerdo con la decisión de SISC de que el estado médico del empleado no cumple con las condiciones establecidas en el artículo 4616.2(d)(3) del Código de Trabajo, al empleado se le pedirá seleccionar un nuevo prestador de la MPN durante el proceso de resolución del conflicto. • Si el médico que trate al empleado no está de acuerdo con la decisión de SISC de que el estado médico del empleado no cumple con las condiciones establecidas en el artículo 4616.2(d)(3) del Código de Trabajo, el empleado lesionado se seguirá atendiendo con el prestador que ya no pertenezca a la red hasta que se resuelva el conflicto.

ANEXO B Política de Transferencia de Atención Médica SISC cumplirá con las disposiciones establecidas en el Código de Reglamentos de California (California Code of Regulations), Título 8, artículo 9767.9 con relación a la Transferencia de la Atención Continua a la MPN. Hasta que el empleado lesionado cubierto sea transferido a la MPN, el médico del empleado podrá hacer referencias a prestadores dentro o fuera de la MPN conforme el artículo 9767.9b. Si un prestador que presta atención continua a un empleado lesionado cubierto ya se encuentra participando en la MPN recientemente implementada, SISC le notificará al empleado lesionado si su tratamiento se está prestando según las disposiciones de la MPN. Si un prestador que presta atención continua a un empleado lesionado cubierto con anterioridad a la entrada en vigencia de la MPN no es un prestador según SISC/CFMC MPN, SISC, como la asociación administradora de reclamos, brindará: • Conclusión de la atención por hasta 90 días de tratamiento por un “estado agudo” según se define en 8 CCR 9767.9(e)(1) como un “estado médico que involucra la aparición súbita de síntomas debido a una enfermedad, una lesión u otro problema médico que require atención médica inmediata y que tiene una duración inferior a 90 días”. La finalización del tratamiento se brindará por la duración del estado agudo. • Conclusión de la atención por el tiempo necesario para terminar un tratamiento por un “estado crónico serio” hasta un año desde la fecha de la decisión de que el empleado lesionado tiene un “estado crónico serio” definido en 8 CCR 9767.9(e)(2) como un “estado médico debido a una enfermedad, lesión catastrófica u otro problema médico o un trastorno médico que es serio por naturaleza y que persiste sin una cura total o empeora durante un período de 90 días y que require tratamiento continuo para mantener la remisión o evitar el deterioro”. La conclusión de la atención deberá prestarse por un período de tiempo necesario, hasta un año: (A) para finalizar un tratamiento aprobado por SISC; y (B) para coordinar la transferencia a otro prestador dentro de la MPN, según lo determine SISC. El plazo de un año para la finalización del tratamiento • comienza con la fecha de recepción por parte del empleado lesionado de la notificación de la decisión de que el empleado tiene un estado crónico serio. • Conclusión de la atención por la duración de una “enfermedad terminal: según se define en 8 CCR 9767.9(e)(3) como un “estado incurable o irreversible que tiene una alta probabilidad de causar la muerte dentro del año o un tiempo menor. • Cirugía u otro procedimiento que hubiera sido autorizado como parte de un tratamiento documentado y que ocurriría dentro de los 180 días desde la fecha de entrada en vigencia de la cobertura de la MPN según se establece en 8 CCR 9767.9(e)(4). • Hasta que el empleado lesionado cubierto sea transferido a la MPN, el médico del empleado podrá hacer referencias a prestadores dentro o fuera de la MPN de acuerdo con el artículo 9767.9.b

SISC evaluará el estado médico del empleado lesionado con anterioridad a cualquier decisión que indique que la atención continua no cumple con los criterios anteriores y por lo tanto podría ser elegible para una transferencia a la MPN. Esta evaluación puede involucrar el asesoramiento de un enfermero TMC, administrador del caso. SISC enviará una notificación sobre la decisión de la transferencia de la atención al domicilio del empleado lesionado y al médico primario que lo esté tratando. La notificación será enviada en inglés y en español, usando términos de una persona llana en la medida máxima posible. Si el empleado lesionado cuestionara la decisión médica que establece que la transferencia de la atención a la MPN es apropriada, él o ella debe solicitar un informe del médico primario que lo esté tratando indicando si la atención continua recae dentro de alguna de las condiciones identificadas anteriormente. Al médico que lo esté tratando se le pedirá brindar este informe al empleado dentro de los 20 días corridos desde la solicitud. Si el médico que lo esté tratando no emite el informe, entonces se deberá aplicar la decisión de SISC relacionada con la finalización del tratamiento. Si el médico primario que está tratando al empleado está de acuerdo con la decisión de SISC que establece que el estado médico del empleado lesionado no cumple con las condiciones identificadas anteriormente (según se establece en 8CCR 9767.9(e)(1) a (4), la transferencia de la atención deberá proceder durante el procedimiento de resolución del conflicto. Si el médico primario que está tratando al empleado no está de acuerdo con la decisión de SISC que establece que el estado médico del empleado lesionado no cumple con las condiciones identificadas anteriormente (según se establece en 8 CCR 9767.9(e) (1) a (4), la transferencia de la atención no deberá proceder hasta que se resuelva el conflicto. Cualquier conflicto relacionado con la decisión médica tomada por el médico primario que esté tratando al empleado con relación a la transferencia de la atención, se resolverá por medio del proceso QME conforme el artículo 4062 del Código de Trabajo. Las referencias hechas a prestadores en forma posterior a la implementación de la MPN deberán hacerse a un prestador dentro de la red. Nada de lo estipulado anteriormente prohíbe a SISC acordar la prestación de atención fuera de la MPN, si SISC decide que conviene que el empleado lesionado continúe el tratamiento con el prestador que no pertenece a la red.

Anexo C Estándares de Acceso (a) Una MPN debe contar al menos con tres médicos de cada especialidad que se espera que traten lesiones communes que sufren los empleados lesionados según el tipo de ocupación o industria en la que trabajen y dentro de los estándares de acceso establecidos en (b) y (c). (b) Una MPN debe contar con un médico primario de tratamiento y un hospital para servicios de antención médica de emergencia, o si está separado de dicho hospital un prestador de todos los servicios de atención médica de emergencia dentro de los 30 minutos o las 15 millas del hogar o lugar de trabajo de cada empleado cubierto. (c) Una MPN debe contar con prestadores de servicios de salud ocupacional y especialistas dentro de los 60 minutos o las 30 millas del hogar o del lugar de trabajo de un empleado cubierto. (d) Si un solicitante de la MPN, dados los hechos y las circunstancias con relación a una sección del área de servicios, particularmente las áreas rurales incluidas aquellas áreas donde los centros de salud están alejados al menos 30 millas, cree que los estándares de accesibilidad establecidos en los incisos (b) y/o (c) son excesivamente restrictivos, el solicitante de la MPN podrá proponer estándares de accesibilildad alternativas para esa sección del área de servicios. El solicitante de la MPN deberá hacerlo incluyendo los estándares alternativos propuestos por escrito en la aprobación del plan o en una notificación de modificación del plan de la MPN. Los estándares alternativos deberán establecer que todos los servicios estén disponibles y accesibles en tiempo razonable para todos los empleados cubiertos. (e) (1) El solicitante de la MPN deberá contar con una política por escrito para coordinar • o aprobar la atención médica que no sea de emergencia para: (A) un empleado cubierto autorizado por el empleador a trabajar o viajar por trabajo temporalmente fuera del área gerográfica de la MPN cuando surja la necesidad de atención médica; • un ex-empleado cuyo empleador tiene obligaciones actuales relacionadas con accidentes de trabajo y que reside permanentemente fuera del área geográfica de servicios de la MPN; y (C) un empleado lesionado que decide residir temporalmente fuera del área geográfica de servicios de la MPN durante su recuperación. (2) La política por escrito deberá brindarles a los empleados mencionados en inciso (e)(1) precedente la posibilidad de elegir entre al menos tres médicos fuera del área geográfica de servicios de la MPN que hayan recibido una referencia del médico primario que esté tratando al empleado dentro de la MPN o que hayan sido seleccionados por el solicitante de la MPN. Además de los médicos dentro de la MPN, el empleado podrá cambiar a los médicos de entre los médicos referidos y podrá obtener una segunda y una tercera opinión de los mismos. 3) Los médicos referidos deberán localizarse dentro de los estándares de acceso descritos en los párrafos (c) y (d) de esta sección. 4) Ninguna disposición de esta sección le prohíbe a un solicitante de la MPN contar con una política por escrito que le permita a un empleado cubierto fuera del área geográfica de servicios de la MPN, elegir su propio prestador de atención médica que no sea de emergencia. • (f) Para los servicios que no sean de emergencia, el solicitante de la MPN deberá garantizar la disponibilidad de una cita para un tratamiento inicial dentro de los 3 días hábiles de haber recibido una solicitud de tratamiento dentro de la MPN. • (g) Para los servicios de especialistas que no sean de emergencia para tratar lesiones comunes que sufren los empleados cubiertos según el tipo de ocupación o industria en la que trabajen, el solicitante de la MPN deberá garantizar la disponibilidad de una cita dentro de los 20 días hábiles de haber recibido una solicitud de referencia a un especialislta dentro de la MPN. • (h) Si el médico primario que está tratando al empleado refiere al empleado cubierto a un tipo de especialista no incluido en la MPN, el empleado cubierto podrá seleccionar a un especialista fuera de la MPN. • (i) El solicitante de la MPN deberá contar con una política por escrito para permitirle a un trabajador lesionado recibir servicios de atención médica de emergencia de un prestador de servicios médicos u hospital que no sea miembro de la MPN.

Employee Report of Injury (To be filled out with Supervisor within 24 hours of accident/injury)

Employee Name:____________________________________

D.O.B.:_______________________

Address:____________________________________________________________________________ City:_____________________________

State:____________________

Zip:______________

Phone Number:_____________________________

Social Security:______________________

Occupation:________________________________

Work Schedule:______________________ (Hours from when to when: 7:30am – 4:30pm)

Work Site:______________________________________ Site of Accident/Injury: ___________________________ Date of Accident:_________________________________ Time of Accident:____________am/pm

Describe what you were doing when injured (specify any tools, equipment being used, etc.): ____________________________________________________________________________________ ____________________________________________________________________________________ Describe where the accident happened (sidewalk, classroom, gym, etc.): ____________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Describe how the accident occurred (be specific): ___________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Describe injury (cut on right hand, sprained left ankle, etc.): ________________________________________________ Witnesses or other persons involved: ____________________________________________________ How might the injury been prevented? __________________________________________________ ___________________________________________________________________________________

Date of this Report:_________________________ Employee’s Signature:_______________________________________________

EL CENTRO ELEMENTARY SCHOOL DISTRICT Supervisor’s Report of Work Related Injury and Illness General Information: Name of injured employee: Date of incident/injury: School Site/Department: Location of injury/incident: Employee # Home address:

Today’s date: Time of incident/injury:

Date reported:

Sex: Male  Female  Date of Birth: Phone number where employee can be reached: Job title: Occupation at time of incident: Months/years in occupation: Pre-placement medical evaluation? Yes  No  Phase of employee’s workday at time of injury or incident Break 

Entering or Leaving Facility 

Meal 

Performing Work 

N/A 

Other________________

Severity of injury/illness/incident Report Only – no treatment 

Physician Treatment 

Lost Workdays-Days Away from Work 

Light Duty-Temporary Assignment  Damage to Equipment, Facility, Etc. over $500 

Other

Other workers involved or witness to incident (attach eye-witness statements): Injury Information (check all that applies):  Contact with  Caught on  Struck by  Electricity  Cumulative  Student caused  Heat  Exposure  Over exertion (strain)  Chemicals  Fall from height  Other  Cold  Slip/Trip/Fall  Caught between  Stress  Caught in  Struck against  Amputation  Fracture  Puncture  Bruise or contusion  Human bite  Repeated trauma  Burn  Illness  Scratch  Cut or laceration  Insect bite  Strain or sprain  Dermatitis  Multiple injuries  Other  Foreign particle in eye  Eyes: R  Knee: R L L  Abdomen Part of L L  Face  Legs: R  Arms: R Body L L L  Ankle: R  Shoulder: R  Feet: R Affected: L L  Back  Finger: R  Wrist: R L  Hand: R  Other  Chest L  Head  Elbow: R Description of how incident/injury occurred: What happened (if digital pictures are taken list picture reference numbers)? Accident Type: (what caused physical harm or discomfort) Nature of Injury:

(Attach additional pages as necessary.)

Page 1 of 2

Supervisor’s Report of Work Related Injury and Illness Contributing Factors Workplace conditions that may have contributed to the accident Unsafe work practices that contributed to the accident

           

Defective tools or equipment Excessive noise Failure to warn or secure Inadequate guard or protection Inadequate lighting Failure to use personal-protective equip. Horseplay Improper body mechanics Improper lifting Improper loading or placement Inattention Making safety devices inoperable

         

Indoor air quality Substandard housekeeping Trip hazard Vapor/Fume exposure Other Operating at improper speed Operating equipment without authority Rushing Servicing equipment in motion Was a code of safe practices violated? If so, which one  Other

Incidence Sequence: List tasks being performed that led to accident. Who was involved in these tasks?

Findings / Root Causes (Knowledge, ability, motivation, design, maintenance, environment) List possible causes or actions that may have contributed to the accident or incident:

Corrective Actions Necessary: What corrective actions need to be taken to prevent another accident (Indicate all that apply)

       

Disciplinary actions Improve warning & posting Loading or placement training Lockout and tagout of energy sources Operating procedures posted Operator training needed Provide better warning Replacement or supply safety equipment

 Safe lifting training  Specific equipment or task instruction  Use of necessary personal protective equipment  Other  Do these corrective actions need to be made at other sites also?

Corrective Actions Taken: Clarify the specific corrective actions taken, who is responsible and when will they be accomplished:

Supervisor’s Name: ______________________ Signature:

Date:

Associate Supt. Signature:

Date: Page 2 of 2

SUPERVISOR’S REPORT OF INJURY INSTRUCTIONS FOR USE The form is comprehensive enough to serve as both the Supervisor’s Report and the template for an accident investigation. Accident/Incident investigation is a required element for all employers under the Injury and Illness Prevention Program (IIPP). Cal/OSHA notes an employer’s investigation procedures, or lack thereof, when following up on complaints or audits. The form has been specifically designed to be able to serve both purposes. It also provides supervisors with a streamlined approach to incident analysis. It is only through thorough incident analysis that effective prevention measures can be implemented. 

The Supervisor’s Report of Injury form should be completed whenever an employee reports a work-related incident. Whether the employee requires medical attention is not a prerequisite to completing the form. Even if an employee does not need medical attention, the form should still be completed. The form is designed to capture all relevant elements of an incident, whether comprehensive or simple.



If the employee does not require medical treatment, the Supervisor’s Report is kept on file by the designated person; usually Human Resources (do not send the form to SISC). No further action is required. If an employee does not believe the incident caused an injury that requires medical attention, do not force the employee to seek such treatment. There is no reason to send an employee to see a physician if not necessary. There is a common misconception that sending an employee to a physician is required to avoid “liability.” There is no such liability being avoided by sending an employee to seek medical treatment when not medically necessary. The Supervisor’s Report is the official documentation and is legally sufficient.



If the incident caused an injury that requires medical attention, provide the employee with the workers’ compensation claim form, DWC-1, and follow the claims procedures outlined by SISC I. In the event an employee reported an incident and originally did not believe medical treatment was necessary, and later believes medical treatment is necessary, the claims process is started at that point. There is no problem, or liability, if this occurs.

If you have any questions about completing the form, or would like assistance in implementing the new form, please contact the SISC Risk Management Services department. Staff are available for in-service, as well as hands-on incident investigation, with district staff.

SISC I WORKERS’ COMPENSATION MEDICAL PROVIDER NETWORK EMPLOYEE HANDBOOK ACKNOWLEDGMENT I have received the following: 1. Medical Provider Network (MPN) Employee Handbook 2. Predesignation of Personal Physician (DWC Form 9783) (New Employees Only)

Employee Name (Please Print)

Employee Signature

School District Date_______________ If you have any questions regarding any of these documents or are in need of additional information, please call the Human Resources Department.

PLEASE RETURN THIS FORM TO HUMAN RESOURCES. RETAIN THE DOCUMENTS LISTED ABOVE FOR YOUR RECORDS.

El Centro Elementary School District

X

(School Name) (760) 352-5712x522

(760) 370-0694

Attn: Rosemary Martinez