Grievance Form Grievance Report Grievance Disposition. 5. Monitor Evaluation Form (#HR2926) 6. Tentative Assignment Form (#HR2957) CLEVELAND HEIGHTS-UNIVERSITY HEIGHTS CITY SCHOOL DISTRICT Human Resources Department APPLICATION FOR ASSAULT LEAVE Employee Name: Building: I began my absence on: I returned to duty on: I was assaulted on: by: (name of employee or student) at: in the following manner: (place where incident occurred) (furnish brief description of occurrence – use back of form if necessary) The assault was witnessed by: and was reported to: on (name of supervisor/administrator) Employee Signature: Date: I treated on the following dates: and have/will discharge(d) from further treatment on In my opinion, was totally disabled from to and will continue to be totally disabled until The disability for which I treated is Printed Name of Physician Signature of Physician Date
Grievance Form Grievance Report Grievance Disposition. 5. Monitor Evaluation Form (#HR2926) 6. Tentative Assignment Form (#HR2957) 7. Appendix 7: Plan Design 8. Appendix 8: Plan Design CLEVELAND HEIGHTS-UNIVERSITY HEIGHTS CITY SCHOOL DISTRICT Human Resources Department APPLICATION FOR ASSAULT LEAVE Employee Name: Building: I began my absence on: I returned to duty on: I was assaulted on: by: (name of employee or student) at: in the following manner: (place where incident occurred) (furnish brief description of occurrence – use back of form if necessary) The assault was witnessed by: and was reported to: on (name of supervisor/administrator) Employee Signature: Date: I treated on the following dates: and have/will discharge(d) from further treatment on In my opinion, was totally disabled from to and will continue to be totally disabled until The disability for which I treated is Printed Name of Physician Signature of Physician Date
Grievance Form Grievance Report Grievance Disposition. 5. Monitor Evaluation Form (#HR2926) 6. Tentative Assignment Form (#HR2957) CLEVELAND HEIGHTS-UNIVERSITY HEIGHTS CITY SCHOOL DISTRICT Human Resources Department
Grievance Form Grievance Report Grievance Disposition. 5. Monitor Evaluation Form (#HR2926) 6. Tentative Assignment Form (#HR2957) 7. Appendix 7: Plan Design 8. Appendix 8: Plan Design CLEVELAND HEIGHTS-UNIVERSITY HEIGHTS CITY SCHOOL DISTRICT Human Resources Department
