HR Forms and Checklists

A-C Forms

• Absence Request
  Personalize
  Employees may use this form when requesting future time off or reporting previous time off. Remember employees can take mandatory paid sick leave upon verbal or written request. This form also gives your employees the opportunity to indicate a family and medical leave of absence, although it is not required.​​​​​
  Preview
• Absence Request — Spanish
  Personalize
  Employees may use this form when requesting future time off or reporting previous time off. Remember employees can take mandatory paid sick leave upon verbal or written request. This form also gives your employees the opportunity to indicate a family and medical leave of absence, although it is not required.​​​​
  Preview
• Accident Injury and Illness Investigation
  Personalize
  Use this form whenever a workplace accident, injury or illness occurs to properly document your investigation.​
  Preview
• Adverse Action Notice - FCRA and ICRAA
  Use this form to notify an applicant of adverse employment action that is being taken against him or her, based at least in part on the results of a consumer report. This notice also must include a statement explaining the consumer’s (applicant or employee) right to dispute directly with the consumer reporting agency.
  
  ​​If the decision is based in whole or in part on criminal history, you must also send a Notice of Final Decision to Withdraw Employment Offer.
  Preview
• Alternative Workweek Adoption Notice to Department of Industrial Relations
  Use this sample letter to file the results of an alternative workweek election, along with the proposed and adopted alternative workweek schedule, with the Office of Policy, Research and Legislation (OPRL), within 30 days of the final election.​
  Preview
• Alternative Workweek Checklist
  This checklist guides you through creating and implementing an alternative workweek schedule. You must file the appropriate information with the Department of Industrial Relations, and maintain the appropriate records to document your compliance with alternative workweek requirements.​​​
  Preview
• Alternative Workweek Sample Calendar
  Use this calendar as an example of an alternative workweek schedule, noting the restrictions associated with alternative workweeks. Limits placed on employers and employees regarding alternative workweek schedules make them difficult to implement properly.​
  Preview
• Attendance Record
  Use this form to record an employee's attendance.
  Preview
• Attendance Record Summary
  Personalize
  Use this form to keep a record of an employee’s attendance throughout his or her employment.
  Preview
• Basic Poster and Notice Requirements Under the Family, Medical and Pregnancy Leave Laws
  Review this chart to determine your responsibilities under family, medical and pregnancy leave laws.
  Preview
• Basic Poster and Notice Requirements Under the Family, Medical and Pregnancy Leave Laws - Spanish
  Review this chart to determine your responsibilities under family, medical and pregnancy leave laws. ​​​
  Preview
• Benefits During Leaves of Absence
  This chart describes leaves of absence, whether they are legally required, if state mandated wage replacement is available, whether health benefits must be continued during the leave, whether use of sick, vacation or PTO can be required and whether sick, vacation or PTO accrue during the leave.
  Preview
• Bereavement Leave Checklist
  Use this checklist to create and implement a bereavement leave policy that complies with California’s bereavement leave requirements for employers with five or more employees
  Preview
• Cal-COBRA - Notice to Carrier
  Personalize
  Send this notice to the health/disability insurance carrier when any qualified beneficiary becomes subject to Cal-COBRA because of a qualifying event. You must notify the employee’s carrier within 31 days of the event.
  Preview
• Cal-COBRA - Notice to Employee
  Personalize
  Send this notice to an employee at least 30 days before a current group benefit plan terminates because of a change in group plans. You must send information about the new group benefit plan, benefits information, premium information, enrollment forms, instructions, etc., necessary to allow the qualified beneficiary (employee) to continue coverage. Send this notice via certified mail and keep a record of the mailing on file.​
  Preview
• California and Local Paid Sick Leave Comparison
  Use this chart to compare California paid sick leave requirements to various local paid sick leave requirements.
  Preview
• California Family Rights Act Fact Sheet
  This fact sheet outlines an employee's right for leave under the California Family Rights Act (CFRA). You may choose to give this fact sheet to each employee eligible for CFRA and/or who requests leave that qualifies as CFRA, but there's no requirement that you do so.​​
  Preview
• California Family Rights Act Fact Sheet - Spanish
  This fact sheet outlines an employee’s right for leave under the California Family Rights Act (CFRA).​ You may choose to give this fact sheet to each employee eligible for CFRA and/or who requests leave that qualifies as CFRA, but there's no requirement that you do so.​
  Preview
• CalOSHA Forms 300 300A and 301
  Free
  A CalOSHA-created spreadsheet containing all three required forms to report workplace injuries.
  Preview
• CalOSHA Training Requirements
  Use this form to help you determine which Cal/OSHA safety standards apply to your company and what corresponding training is recommended.
  Preview
• Certification for Serious Injury or Illness of a Current Servicemember for Military Family Leave Under the Family and Medical Leave Act
  Personalize
  Use this form when an employee requests leave to care for a close family member or next of kin who has a serious injury or illness relating to current military service. California employers, note especially the stated limitations relating to medical information as this information is confidential and protected in California.​
  Preview
• Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave Under the Family and Medical Leave Act
  Personalize
  Use this form when an employee requests leave to care for a close family member or next of kin who is a veteran and who has a serious injury or illness relating to their military service. California employers, note especially the stated limitations relating to medical information as this information is confidential and protected in California.
  Preview
• Certification of Health Care Provider — Employee's or Family Member's Serious Health Condition
  Personalize
  Have the employee's health care provider complete this medical certification as needed. This form is used for employee's taking leave under the Family and Medical Leave Act (FMLA) and California Family Rights Act (CFRA) for their own serious health condition or that of a family member.​​​​
  Preview
• Certification of Health Care Provider — Employee's or Family Member's Serious Health Condition — Spanish
  Personalize
  Have the employee's health care provider complete this medical certification as needed. This form is used for employee's taking leave under the Family and Medical Leave Act (FMLA) and California Family Rights Act (CFRA) for their own serious health condition or that of a family member.​​​
  Preview
• Certification of Health Care Provider for Employee Return to Work
  Personalize
  An employee may use this notice to have their health care provider certify that they may return to work.
  Preview
• Certification of Health Care Provider for Employee Return to Work - Spanish
  An employee may use this notice to have their health care provider certify that they may return to work.
  Preview
• Certification of Health Care Provider for Pregnancy Disability Leave, Transfer And/Or Reasonable Accommodation
  Personalize
  Have the employee's health care provider complete this medical certification as needed. This form is used for employee's seeking reasonable accommodation, transfer or Pregnancy Disability Leave for pregnancy, childbirth or a related medical condition.​​
  Preview
• Certification of Health Care Provider for Pregnancy Disability Leave, Transfer And/Or Reasonable Accommodation - Spanish
  Have the employee's health care provider complete this medical certification as needed. This form is used for employee's seeking reasonable accommodation, transfer or Pregnancy Disability Leave for pregnancy, childbirth or a related medical condition.
  Preview
• Certification of Qualifying Exigency for Military Family Leave
  Use this form when an employee requests leave due to a qualifying exigency relating to a family member's military service. California employers, note especially the stated limitations relating to medical information as this information is confidential and protected in California.
  Preview
• Certification to Consumer Credit Reporting Agency
  Give this notice to your selected provider when requesting an credit report on an applicant or employee.
  Preview
• Certification to Investigative Consumer Reporting Agency
  Give this notice to your selected provider when requesting an investigative consumer report on an applicant or employee.
  Preview
• CFRA Leave Documentation Checklist (Five to 49 Employees)
  Use this checklist to assist you in complying with regulations regarding California Family Rights Act leave for employers with five to 49 employees.
  Preview
• CFRA Notice and CFRA/FMLA Designation (50 or More Employees)
  Use this form to give employees notice of their rights under the California Family Rights Act (CFRA), and to designate leave as CFRA and/or Family and Medical Leave Act (FMLA), to provide conditional approval of the request for leave if more information is necessary or to deny the request.
  Preview
• CFRA Notice and CFRA/FMLA Designation (50 or More Employees) — Spanish
  Use this form to give employees notice of their rights under the California Family Rights Act (CFRA), and to designate leave as CFRA and/or Family and Medical Leave Act (FMLA), to provide conditional approval of the request for leave if more information is necessary or to deny the request.
  Preview
• CFRA Notice and Designation (Five to 49 Employees)
  Use this form to give employees notice of their rights under the California Family Rights Act (CFRA), and to designate leave as CFRA, to provide conditional approval of the request for CFRA leave if more information is necessary, or to deny the request.
  Preview
• CFRA Notice and Designation (Five to 49 Employees) — Spanish
  Use this form to give employees notice of their rights under the California Family Rights Act (CFRA), and to designate leave as CFRA, to provide conditional approval of the request for CFRA leave if more information is necessary, or to deny the request.
  Preview
• CFRA Sample Policy - 50 or More Employees
  Use this sample to create your policy that communicates any employee requirements and gives notice to your employee of their right to California Family Rights Act (CFRA) leave. Use this version if you have 50 or more employees.
  Preview
• CFRA Sample Policy - 50 or More Employees - Spanish
  Use this sample to create your policy that communicates any employee requirements and gives notice to your employee of their right to California Family Rights Act (CFRA) leave. Use this version if you have 50 or more employees.
  Preview
• CFRA Sample Policy - Five to 49 Employees
  Use this sample to create your policy that communicates any employee requirements and gives notice to your employee of their right to California Family Rights Act (CFRA) leave. Use this version if you have five to 49 employees.
  Preview
• CFRA Sample Policy - Five to 49 Employees - Spanish
  Use this sample to create your policy that communicates any employee requirements and gives notice to your employee of their right to California Family Rights Act (CFRA) leave. Use this version if you have five to 49 employees.
  Preview
• CFRA/FMLA - Family Member Leave for a Qualifying Exigency
  This chart describes the types of events that give an eligible employee a reason for leave because of a qualifying exigency under the CFRA/FMLA arising because the spouse, son or child of the employee is on covered active duty or call to active duty.​ 
  Preview
• CFRA/FMLA - Family Member Leave for a Qualifying Exigency - Spanish
  This chart describes the types of events that give an eligible employee a reason for leave because of a qualifying exigency under the CFRA/FMLA arising because the spouse, son or child of the employee is on covered active duty or call to active duty.​ ​
  Preview
• Checklist for Developing a Harassment Prevention Policy
  Use this checklist to develop and enforce your harassment prevention policy to maintain a harassment-free work environment. A written harassment, discrimination and retaliation prevention policy is required for California employers​​. (Formerly Checklist for Developing a Sexual Harassment Policy)​​​​​
  Preview
• CHIP — Children's Health Insurance Program — Model Notice for Employers
  Free
  If you are eligible for health coverage from your employer, but are unable to afford the premiums, some states have premium assistance programs that can help pay for coverage. These states use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums. 
  Preview
• CHIP — Children's Health Insurance Program — Model Notice for Employers — Spanish
  Free
  If you are eligible for health coverage from your employer, but are unable to afford the premiums, some states have premium assistance programs that can help pay for coverage. These states use funds from their Medicaid or CHIP programs to help people who are eligible for employer-sponsored health coverage but need assistance in paying their health premiums. 
  Preview
• CHIPRA Fact Sheet
  Free
  The DOL has posted a model employer Children's Health Insurance Program (CHIP) Notice that can be used to satisfy the employer notice requirement under the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA). CHIPRA added new notice and disclosure obligations for employers that provide group health plans in states that offer Medicaid or state CHIP assistance in the form of premium assistance subsidies.  CHIPRA also created additional HIPAA special enrollment rights that permit eligible employees and their dependents to enroll in an employer's group health plan in two situations: (1) when Medicaid or CHIP coverage is terminated due to loss of eligibility; and (2) upon eligibility for a premium assistance subsidy under Medicaid or CHIP. The Employer CHIP Notice must be provided annually, on an automatic basis and free of charge. It must inform each employee (regardless of enrollment status) of potential opportunities for premium assistance in the state in which the employee resides. ​
  Preview
• COBRA Administration Guide
  Begin using this COBRA Administration Guide when an employee is hired and refer back to it when a qualifying event occurs. Doing so ensures you use the proper, required forms relating to COBRA (20 or more employees) and Cal-COBRA (2 to 19 employees), as applicable.​
  Preview
• COBRA Continuation Coverage Election Notice — California Employees
  Personalize
  Modify this form according to the coverage plans that you offer and send it out with all COBRA notices. The employee is required to fill out and return the form to the plan administrator within 60 days of a qualifying event or the date they were notified of COBRA continuation rights.
  Preview
• COBRA Continuation Coverage Election Notice — Outside California
  Personalize
  Modify this form according to the coverage plans that you offer and send it out with all COBRA notices. The employee is required to fill out and return the form to the plan administrator within 60 days of a qualifying event or the date they were notified of COBRA continuation rights.
  Preview
• COBRA Continuation Coverage Rights General Notice — California Employees
  Provide this form to an employee or spouse within 90 days of the commencement of coverage or the first date at which the plan administrator is required to advise a qualified beneficiary of the right to elect coverage.
  Preview
• COBRA Continuation Coverage Rights General Notice — Outside California
  Provide this form to an employee or spouse within 90 days of the commencement of coverage or the first date at which the plan administrator is required to advise a qualified beneficiary of the right to elect coverage. Use this form for employees outside California.
  Preview
• COBRA Notice to Plan Administrator
  Personalize
  Use this form to provide notice to the plan administrator within 30 days of an employee's loss of coverage due to termination, reduction in hours, death or employer bankruptcy.
  Preview
• COBRA Rights - Acknowledgement of Receipt of Notification
  Personalize
  Provide this form to an employee if the employee has coverage for himself/herself plus any other family members and coverage is being ended due to termination of employment or reduction in hours. You need to send out additional COBRA notices to those individuals indicated on the form who do not reside with the employee.​
  Preview
• Confidentiality Agreement
  Personalize
  Use this form to certify an employee's agreement not to disclose confidential company information, either during the term of his or her employment or at any time thereafter, except as required in the course of employment with the company. 
  Preview
• Consensual Relationship Agreement
  Employees who engage in consensual workplace relationships should sign this document after meeting with their supervisor or the HR director to ensure all policies are reviewed and the company is advised of the relationship.​
  Preview
• COVID-19 Prevention Checklist
  Use this checklist to help develop and implement your written COVID-19 prevention procedures.
  Preview
• CPRA Employee Request
  Employees may use this form when making a request under the California Privacy Rights Act (CPRA) and California Consumer Privacy Act (CCPA). This form also includes instructions for employees on how to make a request, including through a toll-free number, which employers must provide, or by completing the written request form.
  Preview
• CPRA Flowchart: Does the California Privacy Rights Act Apply to My Business?
  Use this flowchart to help determine if the California Privacy Rights Act (CPRA) applies to your business.
  Preview
• CPRA Notice at Collection Checklist and Template
  Businesses covered by the California Privacy Rights Act (CPRA) and California Consumer Privacy Act (CCPA) must provide Notice at Collection, which means providing notice to California-based job applicants, employees and independent contractors of the categories of personal information that the businesses collect from them and the purposes for which they are used. If you are covered by the CPRA/CCPA, use this form to help you create a Notice at Collection as required by the law.
  Preview
• CPRA Privacy Policy Checklist
  Businesses covered by the California Privacy Rights Act (CPRA) and California Consumer Privacy Act (CCPA) must disclose to California-based employees, job applicants and independent contractors their privacy practices and information regarding their privacy rights under the law through a comprehensive privacy policy. If you are covered by the CPRA/CCPA, you can use this checklist to help you create a privacy policy as required by the law.
  Preview
• CPRA: Checklist for Responding to Employee Request
  California Privacy Rights Act (CPRA) covered businesses must respond to verified consumer requests and provide the appropriate disclosures, deletions or corrections. If the CPRA covers you, you may use this checklist to help you respond to the consumer request, as required by law.
  Preview
• CPRA: Employer Confirmation of Receipt for Request Under the CPRA
  Employers may use this form to confirm receipt of a request under the California Privacy Rights Act (CPRA) and California Consumer Privacy Act (CCPA).
  Preview
• Credit Check Checklist
  This checklist provides a process for obtaining a consumer credit report on applicants who handle large amounts of money or may be responsible for your company's finances.
  Preview
• Crime or Abuse Victims' Leave Checklist
  This form will help guide you through providing leave for an employee who has notified you that he or she has become a victim of crime or abuse.
  Preview
• Criminal Background Screening Checklist
  Use this checklist when conducting a criminal background check after a conditional offer of employment has been made to a job applicant to ensure that you are following all legally required procedures and completing all legally required forms. Criminal background inquiries cannot be conducted prior to a conditional job offer.
  
  For information on obtaining and using criminal history, see Restrictions on Obtaining Criminal History and Obtaining Background Checks and Investigations by Employers. For information on investigative consumer reports, see Obtaining Investigative Consumer Reports.
  
  This form is not intended for use if you are hiring in San Francisco, the City of Los Angeles or the unincorporated areas of Los Angeles County; these regions are covered by the San Francisco Fair Chance Ordinance, the Los Angeles Fair Chance Initiative in Hiring Ordinance and/or the Los Angeles County Fair Chance Ordinance for Employers.
  Preview
• Criminal History Individualized Assessment of Applicant
  Use this form to help conduct an “individualized assessment” to determine whether a criminal conviction has a direct and adverse relationship with the specific job duties that justifies denying employment to an applicant.
  Preview