Employee Portal

Name	Category	Download
COVID-19 Self-Certification of Vaccination Status (02/2022)	Current COVID Policies Employee Forms	PDF (177 KB)
Direct Deposit	Employee Forms	PDF (103 KB)
Employee Information Form	Employee Forms	PDF (132 KB)
Federal Withholding (2022 W4)	Employee Forms	PDF (187 KB)
MissionSquare 457 Deferred Compensation Plans Contribution Form	Employee Forms	PDF (103 KB)
Nationwide 457 Participant Agreement	Employee Forms	PDF (77 KB)
State Withholding (DE4)	Employee Forms	PDF (103 KB)

Name	Category	Download
1 – Flowchart & WC Procedures for Processing Claims	WC Forms	PDF (70 KB)
2 – Employee Workers’ Compensation Procedures	WC Forms	PDF (30 KB)
3 – Short Form – Accident or Injury	WC Forms	PDF (160 KB)
4 – DWC-1 Form	WC Forms	PDF (398 KB)
5 – Accident-Incident Investigation Report	WC Forms	PDF (77 KB)
6 – Form 5020	WC Forms	PDF (61 KB)
7 – DWC-7 Form	WC Forms	PDF (526 KB)
8 – PRISM MPN Employee Notification	WC Forms	PDF (97 KB)
9 – Temporary Prescription ID Card	WC Forms	PDF (209 KB)
10 – Intercare Team Organizational Chart	WC Forms	PDF (138 KB)

Name	Category	Download
Aetna EAP Benefits Summary	EAP Aetna	PDF (1.2 MB)
About Talkspace EAP Chat Televideo ARFL	EAP Aetna	PDF (1.5 MB)
Website Flyer ARFL	EAP Aetna	PDF (898 KB)
Wallet Card ARFL	EAP Aetna	PDF (193 KB)
Televideo Service Sheet ARFL	EAP Aetna	PDF (544 KB)
Mobile App Service Sheet ARFL	EAP Aetna	PDF (738 KB)
Legal Services ARFL	EAP Aetna	PDF (2.5 MB)
Financial Services Sheet ARFL	EAP Aetna	PDF (2.5 MB)

Personnel Forms