DPH Employee Toolkit -- DPH Forms

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Utilities / File Viewers

Depending on the software installed on your computer, you may need to download the appropriate FREE File Viewer/s to use materials provided on this page.

Adobe Reader (Use for PDF.)
Excel 2003 Viewer for Windows (Use for XLS.)
Real Alternative - 03/11/2008: CRITICAL SECURITY NOTICE - A security vulnerability in the widely popular RealPlayer digital media player has been discovered for which there is not presently a fix. Division of Public Health computer users should discontinue using RealPlayer immediately. Use Real Alternative instead. (Use for Streaming Media.)
PowerPoint Viewer 2007 (Use for PPT.)
Word Viewer 2003 for Windows or Macintosh (Use for DOC.)

If you require a file in a format different than is available above and the free file viewers are not sufficient to meet your needs, please contact us at 919-707-5160.

Administration

Form	Format, Size	Last Modified*	Notes
Authorization of Fees for Expert Speaker	DOC, 47.5 KB	05/08	Addendum to "Conference Authorization Form" - Authorization of Fees for Expert Speaker.
Conference Authorization Form	DOC, 145 KB	05/08	Conference authorization form for workshops, seminars, training courses, etc.
DPH Six Forks Campus ID/Card Building Access Badge Request	PDF, 22 KB	02/07/06	Badge request form for DPH Employees on Six Forks Campus.
DPH Access Badge/Card Request (Downtown)	File available on external web site	N/A	Badge request form for DPH Employees located in downtown Raleigh facilities; NOT for Dix Campus (Royster).
DPH Dix Campus Identification (ID) Badge/Swipe Card Request Form	DOC, 97 KB	N/A	DPH Employees located on Dix Campus (Royster); DIRM form.

Budget

Form	Format, Size	Last Modified*	Notes
Cost Allocation Plan (CAP) Update Request	DOC, 41 KB	02/08	Form used by the Cost Accounting Branch in establishing and maintaining the Cost Accounting Plan; documents the initiation of cost centers (RCCs) as well as changes to existing centers.
Cost Allocation Plan (CAP) Update Request Instructions	DOC, 26 KB	02/08	Instructions for completing the Cost Allocation Plan (CAP) Update Request.

Contracts

Form	Format, Size	Last Modified*	Notes
Contracts Forms	Varies	See Contracts Forms page	Contracts Unit web site with full list of forms, primarily in Word format.

Grants

Form	Format, Size	Last Modified*	Notes
Request to Apply for Federal and Other Non-Federal Funds	File available on external web site	N/A	NC form to apply for federal and other non-state funds.

Health and Safety

Form	Format, Size	Last Modified*	Notes
Hazardous Substance Inventory List	Excel, 60 KB	05/05/08	Worksheet for hazardous substances inventory listing.
Supervisor's Accident/Incident Investigation Report	File available on external web site	N/A	Supervisor's accident investigation report form from OSP's web site.

Human Resources - UPDATED!!!

DHHS HR Forms

Form	Format, Size	Last Modified*	Notes
DHHS Human Resources Forms	File available on external web site	N/A	Various HR files and formats - One stop for DHHS HR forms.

DPH HR Forms - NEW!!!

Form	Format, Size	Last Modified*	Notes
Beacon Training Acknowledgement	DOC, 54 KB	06/2008	This training MUST be completed before or on the first day of employment.
Employee Action Request	DOC, 142 KB	06/2008	N/A
Position Action Request	DOC, 139 KB	06/2008	N/A

Records Management - NEW!!!

Form	Format, Size	Last Modified*	Notes
Public Records Series Listing	DOC or PDF, File available on external web site	N/A	Complete if a schedule needs to be developed and if a schedule needs to be updated.
Records Retrieval Form	PDF, File available on external web site	N/A	Use to request records stored at the State Records Center or other storage facilities.
Request for Disposal of Unscheduled Records	PDF, 145 KB	N/A	Approval must be obtained to destroy records not listed on a schedule.

Risk Management - NEW!!!

Form	Format, Size	Last Modified*	Notes
Conflict of Interest	PDF, File available on external web site	N/A	N/A
Federal False Claims Act Education Employee Notice	DOC, 27 KB	04/08	N/A

Travel

Form	Format, Size	Last Modified*	Notes
Accident Reporting Form/Vehicle Accident Report	PDF, File available on external web site	N/A	Motor Fleet Management's vehicle accident reporting form.
Budget/Travel Authorization Form (BDA)	DOC, 24 KB	05/07	DHHS travel authorization form.
Conference Authorization Form	DOC, 145 KB	05/08	Conference authorization form for workshops, seminars, training courses, etc.
DOT Gasoline Facilities/Automated Fuel Sites	HTML, File available on external web site	N/A	JPG map of automated fuel sites in NC.
Itemized Statement of Charges for Travel (Form 25)	PDF, File available on external web site	N/A	Industrial Commission's mileage reimbursement form related to workers' compensation.
Payment Verification Form	DOC, File available on external web site	N/A	Direct deposit of travel reimbursement (NOT monthly payroll).
Reimbursement of Travel and Other Expenses	Excel, File available on external web site	N/A	Travel reimbursement worksheet.
State Property Incident Report	DOC, File available on external web site	N/A	For use by state department head to report to the Director of the State Bureau of Investigation information or evidence of an attempted arson, arson, damage to, theft from, or theft of, or embezzlement from, or misuse of any State owned personal property, buildings or other real property.

*Note: "Last Modified" dates apply only to documents maintained by the Division of Public Health and not linked on an external web site.

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