01 (Williston) Forms

Primary Phone: 802-662-7831
Regional Director: lesha.rasco@sdplus.org
Operations Contact Information: Click Here for ‘Who to Contact When…’

Available Documents & Forms

• Paychex Employee Portal

–

      Payroll:

1. Time and Attendance Change Forms
   1a. Williston Change Form
   1b. Printable PDF Here
2. Time Tracker Form

–

      Staff Forms (Formerly: Human Resources):

1. Employee Policy Manual (01.05.26)
   1a. Policy Acknowledgement Page
2. Personal Data Change Form
3. Community Letter
4. PTO and Call Out Procedure (rev 12.29.25)
5. Incident Report (04.08.22)
6. NVT Staff and Student Injury Form  (*Preferred Provider List*) (10.22.24)
7. Reference and Recommendations Guidelines
8. Reference Check Approval Form
9. Employee Evaluation Form
10. Supervisors (10.08.25)
11. 401k Plan Fee Disclosure (10.22.24)
12. Short Term Family Leave
13. Leave of Absence Request Form (12.18.25)

–

      Health Insurance & Other HR Notices:

1. Cobra Initial Notice
2. COVID-19 Extension Notice
3. Medicare Part D Notice
4. Newborn’s Act Notice
5. Patient Protections Notice
6. WHCRA Notice
7. FMLA Notice
8. USERRA Notice
9. CHIPRA Notice
10. Special Enrollment Disclosure
11. QMCSO Notice
12. HIPAA Breach Notification Policy
13. HIPAA Privacy and Security Policy around Transmitting ePHI and Backups

–

      Summary of Benefits:

1. Health Insurance Plan 1 Summary of Benefits
2. Health Insurance Plan 2 Summary of Benefits
3. Dental Insurance Summary of Benefits
4. Vision Insurance Summary of Benefits

–

      Client Materials:

1. Medication Intake Form
2. Calendar for Meds
3. Form 4500 page

–

      Calendars:

1. Payroll Calendar 2025
2. Program/Staff Calendar 2025
3. Payroll Calendar 2026
4. Program/Staff Calendar 2026

–

      Reimbursement:

1. WeCU Savings Account
   1a. Reimbursement Request Form (NVT)
   1b. NVT Savings Account Approved List (2026)
   1c. Tracking Sheet 
2. Materials / Purchase Form (Read me first: Materials Form Quick Reference)

–