DPH Employee Toolkit -- DPH Forms

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Administration

Form	Format, Size	Last Modified*	Notes
Authorization of Fees for Expert Speaker (Travel Forms Workbook)	XLS, 327 KB	09/04/08	Addendum to "Conference Authorization Form" - Authorization of Fees for Expert Speaker.
Conference Authorization Form (Travel Forms Workbook)	XLS, 327 KB	09/04/08	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.
Fixed Asset Input Form (FAS-1)	PDF	N/A	DHHS Form for inventorying fixed assets.
Fixed Asset Input Form Instructions	DOC	N/A	Instructions to DHHS form for inventorying fixed assets.

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

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

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

Purchasing

Form	Format, Size	Last Modified*	Notes
Correction Enterprises Print Order Form (DC 258)	PDF	N/A	Complete for publication print orders.
Fixed Asset Input Form (FAS-1)	PDF	N/A	DHHS Form for inventorying fixed assets.
Fixed Asset Input Form Instructions	DOC	N/A	Instructions to DHHS form for inventorying fixed assets.
N.C. DHHS Publication Review (PA-2)	PDF	N/A	Form to initiate final signoff for all printed and Web materials created within DHHS. Call 733-9190 to talk with your Public Information Officer.
Telecommunications Cable Service Request (TO-4)	DOC	N/A	Request cable services from ITS.
Telephone Order Service Request (TO-5)	DOC	N/A	Request telephone services from ITS.

Records Management

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

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.
DOT Gasoline Facilities/Automated Fuel Sites	HTML, File available on external web site	N/A	JPG map of automated fuel sites in NC.
Employee Travel Advance Request Form	Excel, 25 KB	07/08	Submit at least 5 days before travel.
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).
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.
Travel Forms Workbook Authorization of Fees for Expert Speaker Conference Authorization Additional Speaker Attachment Conference Authorization Form Reimbursement of Travel and Expenses Incurred in the Discharge of Official Duty Subsistence Rates	XLS, 327 KB	09/04/08	Workbook containing forms for travel reimbursement. Download workbook and tab to the form you need.

*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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