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The Wellness Reimbursement Request form is used for employees to request reimbursement for authorized expenses that fall under the company's health and wellness reimbursement policy.
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Related documents may be used in conjunction with this document depending on your situation. Many related documents are intended for use as part of a contract management system.

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Wellness Reimbursement Request
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Writing the Wellness Reimbursement Request document

company name Wellness Reimbursement Request Date. current date Employee. contract first name contract last name Department. department Supervisor. supervisor manager Employee Job Information Position. contract job title Status. Full time N Date of Hire. Work Type. Hourly Salary Shift Type. Day Night Swing Other Instructions. Supervisor must complete the following form and file it with the Human Resources Department. Employee must provide receipt for all reimbursed wellness activities. Description of Wellness Program or Activities Describe the wellness program or activities you are seeking reimbursement for.

Qualifications Does employee have receipt of payment for the activities being submitted for reimbursement. Yes No. Are the activities submitted for reimbursement Qualified Wellness Program activities. Yes No. Qualified Wellness Program Activities Purpose of company name Wellness Reimbursement Plan. The purpose of this plan is to provide our full time employees with financial incentives and assistance to encourage participation in health and wellness activities and programs such as health club memberships aerobic exercise classes health education classes and smoking and tobacco cessation or weight management programs. Who can participate in Wellness Reimbursement. Full time regular employees are eligible to participate in the wellness reimbursement program. The maximum benefit an employee can receive is limited to Insert Amount month for all qualified activities. For an activity to be considered qualified the employee must participate in the activity for three consecutive months to be eligible for reimbursement. The company will also reimburse any previously paid qualified wellness expense so long as it is within six months of the reimbursement request subject to documentation requirements. The following activities shall be excluded from the Wellness Reimbursement plan.

* Recreational sports programs unless included in health club membership dues * Recreational sports events including marathons triathlons tournaments * Personal trainer fees and personal fitness or sports equipment * Classes training or instruction that is not provided by licensed business or instructor proof may be required * Meals supplements or aids for weight loss body building or for smoking tobacco cessation * Massage programs * Medical treatment programs or therapy

* Psychological treatment programs or therapy * Fees finance charges late fees or other charges not part of regular health club or classroom dues Payment Requirements. All reimbursement requests must have paid receipt showing the wellness activity purchased date of purchase the business Tax ID and the period of time that the purchase covers. For multi month purchases made up front company shall reimburse up to Insert Amount month paid on quarterly basis. Company will reimburse only wellness expenses incurred during employment with company name. Expenses prior to employment with company name shall not be considered.

Company reserves the right to request additional information or documentation on all requested reimbursements. Company may also deny reimbursement expense if that expense is determined to be covered under an applicable health insurance plan or other reimbursable program. Employees may not submit wellness reimbursement request for any expense that has already been submitted or paid out through Flexible Spending Account FSA Health Savings Account HSA or Medical Reimbursement Account MRA. If you have any questions concerning the eligibility of any wellness expense please consult the Human Resources Department. Notes. Supervisor Signature Date For Office Use Only Received By signator authorized signature or signer. Human Resources Manager Date Include Employee Contact HR Information address address city state or province zip or postal code

Phone phone number

Writing the Expense Reimbursement Plan document (alternate or related contract document)

REIMBURSEMENT OF EXPENSES PLAN ACCOUNTABILITY PLAN Accountability Plan. Declarations and Conditions company name Company wishes to establish an employee expense reimbursement plan by which employees in the employ of Company may be reimbursed for approved expenses or receive advances for specific future expenses so long as those expenses are properly documented and approved prior to disbursement. A reimbursement request shall be deemed appropriate if it meets the following guidelines. * The expense is considered to be necessary and ordinary and is connected to or incurred on behalf of Companys business operations or the performance of an employees normal job functions or travel.

* The expense has been approved by Company and the employees purchase of goods or services is merely for the convenience of Company. * The expense is suitably documented and substantiated and submitted to Company within reasonable period of time. For the purposes of this plan document reasonable period of time shall be considered as submitted for reimbursement within days of when the expense was occurred and paid for by the employee. * Any advanced monies given to employees in excess of what is required are returned to Company within days of disbursement. A reimbursement request that meets the above conditions shall be considered to be covered under the Company accountability plan. All reimbursements shall be excluded from an employees gross pay and shall be remitted to the employee by check or by direct reimbursement as line item on the employees normal paycheck. Accountability Plan. Exceptions Notwithstanding the above the following items shall not be considered to be reimbursable expenses under this plan and may be subject to other Company policies that fall outside of the scope of this accountability plan.

* Insert exclusions here. * Insert exclusions here. * Insert exclusions here. The above listed guidelines constitute the Companys Accountability Plan and in no way limit Companys ability to further limit the amount of monies that an employee may be reimbursed. Company reserves the right to modify this plan at any time or to develop plan limitations on an individual employee basis. Company Officer Name current date

How do you write a Petty Cash Policy document? (example of another included contract document)

company name PETTY CASH POLICY Introduction company names policy on handling petty cash is described below. Use this page to describe your organizations policys for using and handling petty cash small amounts of bills and coins. Purpose and Permitted Usage Describe here how and when petty cash should be used as well as usages that are not permitted. For example you might say something like The petty cash supply is maintained and used for making change during ticket sales only. Any other use must be approved in advance by the manager. Authorized Users List the names of individuals or the category of people e. g. cashiers or waiters who are authorized to handle the petty cash. Setup and Reimbursement of Cash Supply

Describe your policy for accounting for petty cash at the beginning of time period. For most organizations this would be the beginning of work shift or business day but it also could be every time different employee handles the cash. Describe how and by whom the cash is acquired and counted during setup for the work period or event. Be sure to include the numbers and types of bills and coins that are required at the beginning of the period too as well as describing how and by whom petty cash will be resupplied after spending. Documentation Accounting Describe how records will be kept of how cash was disbursed. For example you might say All usages of petty cash the amount the recipient the reason must be entered in the ledger that accompanies the cash box or Each disbursement from the petty cash fund must be entered in the XYZ spreadsheet online. Reconciliation Describe who is responsible for reconciling the records of expenditures from the petty cash fund and when this must happen. For example you might write At the end of each shift the supervisor must reconcile the usage of petty cash with the remainder write the total usage and remainder in the ledger and sign next to the daily total. In the event that the amounts cannot be reconciled this discrepancy must be reported to the division manager. Securing the Petty Cash

Describe how and where the petty cash will be kept and who has the responsibility for securing the funds when they are not in use. This might include routinely depositing funds in excess of specific amount in bank account locking the funds up in safe etc. Other Considerations Describe any other important issues. These might include your policies for changing the amount of petty cash on hand closing an account authorizing substitute personnel on occasion or penalties for mishandling the petty cash any details that are part of your petty cash policy and have not been described above. Effective Date. current date Approval. approved approver

How do you write a Personal Technology Usage Policy document? (example of another included contract document)

PERSONAL TECHNOLOGY USAGE POLICY Tablets Smartphones Laptops and other Devices The purpose of this document is to set forth Company Personal Technology Usage Policy by which employees and contractors will abide while using leasing or otherwise making use of personal technology in the course of their duties while employed at company name. The intent of this policy is to provide proper guidance to employees and contractors who make use of personal technology during the course of their work with company name. As an employee or contractor of company name you are required to comply with this policy at all times. Terms and Conditions The Personal Technology Usage Policy is as follows. 1. Definitions. For the purpose of this Personal Technology Usage Policy Personal Technology shall be defined as hand held computing device tablet or phone smartphone that provides Internet access wireless cellular or otherwise software applications communication and or email services and network connectivity through cellular Wi Max Wi Fi or other ad hoc networks. For the purpose of this Personal Technology Usage Agreement Company Services shall be defined as all resources provided to employees by Company in order to fulfill their duties as employees.

This list includes but is not limited to. * Email webmail chat and other forms of communication associated with the Company. * FTP SFTP SSH Remote Access or Virtual Private Networks VPN. * Online access to Company portals online software or resources. * Remote access to Company computers or servers. 2. Approved List of Devices Hardware.

Due to the changing nature of Personal Technology devices company name may at its sole discretion decide to not allow or support specific devices or technologies that interact with its network. This list is subject to change and may be amended to adapt to specific Company needs and requirements. The following devices shall be allowed to interact with Company networks or resources. Insert Supported Hardware Here 3. Approved List of Software and Technologies. In order to effectively interface with Company resources networks mail servers and other communication systems the following software and technologies shall be required for use in the following Company tasks. There shall be no exception to this list without prior written approval from IT Department Manager etc. Due to the changing nature of Personal Technology devices company name shall only support limited number of hardware devices and configurations. This approved list is subject to change and may be amended to adapt to specific Company needs and requirements. The following required software and technologies shall be used for the following tasks. Email Calendar Client Insert Supported Software or Requirement Here by device if needed

Docking Hot Synch or other Synchronization Systems Insert Supported Software or Requirement Here by device if needed Operating Systems OS Insert Supported Software or Requirement Here by device if needed Virtual Private Networking VPN Insert Supported Software or Requirement Here by device if needed FTP SFTP or SSH Access

Insert Supported Software or Requirement Here by device if needed Instant Messenger IM or Chat Programs Insert Supported Software or Requirement Here by device if needed Other Software Systems Insert Supported Software or Requirement Here by device if needed

4. Limits on Use of Personal Technology. The use of Personal Technology is for the Companys benefit and the convenience of the Employee. Employees must still adhere to the Company Communications and Email policies whether they are using Personal Technology Devices or their normal work station s. Any integration between Personal Technology device and Company resources must not use the Company resource Company email VPN etc. for personal usage. 5. Personal Technology General Usage Policies. Use of Personal Technology by Company employees and contractors shall be governed by the Company Internet Access and Asset Usage Policy as well as the Company Wireless Network Usage Policy. Copies of these policies may be obtained from the Company Human Resources Department. Companys general personal technology usage policies are as follows. * All Personal Technology must have the Company required applications and security software installed prior to accessing Company resources or networks. Employees must have the Company IT Department review and certify that all Personal Technology meets the Company Network Security Policy prior to use. * All Personal Technology shall make use of access control systems password protection and encryption. Personal Technology devices that interact with Company resources can get lost and access control systems help prevent outsiders from gaining access to Company networks and systems.

* All Personal Technology and software running on Personal Technology devices must use complex passwords and secure digital certificates for remote access where appropriate. * All Personal Technology shall make use of self updating or software that automatically updates itself to ensure that the devices comply with the Company Network Security Policy. * All Personal Technology whether owned by the employee or not that interacts with Company resources shall be subject to on demand audits by the IT Department or Managers to ensure compliance with the Company Network Security Policy. 6. Personal Technology Usage and Your Health and Safety. Improper usage or overuse of Personal Technology can lead to injury tendonitis or swelling of tissues and joints. The following tips are provided to help you avoid such injury while you use your Personal Technology. If you have questions or concerns or would like demonstration of these safety techniques please contact the Human Resources Department.

Proper use of your Personal Technology includes. * Taking frequent breaks from using your Personal Technology. * Immediately stopping use if you experience any of the following symptoms. pain in your thumb fingers wrist joints or anywhere else on your body. * Immediately stopping use if your hands or extremities feel numb or are tingling. * Avoiding typing for more than few minutes at time. * Avoiding typing only with your thumb. * Making sure that your wrists are in an upright position and not flexed or bent when typing. Try placing support underneath your Personal Technology whenever possible.

The following is the Company policy for using Personal Technology while operating motor vehicle. * You may not text email use web browser or otherwise use your Personal Technology in any way while driving or operating motor vehicle. The American Physical Therapy Association recommends the following simple exercises. * Tap each finger with the thumb of the same hand. Repeat five times. * Alternate tapping the palm of your hand and the back of your hand against your thigh as quickly as you can. Repeat times. * Open your hands and spread your fingers as far apart as possible. Hold for seconds and repeat eight times. * Fold your hands together and turn your palms away from your body as you extend your arms forward. You should only feel gentle stretch. Hold for seconds and repeat eight times. * Fold your hands together turn your palms away from your body and extend your arms overhead. You should feel the stretch in your upper torso and shoulders to hand. Hold for seconds and repeat eight times. 7. Responsibility and Storage of Personal Technology.

Company shall not be responsible for any loss or damage that may occur to their Personal Technology Devices at any time. 8. Modification of Policy. Company reserves the right to add modify or delete any provision of this Policy at any time and without notice. Company reserves the right to restrict any access right at any time whether violation of this Policy occurs or not. Company reserves the exclusive right and will be the sole arbiter as to what constitutes violation of any of these provisions. 9. Improper or Illegal Conduct. Failure to adhere to the provisions of this Policy may result in disciplinary actions and or termination. The following shall be construed as violations. a Allowing access to any restricted information by unauthorized personnel or purposefully allowing unauthorized personnel to gain access to Personal Technology for non company or non authorized activities. b Allowing dangerous or restricted software or applications to be installed on the Personal Technology at any time. c Engaging in any behavior with Personal Technology that would violate the Company Wireless Network Usage Policy or Company Internet Access and Asset Usage Policy. 10. Consequences of Violation.

If Company becomes aware of an alleged violation of any of the terms contained in this Policy or any other policy that has been posted on its web site made available to employees or contractors via email or posted in any other form Company shall initiate an investigation. During the investigation Company may restrict access to the employees Personal Technology whether personally owned or otherwise in order to prevent further possible unauthorized activity. Company may at its sole discretion restrict suspend or remove employees Personal Technology without notice or refund or pursue civil remedies as it deems necessary. Company shall notify the appropriate law enforcement department of any such violations. Company shall not be responsible for any payment refunds or compensation in any way for service disruptions or termination resulting from violations of this Policy. Effective Date. current date

How to write my Wireless Networking Usage Policy document (example of another included contract document)

company name WIRELESS NETWORK USAGE POLICY This policy sets forth guidelines for expected conduct and defines the conditions under which an employee contractor vendor or any other person user may use Wireless Networks or other Internet Access Points including but not limited to. Company Internet access; its private network ; its vendors suppliers and partners networks and its email system or any other access point or connection resource while conducting business for or on behalf of the Company. 1. Introduction. The Company makes available its various assets hardware software services and computer network in order to allow its employees access to resources to effectively execute their job functions and duties. This policy defines the Companys official policy regarding Internet connectivity and usage. Before access to the Internet via the company network is approved the user is required to read and sign the Wireless Network Usage Policy.

2. Definitions. Authorized Use Authorized Use shall mean any use of wireless network access points or hot spots which is deemed to be necessary and consistent with the execution of the individual duties and obligations of employees contractors and staff associated or employed by the Company. Authorized Users Authorized Users shall mean all current employees contractors vendors or staff who are authorized by the Company to use specific network or computing resource by the department responsible for overseeing or managing the resource. Non authorized Users Non authorized Users shall mean anyone including but not limited to employees contractors vendors staff or anyone else who are NOT authorized by the Company to use specific network or computing resource by the department responsible for overseeing or managing the resource. Mobile Computing Equipment or Devices Mobile Computing Equipment or Devices shall mean any handheld PDA cell phone or other computing or communication device which is not physically connected to Company network environment.

Public Wireless Networks Public Wireless Networks or Internet Hotspots shall mean any device appliance or broadcast which offers access to the Internet. Untrusted Wireless Networks Untrusted Wireless Networks shall mean an insecure Public or Private Wireless Network or Internet Hotspot which offers access to the Internet and which does not employ SSL or secure encryption. 3. Company Wide Standards. Use of mobile computing devices by Company employees and contractors shall be governed by the Company Internet Access and Asset Usage Policy as well as this Company Wireless Network Usage Policy. Copies of all Company policies may be obtained from the Company Human Resources Department. Users are expected to use mobile computing equipment responsibly and professionally and shall make no intentional use of the equipment or internet services in an illegal malicious or obscene manner.

The following rules shall apply to all use of Wireless Networks by mobile computing devices. * Access to internal Company network resources or internal systems from public wireless networks must be obtained using secure encrypted connections and secured at the device level through virtual private network VPN session and connection. * Employees may make personal use of the Internet subject to the Company Acceptable Use Policy see below so long as there is no negative security impact or impact on the performance of the employees obligations and duties that creates an unreasonable cost to the Company. * Sending or receiving personal email shall be allowed so long as any email that is sent using Company email account has the authorized company disclaimer at the bottom of the email stating that the contents of this message may not represent the views of the Company. * Use of any company mobile computing equipment or accessing company network resource or Internet access point implies an agreement to abide by all Company policies and procedures in existence governing such use. * Use of any company mobile computing equipment must be secured in accordance with the security standards set forth in the Company Network Access and Security Policy. * Mobile computing devices or wireless access may not be used for commercial or other activities from which they directly or indirectly personally profit or have profit motive. * All mobile computing devices must have the Company required Applications and Security Software installed prior to accessing Company resources or Networks. Employees must have the Company IT Department review and certify that all mobile computing devices meet the Company Network Security Policy prior to their use.

* All mobile computing devices shall make use of access control systems and encryption. * All mobile computing devices and software running on mobile computing devices must use complex passwords and secure digital certificates for remote access. * All mobile computing devices must be configured to require hardware BIOS password upon start up which must be changed every months. * All mobile computing devices shall make use of self updating or software that automatically updates itself to ensure that the devices comply with the Company Network Security Policy. * All mobile computing devices whether owned by the employee or not shall be subject to on demand audits by the IT Department or Managers to ensure compliance with the Company Network Security Policy. * All mobile computing devices provided to employees and contractors must be serialized and recorded into Company Inventory. This includes all mobile computing devices purchased by employees or contractors that they are later reimbursed for. * All mobile computing devices that connect to an untrusted network must meet the following minimum security and safety standards including.

o The most recent versions of Company approved anti virus and firewall applications must be installed. o The most recent versions of spyware and malware applications must be installed. o All digital certificates used must be current and non expired. o All logins and access must be conducted over SSL HTTPS. o Active intrusion detection and countermeasures must be in place. o Internet and network activity monitoring and reporting must be active and enabled. 4. Training and Education. Employees who will use mobile computing devices and wireless Internet access may be required to participate in network security awareness training in order to educate themselves on the specific dangers and risks that may accompany access to public wireless Internet access points. The goal of such training is to equip our employees with the knowledge and tools they need in order to comply with Company policies concerning data and network security while traveling outside of the Company office. Department managers shall document and retain evidence of training provided to each user.

5. Sensitive and Confidential Information. Every employee contractor or staff member has the obligation to protect sensitive and confidential information. All mobile computing users who make use of wireless networks must use VPN encryption protocols when sending or transmitting sensitive or confidential information in any form. No employee contractor or staff member should ever access an internal company network resource without being secured by VPN encryption protocols as all Company internal networks network resources or other internal assets shall be deemed sensitive and confidential information. 6. Definition of Unacceptable Use of Wireless Networks. Unacceptable use shall be defined as but not limited to the following examples. * Using the Internet for personal commercial purposes. * Sending bulk unsolicited email Spam.

* Engaging in file sharing or Peer to Peer Networking P2P. * Accessing Social or Professional Networking Sites MySpace. com Facebook. com etc. Blogging Platforms Blogger Blogspot etc or other sites that are non essential to the performance of your job duties and obligations. * Disseminating any confidential information about the Company or its customers. * Downloading or using excessive amounts of internal Company bandwidth or external Internet resources i. e. paid Internet access billed to the Company or reimbursed in some way to employee contractor or staff member for non essential non work related activities. * Downloading Shareware or Freeware programs or software that have not been authorized while on wireless network.

* Installing ANY software on Company computer or other asset without prior approval from manager or supervisor while on wireless network. * Compromising the security of the Company network company computers or any other company resource by engaging in unacceptable usage of the Internet. * Knowingly causing someone to view content that may be deemed as obscene immoral or illegal or that may cause the Company to be held liable for discrimination or obscenity. * Knowingly causing disruption or interference with any network or user whether associated with the Company or not. * Searching for requesting acquiring storing or disseminating images text or data that are pornographic whether legal or not or that negatively depict race religion sex age or creed. * Conducting third party business or personal business enterprise not benefiting the Company participating in political or religious activity engaging in illegal or fraudulent activities or knowingly disseminating false or otherwise libelous materials. * Engaging in online gaming or gambling while on wireless network. * Accessing any Company resource or asset that is not within the scope of the users normal work and job functions. Examples include but are not limited to. customer information personnel files and data or any other documents not required for the proper execution of the users normal job functions or duties.

* Any other illegal purpose whether listed here or not whether through wireless network or not that would encourage or conduct criminal activity offense exposure to civil liability or otherwise violate any regulations local state national or international law including without limitations US export control laws and regulations. 7. Consequences of Violations. Violations of the Wireless Network Usage Policy are logged and documented. Violations may lead to revocation of the employees Internet access privileges and or may lead to disciplinary action including termination. The Company also reserves the right to pursue legal remedy for damages incurred as result of an employees violation. Certain illegal activities will require that Company immediately notify or comply with the proper authorities upon discovery. The Company reserves the right to examine any users Email Account Web Logs Chat Logs or any other information passed through Company resources or Network or stored on Company computers at any time and without prior notice.

8. Inappropriate Use of Resources. Inappropriate use of resources shall be defined as engaging in any activities by users that are inconsistent with the business needs and goals of the Company. Engaging in any activity that adversely affects the users productivity will not be tolerated. When you access the Internet for business purposes you are representing the Company with each site or activity you engage in. Special attention must be paid to such activities that do not directly contribute to the fulfillment of the employees job description or duties. 9. Responsibility for Online Activities. Users are responsible for their online activities. Each employee must indemnify the Company from all claims of loss whether direct or indirect and from any consequential losses suffered by the Company due to breach of the Company Wireless Network Usage Policy. Company is not responsible for users who display store or otherwise transmit any personal information such as passwords banking information credit card numbers social security or tax ID numbers or make use of Internet passports or wallets. Company shall not be held liable for damages resulting from any loss of such information abuse by other parties or any consequential loss of personal property or injury resulting from the storage or loss of such information.

The practices described in this Wireless Network Usage Policy are current as of current date. Company reserves the right to modify or amend this policy at any time. Appropriate notice will be given to all employees contractors vendors or other users of Company resources governed under this Agreement concerning such amendments. Effective Date. current date I hereby declare that have read and fully understand my duties and obligations set forth in the above Wireless Network Usage Policy for company name and will uphold these duties and obligations at all times. EXECUTED as of the date first written above. contract first name contract last name By signator authorized signature or signer. Job title of signator authorized signature or signer. Date when the contact was signed

company name By signator authorized signature or signer. Job title of signator authorized signature or signer. Date when the contact was signed Company Initials Employee Initials

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