Assistance Plan - here is what you will do to support yourself in this process: Description Initial Discussion date: _____ ___________________________/______________ ___________________________/______________ Employee’s Signature Date Administrator’s Signature Date (Blue Ink Only) (Blue Ink Only) Date(s) for Follow-Up: ______________________________ Comments: ___________________________/______________ ___________________________/______________ Employee’s Signature Date Administrator’s Signature Date (Blue Ink Only) (Blue Ink Only) Date(s) for Follow-Up Review: ______________________________ Comments: ___________________________/______________ ___________________________/______________ Employee’s Signature Date Administrator’s Signature Date (Blue Ink Only) (Blue Ink Only) Continued Closed
Assistance Plan - here is what you will do to support yourself in this process: Description Initial Discussion date: _____ ___________________________/______________ ___________________________/______________ Employee’s Signature (Blue Ink Only) Date Administrator’s Signature (Blue Ink Only) Date Date(s) for Follow-Up: ______________________________ Comments: ___________________________/______________ ___________________________/______________ Employee’s Signature (Blue Ink Only) Date Administrator’s Signature (Blue Ink Only) Date Date(s) for Follow-Up Review: ______________________________ Comments: ___________________________/______________ ___________________________/______________ Employee’s Signature (Blue Ink Only) Date Administrator’s Signature (Blue Ink Only) Date Continued Closed
IP-PDAP_Dimension_1_template.docx