Chamberlin & Reinheimer work with hundreds of specialized businesses just like yours. We have crafted the following editable forms for your office to help make sure your policies and procedures are in place AND signed before a claim. By taking the time to make sure every part of your business is protected will make the policy the strongest it can when a claim arises.You are only as good as your employee file and the following items are provided to our clients for FREE to help your business.
Each file that is provided is editable in word allowing you to put your logo, colors and customize questions if needed for your specific business. Taking the time to do things right will strengthen your business for any claims. With Chamberlin & Reinheimer by your side, know that you have your best interest in mind and will always provide the latest materials to help you succeed.
CHAMBERLIN & REINHEIMER INSURERS, INC
POLICY AND PROCEDURES PROVIDED TO CLIENTS
ALL ARE EDITABLE
Sample MVR Release Form – This is an authorization release for the employed Caregiver to give you permission to run their Motor Vehicle Report
Sample Cell Phone Policy – Provides detail what is allowed usage of a cell phone while driving on company time
Personal Vehicle Hired Non-Owned Driving Policy – Detailed driving policies and what to do when a caregiver is involved in an accident using their personal vehicle for work
Sample Sexual Abuse Policy – What to look for and what to do when abuse is suspected in the Home by the caregiver
Client Theft of Property Policy – Company policy signed by caregiver on how valuables are to be handled within the clients home / facility
Formalized return to work program for Light Duty – This provides jobs descriptions that can be given to an injured employee when on Workers Compensation.
Sample How to Help Someone Who Uses a Wheelchair – How to Transfer someone in a Wheelchair
Sample Gait Belt Procedures – How use a gait belt properly
Sample Client Permission Car Release Form – This form is used when a Client askes the Caregiver to drive their car
Sample Client Home Evaluation Checklist – This form is for the case manager to use in evaluating the physical hazards of the Home that the Caregiver will be going in to
Sample Drug Testing Acknowledgment Form – This is a sample policy for Drugs and Alcohol for the Home Care / Home Health Agency
Bicycle Safety Agreement – For agencies in urban environments – if Caregivers are using a bike to travel to client’s homes
Credit Card Debit Card Usage Form – This is required to be filled out by the caregiver anytime purchase are made on behalf of the client
Customizable Lift Policy – A Client Patient Transfer Policy and Procedures
Dog Attack Dangers – Describes the dangers of dogs and the cost of Bites for Workers Compensation Claims
Medical Waiver Form – Form used when a caregiver refuses treatment for a work injury
Sample Physical Exam Form – This form is signed by the Primary Care Physician on caregivers’ physical abilities to do their job
Walking Safety Agreement – For Agencies that are in Urban areas where Caregivers walk to see Clients / Patients
Onsite Drug Testing – We have a relationship with an on-site drug testing kit provider – the price is 2.65 per test
