FREE Forms for our Clients

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.


Sample MVR Release FormThis 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 PolicyWhat to look for and what to do when abuse is suspected in the Home by the caregiver

Client Theft of Property PolicyCompany policy signed by caregiver on how valuables are to be handled within the clients home / facility

Formalized return to work program for Light DutyThis provides jobs descriptions that can be given to an injured employee when on Workers Compensation.

Sample How to Help Someone Who Uses a WheelchairHow to Transfer someone in a Wheelchair

Sample Gait Belt ProceduresHow use a gait belt properly

Sample Client Permission Car Release FormThis form is used when a Client askes the Caregiver to drive their car

Sample Client Home Evaluation ChecklistThis 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 FormThis is a sample policy for Drugs and Alcohol for the Home Care / Home Health Agency

Bicycle Safety AgreementFor 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 PolicyA Client Patient Transfer Policy and Procedures

Dog Attack DangersDescribes the dangers of dogs and the cost of Bites for Workers Compensation Claims

Medical Waiver FormForm used when a caregiver refuses treatment for a work injury

Sample Physical Exam FormThis form is signed by the Primary Care Physician on caregivers’ physical abilities to do their job

Walking Safety AgreementFor Agencies that are in Urban areas where Caregivers walk to see Clients / Patients

Onsite Drug TestingWe have a relationship with an on-site drug testing kit provider – the price is 2.65 per test