Effective Date
Instructions
Updated 11/2024
Purpose
To inform Consumer Directed Services (CDS) employees about the Employee Misconduct Registry (EMR).
Procedure
When to Prepare
The employer provides Form 1732-EMR at the time of initial orientation and at annual evaluations.
The employee must sign Form 1732-EMR within five days of being hired.
Number of Copies
Original and two copies.
Transmittal
The employer maintains the original in each employee’s file. The employer gives a copy of the signed form to the employee and sends a copy to the Financial Management Services Agency (FMSA) within 30 calendar days of initial orientation and annual evaluation.
Supply Source
This form and the addendum must be printed or downloaded from the Consumer Directed Services Handbook.
Form Retention
The employer and the FMSA must keep this form for five years after the employee is terminated or until all outstanding litigation, claims and audits are resolved.
Detailed Instructions
Employee Name — Enter the employee's name.
Date of Hire — Enter the date the employee started work.
Position — Enter the position for which the employee has been hired.
Employer Name — Enter the CDS employer's name.
Printed Employee Name — The employee prints their name to acknowledge they understand the EMR notification.
Employee Signature and Date — The employee signs and dates this addendum to acknowledge the employer notified them of the EMR within five working days of being hired.