Professional New Hire/Re-Hire Checklist

• Declaration of Outside Compensation [docx]
• Mandatory Furlough Information [pdf]
• Information on ESS to set up Direct Deposit
• Designation of Beneficiary for Unpaid Compensation - Salary [pdf]
• W-4 Tax Form [pdf]
• Employment Eligibility Verification Form (Form I-9) - requires personal identification to be shown to employer
• Employment Contract Attachment - Loyalty Oath [pdf]
• Academic Faculty Policy and Evaluation Forms [pdf]

• CSN's Approved Policies
• Board of Regents Handbook
• NSHE Sexual Harassment Policy [pdf]
• Sexual Harassment Policy Acknowledgement Form [.pdf]
• Nepotism Policy [.pdf]
• Nepotism Policy Acknowledgement Form [.pdf]
• Acknowledgement Form for the following Policies [pdf]
• Alcohol and Drug-Free Workplace Policy [pdf]
• CSN ADA Policy Statement [.pdf]
• Workplace Safety: Your Rights and Responsibilities [pdf]
• Disclosure of Improper Governmental Action "Whistle Blower Law" [pdf]
• Acceptable Use of College Equipment and Property [pdf]
• Ethical Standards [.pdf]
• Nevada Acknowledgement of Ethical Standards [.pdf]
• Exposure to Bloodborne Pathogens Determination Form [.pdf]
• Emergency Notification System [.pdf]
• Clery Act Information [.pdf]

EMPLOYEE Occupational Accidents / Injuries / Illnesses

What to do if you are injured at work:

1. Report all accidents, injuries or illnesses to your supervisor, no matter how minor.
2. Complete the following forms:
   1. Written Statement - Incident Report
   2. C-1 Notice of Injury or Occupational Disease
   3. if appropriate the Report of Exposure to Bloodborne Pathogens. See links below under Forms & Resources
   4. If you need medical attention, please contact your supervisor immediately.
   5. If the injury is life-threatening or an emergency call 911 (9-911 from a campus line) or proceed to the nearest medical facility. In this case, complete the C-1 Notice of Injury or Occupational Disease as soon as feasible.
   6. If emergency treatment is not required, you must seek medical evaluation by one of the approved medical providers listed in the Workers' Compensation Information link below.
      Note: Under Nevada Law, an employee is required to seek medical treatment from an approved clinic, unless emergency treatment is required.
   7. Tell the doctor you were injured at work.
   8. The healthcare provider must complete a C-4 Employee Claim for Compensation/Report of Medical Treatment (the official claim form) at the doctor's office. Must be completed within 90 days from the date of injury.
   9. Following the medical visit contact the Workers' Compensation Administrator for further assistance. See link below under Forms & Resources
   10. Communicate with your supervisor regarding the outcome of the medical evaluation, treatment and any work restrictions ordered by the healthcare provider.
   11. Stay in touch with the workers' compensation administrator. Supervisors must submit the Supervisor's Injury / Illness / Incident Report to Workers' Compensation Office. See link below under Forms & Resources

Workers' Compensation Program

CSN's Workers' Compensation Insurance Program is administered at Nevada System of Higher Education, Business Center South located on UNLV campus.  View the Workers' Compensation Insurance information for CSN employees.

Workers' Compensation Program - Approved Medical Clinics

View the approved medical clinics for work-related, non-emergency injury or illness.

Workers' Compensation Administrator

Michele Washington
NSHE Business Center South / UNLV Risk Management and Safety
702-895-5404
fax 702-895-5227

Forms & Resources

• Written Statement - Incident Report
• C-1 Incident Report - CSN Employee 'Notice of Injury or Occupational Disease'
• Report of Exposure to Bloodborne Pathogens
• Supervisor's Injury / Illness / Incident Report

• Statement Concerning Your Employment in a Job Not Covered by Social Security (SSA 1945) [.pdf]
• NSHE Retirement Plan Company Allocation Instructions - Retirement Plan Alternative (RPA). TIAA/CREF 100%
• Public Employees' Retirement System of Nevada (PERS) Member Enrollment Form; for PERS participants only [.pdf]

• Affordable Care Act Information [pdf]
• Employee Hiring Form (State of Nevada - PEBP). If covering dependent(s), copy of certified marriage certificate required for spouse coverage and copy of birth certificate(s) required for children. PEBP will send packet to enroll.
• State of Nevada (PEBP) basic life insurance policy ($25,000), the Standard Insurance Company, Beneficiary Designation

Request for Supplemental Retirement and Insurance/Products Information [pdf]

• Tax-Sheltered Annuities (403B, 403B Roth, 457 Plans)
• Salary Redirection Agreement (For "ASI, Inc.," pre-tax flexible spending accounts - medical and dependent care)
• Cancer Care Policy - American Fidelity
• Short-Term Disability - American Fidelity & Standard Insurance
• Personal Accident Policy - The Hartford
• Liberty Mutual Automobile/Homeowner's Insurance
• Supplemental Policies through MetLife

• CSN Strategic Plan for 2010-2017 [pdf]
• Employee Assistance Program
• Retirement Plan Alternative (RPA) Guide
• Professional Grant-in-Aid Procedures
• State Training [pdf]
• Resources for Success [pdf]

Human Resources information contained on the World Wide Web is in no way to be interpreted as a contract between the College of Southern Nevada and any of its employees. This information is provided as a service to the CSN community and will change as CSN changes. From time to time, CSN must modify its policies. Information is current as of the time of its presentation and may be subject to change or repeal at any time, with or without notice, at the discretion of CSN.