Procedures for Supervisory Referrals

• HR calls ACI to discuss the purpose for the referral and requests a blank Supervisory Referral Form if needed
• HR and employee discuss Job Performance Problem and determine deadline by which employee must contact ACI and have an initial EAP assessment. Supervisory Referral Form is then signed by both the employee and HR/ Supervisory Representative
• Supervisory Referral Form is faxed to ACI, attn: Clinical Manager
• Employee calls ACI intake operator and requests a referral to a provider
• Employee calls provider and schedules an appointment as per agreement
• ACI Clinical Manager contacts provider and HR/Supervisor to begin the process of mediation between the provider and HR regarding the employee’s treatment plan and progress.

Supervisory Referral Forms

Employee Supervisory Referral Form (42 KB)

Procedures for Supervisory Referrals (72 KB)