Employee Personal Action Form (EPA) 

All of the personnel actions listed below should be done according to the employee's pay status, i.e. every two weeks or on a monthly basis. An election form P-28 will be completed by the employee indicating:

·  Employee chooses to receive a check from workers compensation only.
Department should process a medical LWOP for the entire time period the employee is gone.

·  Employee chooses to supplement with their vacation, sick or comp time leave.
The adjusted leave amount will appear in a routed EPA from Human Resources and will document workers compensation payment for the employee. The department follows-up with a corrected leave form when the employee has been gone more than 14 days; at that point workers compensation will reimburse the employee for the first 3 days. Those days should then reflect use of an adjusted rate instead of a whole day of vacation and sick leave use. (EPA Type of Action: W)

·  Employee comes back to restricted duty, but not for a full day and supplements.
The adjusted vacation, sick or comp time leave amount will appear in a routed EPA from Human Resources and the department will modify the amount based on actual time worked.