Sample Employee Handbook

INSERT NAME OF DENTAL
PROGRAM
EMPLOYEE HANDBOOK
Revised September, 2015
No part of this document may be reproduced in any

manner without the express written consent of Insert Name of Dental Program
All Rights Reserved

Insert Name of Dental Program
MISSION STATEMENT.............................................................................................................................................1
COMPANY HISTORY................................................................................................................................................2
WHO IS COVERED BY THIS HANDBOOK..........................................................................................................3
COMPANY POLICIES...............................................................................................................................................4
EQUAL EMPLOYMENT OPPORTUNITY................................................................................................................... 4
INTRODUCTORY PERIOD...................................................................................................................................... 4
ANTI-HARASSMENT POLICY................................................................................................................................ 4
SOLICITATION AND DISTRIBUTION POLICY.......................................................................................................... 6
OFFICIAL PROGRAMS.......................................................................................................................................... 6
HIRING PROCEDURES.......................................................................................................................................... 6
REHIRE ELIGIBILITY........................................................................................................................................... 6
EMPLOYMENT OF RELATIVES AND CLOSE RELATIONS AND PERSONAL RELATIONSHIPS AMONG CO-WORKERS.......6
EVALUATIONS AND COMPENSATION REVIEW....................................................................................................... 7
COMPANY PROMOTION....................................................................................................................................... 7
EMPLOYEE SUBSTANDARD PERFORMANCE AND TERMINATION PROCEDURE.........................................................7
COMPLAINT RESOLUTION PROCEDURE................................................................................................................ 8
PERSONNEL FILES............................................................................................................................................... 8
HIPAA PRIVACY REQUIREMENT......................................................................................................................... 9
PRIVACY OFFICER............................................................................................................................................... 9
RESIGNATIONS.................................................................................................................................................... 9
EVACUATION PROCEDURE................................................................................................................................. 10
SOCIAL MEDIA POLICY..................................................................................................................................... 10
COMPENSATION POLICIES.................................................................................................................................12
EMPLOYMENT CLASSIFICATIONS....................................................................................................................... 12
NEW EMPLOYEE PROCEDURES.......................................................................................................................... 12
THE WORKWEEK.............................................................................................................................................. 12
SCHEDULES AND TIME OFF REQUESTS.............................................................................................................. 13
SICK AND TARDINESS CALLS............................................................................................................................ 13
RECORDING OF WORK HOURS.......................................................................................................................... 13
PAYMENT OF WAGES........................................................................................................................................ 13
SNOW DAY, PLANNED BUSINESS CLOSINGS, AND OTHER EMERGENCY CLOSINGS..............................................14
CLINIC MEETING COMPENSATION POLICY......................................................................................................... 14
EMPLOYEE CONDUCT..........................................................................................................................................15
RULES AND REGULATIONS................................................................................................................................ 15
WORKPLACE VIOLENCE.................................................................................................................................... 16
PERSONAL APPEARANCE................................................................................................................................... 16
CLINIC APPEARANCE........................................................................................................................................ 16
CHILDREN AND PETS........................................................................................................................................ 16
CLINIC ACCESS................................................................................................................................................. 16
POSTAGE.......................................................................................................................................................... 16
TELEPHONE USAGE, SYSTEMS USAGE AND PRIVACY POLICY.............................................................................16
PRESS POLICY AND DISSEMINATION OF INFORMATION.......................................................................................17
POLICY ON DRUGS, ALCOHOL AND WEAPONS................................................................................................... 17
SMOKING POLICY............................................................................................................................................. 17
SAFETY............................................................................................................................................................ 18
ELECTRONIC COMMUNICATIONS POLICY........................................................................................................... 18
PERSONAL CELLULAR PHONES.......................................................................................................................... 18
PROFESSIONAL STANDARDS..............................................................................................................................19
AND BUSINESS CONDUCT....................................................................................................................................19

SOFTWARE DUPLICATION.................................................................................................................................. 19
WRITTEN INFORMATION SECURITY PROGRAM (WISP).......................................................................................20
BUSINESS EXPENSE REIMBURSEMENT..........................................................................................................21
TRAVEL/ENTERTAINMENT/MEALS..................................................................................................................... 21
CLINIC PURCHASES........................................................................................................................................... 21
PETTY CASH..................................................................................................................................................... 21
PARKING SPACES.............................................................................................................................................. 21
BENEFITS...................................................................................................................................................................22
HEALTH INSURANCE BENEFITS.......................................................................................................................... 22
AFLAC INSURANCE........................................................................................................................................... 22
PAID HOLIDAYS................................................................................................................................................ 22
SICK TIME POLICY............................................................................................................................................ 23
ABSENTEEISM OR TARDINESS............................................................................................................................ 23
VACATION TIME POLICY................................................................................................................................... 24
MASSACHUSETTS MATERNITY/PATERNITY LEAVE............................................................................................. 24
JURY DUTY LEAVE........................................................................................................................................... 25
MILITARY LEAVE............................................................................................................................................. 25
BEREAVEMENT LEAVE...................................................................................................................................... 25
CONTINUATION OR CONVERSION OF GROUP HEALTH INSURANCE......................................................................25
BLOODBORNE PATHOGENS...............................................................................................................................27
WORK-RELATED INJURIES OR ILLNESS........................................................................................................27
Notice of Privacy Practices for Protected Health Information...................................................................................28

INSERT NAME OF DENTAL PROGRAM
MISSION STATEMENT
To provide excellent affordable dental care, in a friendly, comfortable environment to people of

all ages in the (insert name of community) and surrounding communities including people who
have limited or no dental insurance.
UNDERSTAND THAT YOUR EMPLOYMENT RELATIONSHIP WITH THE COMPANY IS AT WILL. THIS MEANS THAT EITHER YOU
OR THE COMPANY MAY TERMINATE YOUR EMPLOYMENT AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR
NOTICE.
Page 0
COMPANY HISTORY
Insert history of company
NOTICE.
Page 1
WHO IS COVERED BY THIS HANDBOOK
This Handbook covers all Insert Name of Dental Program employees.
The policies outlined in this handbook are intended as guidelines only and are subject to change as
circumstances dictate. This handbook should not be construed as and does not constitute a contract.
Therefore, this handbook does not create any contractual obligations on the part of you or the company,
nor does it guarantee employment for any specific duration.
Understand that your employment relationship with the company is “At Will”. This means that either
you or the company may terminate for any reason, with or without cause or notice.
Please understand that only the CEO has the authority to enter into an agreement with you for
employment for a specified period of time or to make promises or commitments contrary to the
foregoing. Further, any such employment agreement shall be enforceable only if it is in writing.
Revisions:
This Handbook is a work in progress and Insert Name of Dental Program reserves the right to amend it
from time to time. Insert Name of Dental Program will distribute revisions to the Handbook to you when
it makes changes and amendments. Please replace the outdated sections, so that you maintain your
Handbook in current order.
It is to be understood that all Employee Handbooks and Policy Statements distributed prior to the
issuance of this current volume are null and void.
NOTICE.
Page 2
COMPANY POLICIES
Equal Employment Opportunity
Insert Name of Dental Program strongly believes in equal employment opportunities for everyone. Insert
Name of Dental Program will not discriminate on the basis of religious creed, color, race, national origin,
ancestry, age, physical or mental disability, medical condition, marital status, sex, sexual preference,
veteran status, pregnancy, childbirth, genetic information or related medical condition.
Insert Name of Dental Program subscribes to the principles of equal opportunity employment. This
policy applies to all terms and conditions of employment, including, but not limited to, hiring,
placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, benefits, and
training.
Introductory Period
As a new team member, you will have an introductory period for the first ninety (90) continuous,
calendar days you work at Insert Name of Dental Program. During this period, appropriate on-the-job
training will be provided and your performance will be evaluated regularly. Your successful completion
of the introductory period does not guarantee your employment for any period of time thereafter.
Anti-Harassment Policy
Sexual harassment in the workplace is unlawful, and it is unlawful to retaliate against an employee for
filing a complaint of sexual harassment or for cooperating in an investigation of such a complaint. Insert
Name of Dental Program subscribes to the following guidelines concerning sexual harassment and has
adopted them as company policy.
Moreover, as a part of Insert Name of Dental Program overall nondiscrimination policy, the company
prohibits all forms of harassment of others because of race, color, religion, sex, age, national origin,
ancestry, sexual orientation, physical or mental handicap, veteran, or other protected status. In particular,
an atmosphere of tension created by discriminatory remarks or discriminatory animosity does not belong
in our workplace and will not be tolerated.
For purposes of this policy, sexual harassment is defined as any type of sexually-oriented conduct,
whether intentional or not, that is unwelcome and has the purpose or effect of creating a work
environment that is hostile, offensive or coercive to a reasonable man or woman, as the case may be.
The following are examples of conduct that, depending upon the circumstances, may constitute sexual
harassment: (a) unwelcome and unwanted sexual jokes, language, epithets, advances or propositions; (b)
written or oral abuse of a sexual nature, sexually degrading or vulgar words to describe an individual: (c)
the display of sexually suggestive objects, pictures, posters, or cartoons; (d) unwelcome and unwanted
comments about an individual's body, sexual prowess, or sexual deficiencies; (e) asking questions about
sexual conduct; (f) unwelcome touching, leering, whistling, brushing against the body, or suggestive,
insulting or obscene comments or gestures; and (g) demanding sexual favors in exchange for favorable
reviews, assignments, promotions or continued employment, or promises of the same.
NOTICE.
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If you believe that you have been the subject of sexual harassment or subjected to a hostile, offensive or
coercive work environment, or if you are not sure whether certain behavior is sexual harassment or
whether it is actionable under this policy, you are strongly encouraged to immediately notify the
president so that the company may have the opportunity to investigate and deal promptly with your
complaint.
You should contact the Clinic Manager whose telephone number is listed below:
Name and contact info for Clinic Manager
An investigation of all complaints will be undertaken immediately, and all information will be handled
with the highest degree of confidentiality possible under the circumstances and with due regard for the
rights and wishes of all parties. Employees may also contact:
Massachusetts Commission Against Discrimination (MCAD)
One Ashburton Place, 6th Floor
Boston, Massachusetts 02108
(617) 994-6000
or
436 Dwight Street, Room 220
Springfield, MA 01103
413-739-2145
Equal Employment Opportunity Commission (EEOC)

One Congress Street, 10th Floor
Boston, Massachusetts 02214-2023
(617) 565-3200
Any employee of Insert Name of Dental Program who is found after an investigation to have harassed
another in the workplace will be subject to appropriate discipline up to and including termination,
depending upon the circumstances of the situation. We trust that all employees of Insert Name of Dental
Program will continue to act responsibly to establish a pleasant working environment free of
discrimination. We also trust that, given the serious effects that false accusations of harassment can have
on innocent people, all employees will utilize this policy in a responsible and sensitive manner.
NOTICE.
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Solicitation and Distribution Policy
To avoid unnecessary annoyances and interruptions from your work, solicitation by a staff member of
another staff member or by any outside party is prohibited while either person is on working time and in
any working areas of the Company.
Official Programs
This policy is not intended to prevent the Company from carrying on its normal community / Employee
relations programs that may, from time to time, involve management approval of distributions and
solicitations on Company premises.
Official company-approved solicitation programs will continue to be communicated to you in accordance
with established Company practice.
Hiring Procedures
All applications and references should be reviewed thoroughly by the Clinic Manager or other designated
employee(s) before making any offers to candidates. Background checks must be conducted prior to the
offer of employment for all positions. In addition, any positions responsible for directly handling money
or those that may have unsupervised contact with children will be required to have a credit and/or
criminal background check in addition to the employment and educational background checks.
Rehire Eligibility
The decision to rehire an employee is at the sole discretion of the Company. Documented performance
deficiencies, failure to give proper notice of resignation or termination for violation of company policies
will be reasons for ineligibility for rehire.
Staff members who leave the Company in good standing and later wish to return are eligible for
consideration for rehire provided an appropriate position is available. A previous staff member who is
rehired will be given credit for prior service for purposes of vacation eligibility and other pertinent
benefits if no more than two years have elapsed between termination date and rehire.
In the event of a rehire, the employee is required to complete a new employment application.
Employment of Relatives and Close Relations and Personal Relationships among Co-workers
While applications for employment from relatives or close relations will be considered with other
qualified applications when staff vacancies occur, there are some restrictions on job placement of
relatives or close relations. “Relatives” or “close relations” include child, parent, grandparent, sibling,
parent-in-law, aunt/uncle, sister/brother-in-law, niece/nephew, spouse, domestic partner, or any
individual with whom an employee has a personal relationship.
Relationships between staff that are, or are perceived to be, romantic or excessively personal can cause
serious problems for supervision, morale and, in certain circumstances, may even create liability for the
Insert Name of Dental Program. For this reason, employees are required to maintain professional, and
not romantic or otherwise overly social, relationships with other employees.
The company will, when possible, make employment decisions on the following principles:
1. Where possible, relatives or close relations of staff cannot be of direct reporting, unless there is a
business necessity.
NOTICE.
Page 5
2. If employees become related or romantically involved after starting employment, or if
reorganization creates a situation in which one relative or close relation is supervising the other,
the effected employees must immediately notify the Clinic Manager. The Clinic Manager will
provide reasonable time to resolve the matter voluntarily or, if a voluntary solution cannot be
reached, will transfer one of the staff members. If transfer is not possible or appropriate, the staff
member with the most recent start date may be released. If an employee has worked for Insert
Name of Dental Program on several separate occasions, only the most recent start date will be
considered when determining which of the employees is subject to discharge.
Evaluations and Compensation Review

All employees are given verbal performance evaluations at the end of their Introductory period (first three
months of continuous employment). Written evaluations are given to all employees on an annual basis
(from employee’s start date). Performance reviews are opportunities for the exchange of ideas between
staff and the Clinic Manager. Through this dialog, employees should gain a better understanding of their
performance expectations and establish clear and achievable goals for the review period. The
performance review process and the ongoing dialog between staff and management is critical to
achieving the mission and goals of the organization.
In addition to the regular performance evaluations, special written or verbal performance evaluations may
be conducted by management at any time to advise you of the existence of performance or disciplinary
problems, or other work related issues. Should you not concur with any evaluation, you may respond in
writing. The response will be placed in your personnel file along with the performance review. You may
also request a meeting with management to discuss your response to the evaluation.
Compensation increases are based on annual job performance reviews. Employees with unsatisfactory
performance reviews will not be eligible for an increase.
The company may implement bonus or incentive programs where possible. Employees who meet job
performance standards are eligible if given. Employees with unsatisfactory performance reviews will not
be eligible.
Company Promotion
Insert Name of Dental Program is a small sized company whose primary business is Dental Care.
Because of the size, job promotions are somewhat limited. However, Insert Name of Dental Program
offers opportunities for qualified employees, for further career growth. Contact the Clinic Manager for
further information.
Employee Substandard Performance and Termination Procedure

In the event of less than satisfactory performance on the job, management must meet with the employee
to discuss the problem. The discussion should focus on 1) outlining the nature of the problem or
problems; 2) establishing the expected standard of performance or behavior; and 3) making clear the
consequences for failing to meet the expected performance criteria (typically further disciplinary action,
up to and including termination).
This discussion is considered a verbal warning and should be documented by a follow-up memo from
management to the employee summarizing the three points mentioned above. A copy may be placed in
the employee’s personnel file if desired.
It is expected that the issues discussed in the verbal warning will be addressed within one month of the
date of the discussion. If there is not sufficient resolution to the issue within that time, or if the problem
NOTICE.
Page 6
or problems addressed in the verbal warning recur within six months of the date of the discussion, the
employee will be given a written warning.
The written warning should address the same points as the verbal warning but should be presented to the
employee in written form. Space should be provided on the document for both the employee and the
supervisor to sign. If the employee refuses to sign, a third party who is present at the time of the
discussion may sign to attest that the document was delivered and discussed with the employee. For this
reason, an appropriate third party should be present at the discussion.
Based upon the nature of the substandard performance and the employee’s length of employment, a
probationary period of up to three months will be given to address the issues outlined in the written
warning. If, at the end of the probationary period, performance is still deemed substandard by
management, employment will be immediately terminated. Should the performance issues be resolved
during the probationary period, but those same issues recur within one year of the end of the probationary
period, your employment may be terminated without further warnings. If there is a violation of any
Work Rules & Regulations listed in the Employee Conduct section of this Handbook, no warning needs
to be provided for termination.
Complaint Resolution Procedure

Insert Name of Dental Program fosters an open door policy. Employees are encouraged to talk about
issues with management who can best address the issue.
Insert Name of Dental Program encourages employees to bring any questions, suggestions, and
complaints to management's attention. All issues will be dealt with objectively and fairly. Management
will exercise care in respecting the individual's privacy and the privacy of others by keeping the matter as
confidential as possible. There can be an honest difference of opinion about Company policies, working
conditions, and a number of other areas that may be causing a problem. Remember that a problem cannot
be addressed until it is brought to the attention of management.
Here are the steps you may take if you have a complaint. It is an employee's right and privilege to go
directly to the "top" if necessary.
If a problem arises, you should present the situation to the Clinic Manager as quickly as you can.
Experience shows that a simple examination and discussion of the facts can resolve most
problems. The Clinic Manager will meet with all interested parties and make a final decision.
Don't be afraid to speak up. We want all employees to know that someone is here to listen to them, and
work to correct any problems that may arise. Insert Name of Dental Program prohibits any form of
retaliation against any employee for filing a bona fide complaint under this policy or for assisting in a
complaint investigation. However, if after investigating any complaint, it has been determined that an
employee has intentionally provided false information regarding the complaint, disciplinary action up to
and including termination may be taken against the individual who gave the false information.
Personnel Files
Insert Name of Dental Program maintains personnel files on every employee. These files contain
documentation regarding all aspects of the your tenure with the Company, such as performance
evaluations, benefit enrollment forms, employee emergency notification forms, annual evaluations,
disciplinary warning notices, and letters of commendation. Any Staff member who would like to review
his/her file must submit a request in writing and will be able to view or have a copy of their file within 5
business days. She/he can review the file in the presence of the Clinic Manager during regular business
hours twice a year. No original paperwork may be taken and/or destroyed.
NOTICE.
Page 7
Employees will be notified within 10 days that a document that may be viewed as negative has been
placed in their personnel file.
If you disagree with anything contained in your personnel file, you may submit a written statement of
your position that will be kept in your file.
All items regarding medical coverage and other benefit related information, including vacation/sick time
will be placed in a separate file in a separate location and is not accessible to any one but the Clinic
Manager and the employee.
Records in your personnel file are held in strict confidence. Only those with a need to review the
documents are authorized to do so. Further, no request for information (except position and dates of
employment) from anyone outside the Company will be honored without written permission from you.
To ensure that your personnel file is up-to-date at all times, notify the Clinic Manager of any changes to
your name, address, telephone number, marital status, number of dependents, or individual to notify in
case of an emergency.
HIPAA Privacy Requirement

A federal law called the Health Insurance Portability and Accountability Act (HIPAA) has some
important privacy requirements. These requirements outline specific ways in which we must protect the
personal medical information of our employees. Our procedures are strong safeguards to ensure that we
comply with the requirements of HIPAA.
Because of this law, some of the programs and practices enacted may be limited. For example, if your
spouse asks us for protected health information (PHI) about you or a dependent who is not a minor, we
must first receive your written authorization for the disclosure.
Included in this Employee Handbook is our Notice of Privacy Practices for Protected Health
Information which describes in depth how our company protects health information, what information we
can be required by law to share and your rights regarding your health information. After reading it, if
you have any questions or concerns, please contact the Clinic Manager, Clinic Manager at 508-821-9041.
Privacy Officer
There are two Privacy Officers for Insert Name of Dental Program. The first Privacy Officer is the Clinic
Manager. The second Privacy Officer is insert name. The primary duty of a Privacy Officer is to oversee
all ongoing activities related to the development, implementation, maintenance, and adherence to the
organization’s policies and procedures covering the privacy, access, and patient health information in
compliance with Federal and state laws and the healthcare organization’s information privacy practices.
A complete Privacy Officer Position Description is on file and available for review upon request.
Resignations
Should you decide to resign the Company requests that you give as much notice as possible so
arrangements can be made to cover your responsibilities. Our minimum expectation is that staff
members will give at least two weeks' notice. No vacation or personal time may be taken during the
notice period without written permission of the Clinic Manager. Notice should be given in writing, and
should be directed to the Clinic Manager. Upon receipt of notice, an exit interview will be scheduled
between management and the employee. All company material will be returned at this time. If you
voluntarily resign, your final paycheck will be processed during the next regularly scheduled payroll
period. If the company terminated you, your final paycheck will be provided at the exit interview
meeting. Failure to attend your exit interview however does not result in paychecks being mailed.
NOTICE.
Page 8
Evacuation Procedure
All fire alarms must be taken seriously. Evacuating the building is your first priority. Staff members
should all meet outside the parking lot for attendance. The Clinic Manager should verify a Staff
Members scheduled for the day are present and accounted for as well as all guests, patients and visitors.
Management should direct all Staff Members, visitors and patients out of the building through the closest
emergency exit. Please follow the evacuation plan. If you are first on the scene, pull the closest fire
alarm or call 911.
Social Media Policy
Just as the internet has changed our world forever, social media has changed the way people
communicate. The Company views social media and networking sites as powerful tools to strengthen our
brand and to further your personal reputations as staffing experts.
Social media can take many different forms, including internet forums, blogs & microblogs, online
profiles, wikis, podcasts, pictures and video, email, instant messaging, music-sharing, and voice over IP,
to name just a few. Examples of social media applications are LinkedIn, Facebook, MySpace, Wikipedia,
YouTube, Twitter, Yelp, Flickr, Second Life, Yahoo groups, Wordpress, ZoomInfo – the list is endless.
When you are participating in social networking, you are representing both yourselves personally and
The Company. It is not our intention to restrict your ability to have an online presence and to mandate
what you can and cannot say. We believe social networking is a very valuable tool and continue to
advocate the responsible involvement of all The Company employees in this space. While we encourage
this online collaboration, we would like to provide you with a company policy and set of guidelines for
appropriate online conduct and to avoid the misuse of this communication medium.
Policy Guidelines:
Do not post any financial, confidential, sensitive or proprietary information about The Company
or any of our clients and candidates.
Speak respectfully about our current, former and potential customers, partners, employees and
competitors. Do not engage in name-calling or behavior that will reflect negatively on your or
The Company’s reputations. The same guidelines hold true for The Company vendors and
business partners.
Beware of comments that could reflect poorly on you and the company. Social media sites are
not the forum for venting personal complaints about supervisors, co-workers, or the company.
As a Company employee, be aware that you are responsible for the content you post and that
information remains in cyberspace forever.
Use privacy settings when appropriate. Remember, the internet is immediate and nothing posted
is ever truly private nor does it expire.
If you see unfavorable opinions, negative comments or criticism about yourself or The Company,
do not try to have the post removed or send a written reply that will escalate the situation.
Forward this information to the Clinic Manager.
If you are posting to personal networking sites and are speaking about job related content or
about The Company, identify yourself as a The Company employee and use a disclaimer and
make it clear that these views are not reflective of the views of The Company. “The opinions
expressed on this site are my own and do not necessarily represent the views of The Company.”
NOTICE.
Page 9
The Company Social Networking Policy
Many sites like Facebook and Twitter blur the lines between business and personal. Keep this in
mind and make sure to have a balance of information that shows both your professional and
personal sides. And always balance negative with positive comments.
Be respectful of others. Think of what you say online in the same way as statements you might
make to the media, or emails you might send to people you don’t know. Stick to the facts, try to
give accurate information and correct mistakes right away.
Do not post obscenities, slurs or personal attacks that can damage both your reputation as well as
The Company’s.
When posting to social media sites, be knowledgeable, interesting, honest and add value. The
Company’s outstanding reputation and brand is a direct result of our employees and their
commitment to uphold our core values of Integrity, Dedication, Teamwork and Excellence.
Do not infringe on copyrights or trademarks. Don’t use images without permission and
remember to cite where you saw information if it’s not your own thoughts.
Be aware that you are not anonymous when you make online comments. Information on your
networking profiles is published in a very public place. Even if you post anonymously or under a
pseudonym, your identity can still be revealed.
If contacted by the media, refer them to the Clinic Manager.
The Company may monitor content out on the web and reserves the right to remove posts that
violate this policy.
Users who violate the Policy may be subject to discipline, up to and including termination of
employment. If you have any questions about this policy or a specific posting out on the web,
please contact the Clinic Manager.
NOTICE.
Page 10
COMPENSATION POLICIES
Employment Classifications
Insert Name of Dental Program employees are classified as full-time or part-time; as regular, per-diem, or
temporary; and as “exempt” or “non-exempt” as defined below under state and federal wage and hour
laws. All employees are employees “at-will.”
Hours of Work
Full-time 40 regularly scheduled hours per week
Part-time Fewer than 40 regularly scheduled hours per week
Terms of Employment
Regular Hired for an unspecified duration
Temporary Hired for a specified period of time
Per Diem Hired to work as needed. Provides on-call or intermittent service.
Overtime Eligibility Status (Non-Exempt/Exempt)

State and federal wage and hour laws determine whether employees are “exempt” (salaried) or
“nonexempt” (hourly) based on duties, responsibilities, and compensation. If you are classified as non-
exempt, you are eligible for overtime pay according to applicable state and federal guidelines. (All non-
exempt employees must keep a true and accurate record of their time at work). As discussed in greater
detail below, a non-exempt employee should work overtime only if that work is approved in advance by
the Clinic Manager. A non-exempt employee who works unauthorized overtime will be paid for that
overtime, but may be subject to discipline for violation of this rule. Employees in exempt positions are
not eligible for overtime pay.
All employees, regardless of classification are required to keep a record of hours worked.
You will be informed of your employment classification and of your exempt or nonexempt status upon
offer of employment. If you change positions or your position responsibilities change during your
employment as a result of promotion, or transfer, or otherwise, you will be informed by management of
any change in your employment classification.
New Employee Procedures

On the first day of employment, employees must complete section 1 of the I-9 form. Within the first
three days of employment, employees must present to the Clinic Manager appropriate documentation to
prove eligibility to work and identity, and to complete any other applicable paperwork, such as the W-4
form.
The Workweek
The workweek is defined as Sunday through Saturday for all employees covered by this handbook.
Regular employee work hours are based upon a 40-hour workweek. Shifts are based upon an 8 hours per
day, which includes a paid 60-minute break.
Part-time employee work hours may vary. When a part-time employee is scheduled for more than six
hours in one day, a paid 30-minute break is included. When a part-time employee is scheduled for a full
eight hour shift, a paid 60-minute break is included.
NOTICE.
Page 11
Schedules are solely based upon business needs. Employees can be scheduled for any shift, for any
period of time. Management will attempt to provide you with reasonable notice when the need arises.
However, that advance notice may not always be possible.
Schedules and Time Off Requests

Management strives to post schedules a month in advance, but advanced notice may not always be
possible. Schedules are based upon Business needs and are subject to change.
Special scheduling or time off requests must be submitted in writing to the Clinic Manager. Submitting
requests are not considered approved unless employee receives approval in writing from the Clinic
Manager. Though Management will attempt to accommodate the request(s), employees should not
assume request will be approved. Business needs will determine whether request is approved.
Two or more employees, (whether full-time or part-time) may not be approved for the same time
off/special request.
Employees can only request time off when vacation has been accrued.
Employees may not take unpaid time off in lieu of vacation time.
Any schedule changes including shift exchanges or "switches" with other employees (but not limited to)
require prior approval from the Clinic Manager.
Sick and Tardiness Calls

Though emergencies occur, contacting the Clinic Manager as soon as possible is required.
The employee is required to contact the Clinic Manager directly.
Recording of Work Hours

All employees are required to complete their own individual time sheet using the Time clock - recording
the date, work start time, and completion for the day. No employee can complete a time sheet for another
employee. On any day that you are absent during your normally scheduled hours, you should write
“vacation day”, “sick time”, "holiday", if available, directly on your timecard. The timecard must be
completed and signed by you. If an employee forgets to record work time, the employee must contact the
Clinic Manager directly. The Clinic Manager will collect the timecards for payroll and set up new ones
for the next payroll week. Actual hours worked and leave time taken should be recorded accurately.
Falsification of a time record is a breach of Company policy and is grounds for disciplinary action,
including termination of employment.
Payment of Wages
All employees are paid for the two-week period preceding the pay-week. Paydays occur on alternating
Fridays.
If your position is part-time, nonexempt, and/or you work less than forty hours in a workweek, you will
be paid straight time (your regular hourly rate of pay) for all the hours worked. You will be paid one
and one-half times your regular hourly rate of pay for all hours worked beyond the fortieth hour in any
given workweek.
Please review your paycheck for errors. If you find a mistake, or if your check is lost or stolen, report it
to the Clinic Manager immediately. After it is verified that the check has not cleared the bank, a stop
payment will be placed on the check, and you will be issued another check. The Company reserves the
right to pass the cost of the stop payment on to you. Unfortunately, in the event that a stop payment
NOTICE.
Page 12
cannot be placed on the check, the Company is unable to take responsibility. You alone will be
responsible for such loss.
Snow Day, Planned Business Closings, and Other Emergency Closings

The Clinic Manager will contact all the employees who are scheduled to open the Clinic.
When the Clinic is closed prior to start of the business day: Full-time, non-exempt employees will be
paid for up to three (3) closings during the calendar year. After this, Full-time, non-exempt employees
may use vacation or sick time if accrued. Part-time, non-exempt employees will not be paid. Full-time,
exempt employees are paid their regular wages for the week and company closing is not deducted.
When the Clinic is closed during business hours: Full-time, exempt employees will be paid their regular
salary if they were working during the time when the Clinic closed. Full-time and Part-time, non-exempt
employees will be paid for their scheduled time worked or for a minimum of three hours as required by
law, if worked during the time of the closing. Full-time, non-exempt employees may use vacation or sick
time if accrued for the remainder of the shift.
When the Clinic closes prior to a specific shift that an employee is scheduled for, the Full-time, non-
exempt employees will have the option of using vacation or sick time if accrued. Part-time, non-exempt
employees will not be paid.
When the Clinic opens later, Full-time, exempt employees will be paid if the Clinic opens later, but
during their scheduled shift. Full-time and Part-time non-exempt employees will be paid for hours
worked or for a minimum of three hours as required by law, if worked during the time of the closing.
Full-time, non-exempt employees may use vacation or sick time if accrued for the remainder of the shift.
Clinic Meeting Compensation Policy

Meetings may be scheduled periodically outside of normal working hours and may be mandatory. For
part-time, non-exempt employees, you will be compensated at your normal hourly rate. If you are a
regular, exempt employee, attendance is considered part of the professional development and you will not
be compensated.
NOTICE.
Page 13
EMPLOYEE CONDUCT
Rules and Regulations
Every organization must have some rules and regulations in order to function efficiently. The following
rules are intended to serve as guidelines for conduct on the job. Remember that this list is not intended
to be all-inclusive and may change from time to time.
Disciplinary action for committing any of the following violations while on the job can range from a
verbal warning to immediate discharge, depending on the severity of the offense, and the circumstances
of each individual case. Steps may be skipped, again depending on the severity of the offense.
 Violation of established safety regulations
 Violation of established Practice Standards
 Insubordination or refusal to complete an assignment
 Professional misconduct including speaking ill of fellow workers or others
 Disorderly conduct (including fighting), use of profanity, rude to patients
 Unexplained or excessive absenteeism or tardiness
 Falsification of company documents and records (including personnel matters)
 Falsification of timesheets
 Failure to accurately record your time
 Leaving the Clinic unattended
 Opening the Clinic late
 Providing confidential information of patients, other employees, business related, or other
 Stealing
 Destruction or waste of Company property or material or another personal property or material
 Sale, possession, distribution or use of, or being under the influence of, illegal drugs or alcohol in
the workplace
 Sale, possession, distribution or use of weapons of any kind unless props
 Gambling on company property
 Violation of Workplace Violence Policy
 Violation of Harassment and discrimination policies
 Violation of Smoking Policy
 Violation of HIPAA Privacy Policy and Practices
NOTICE.
Page 14
Workplace Violence
Violent or threatening behavior is not tolerated in the workplace. Employees are responsible for
reporting threats and unusual actions or situations that have the potential for workplace violence. These
situations include, but are not limited to, the following:
Threats or threatening behavior directed at an employee from a family member, co-worker, patient, or
other individual(s).
Knowledge of threats directed to another employee by family member, co-worker, patient, or other
individual(s).
Employees should never assume that a threat or suspicious action indicating a potential for violence will
not take place. All such indications and threats must be reported immediately to the Clinic Manager, a
member of security or any member of management.
Personal Appearance
A neat appearance is expected. The Dental Assistants are required to provide their own scrubs. The
employer provides lab-coats to all staff.
Clinic Appearance
Employees are required to keep the Clinic and the work environments clean and orderly. The reception
desk, employee only areas, and other should be kept organized so as to present a neat and orderly
appearance. Materials of a sensitive or confidential nature should be kept secured.
Children and Pets

In the event of an emergency you find you must bring a child to work, it is your responsibility to ensure
the child is not disruptive to the business.
No pets are allowed.
Clinic Access
The employee is responsible for ensuring that you have a key to open/close the Clinic for which you are
scheduled for. Keys for Clinic access are provided to employees as needed. Employees are also
responsible for ensuring they use their own alarm code. Codes are provided to employees as needed.
Any lost or stolen keys should be reported to the Clinic Manager immediately. Only the Clinic Manager
or Operations Manager can purchase duplicate keys.
Postage
Postage is for business use only. Company purchased stamps cannot be taken and used for personal use
nor can petty cash be used to purchase stamps for personal use by an employee.
Telephone Usage, Systems Usage and Privacy Policy

Generally, all Insert Name of Dental Program telephone communication and storage systems (such as
telephones, fax, voice mail, computers, etc.) are not to be used for private purposes. These systems must
NOTICE.
Page 15
not, at any time, be used to communicate improper messages, e.g. messages that are harassing or
discriminatory, defamatory, derogatory, obscene, or otherwise inappropriate.
Loading software and/or accessing files from diskettes or other means, must be pre-approved by
management.
Additionally, you should not consider any material on these systems to be private. Even erased or deleted
material may remain accessible. To ensure the legitimate use of its electronic systems, the Company
reserves the right to look at, listen to, monitor, or use anything on its systems, and to by-pass any pass
code at any time. Violations of Company policy regarding the use of electronic media are subject to
disciplinary action, up to and including termination.
Telephone usage is restricted to business use only. Outgoing personal calls are for emergencies only.
Press Policy and Dissemination of Information

All contact with the media or vendors must go through the Clinic Manager. If a member of the media
does contact you directly, you should refer him or her to the Clinic Manager. The Clinic Manager should
also be informed of all media-related events that might be occurring.
Authorization for business vendors must go through the Clinic Manager.
Additionally, all information pertaining to Insert Name of Dental Program, its employees, members,
agents, representatives, and trustees that is disseminated to the press must be cleared through the Clinic
Manager. This policy is designed not to inhibit anyone's freedom of expression, but to insure that the
image that the Company presents to the community is clear and consistent.
Policy on Drugs, Alcohol and Weapons

The possession, use, sale or distribution of alcohol, weapons, unauthorized or illegal drugs, or the misuse
of legal drugs while on Company premises or business is strictly prohibited. Reporting to work under the
influence of alcohol or such drugs is similarly prohibited. An employee who violates these prohibitions
may be subject to discipline, up to and including termination.
Regardless of whether there are company-sponsored social functions that occur on or outside Company
premises, during or after normal working hours, Company employees are expected to conduct themselves
professionally. Such professional conduct includes, but is not limited to, the exercise of sound judgment,
respect for the rights and feelings of others, and consideration of the Company’s reputation. The fact that
alcoholic consumption may be allowed at certain Company-sponsored functions in no way lessens an
employee’s obligations to use alcohol in a responsible manner, and an employee’s decision to consume
alcohol will not excuse any departure from standards of professional conduct.
Smoking Policy
Since Insert Name of Dental Program promotes good health, smoking is a conflict of interest.
Smoking is not permitted inside the Clinic, anywhere outside surrounding the Clinic, within the parking
lots, or within view of patients.
If you are found smoking within any of the premises, you may be subject to disciplinary action up to and
including suspension or termination based on the circumstances of the case, including the number of
offenses.
NOTICE.
Page 16
Safety
Insert Name of Dental Program is responsible for providing you with a safe and healthy place to work.
The organization complies with the safety and health standards, regulations, and orders issued under
state, federal and local statutes. Management is responsible for ensuring that risk from potential hazards
is minimized. It is an employee’s duty to report all unsafe conditions or unsafe practices to management.
You are expected to work safely, wear required safety equipment and apparel and observe all posted
safety rules.
Electronic Communications Policy

Staff members should be aware that communications on a company-owned computer that were made
through a private, password-protected Internet e-mail service are stored on the hard disk of the company’s
computer in a “screen shot” temporary file. The company expressly reserves the right to retrieve those
temporary files and read them.
All electronic communication systems as well as all information transmitted, received or stored in these
systems are the property of the Company. Such systems are to be used solely for job-related and not for
personal purposes. Team members should have no expectation of privacy in connection with the use of
this equipment or the transmission, receipt, or information stored in such equipment.
Staff members are not to use a program, access a file, or retrieve any stored communication unless
authorized; The Company may monitor use of a Staff member’s equipment at any time at its discretion.
Such monitoring may include printing and reading all e-mail entering, leaving, or stored in these systems.
Personal Cellular Phones

While at work Staff members are expected to exercise the same discretion in using personal cellular
phones as is expected for the use of company phones. Excessive personal calls during the workday,
regardless of the phone used, can interfere with team member productivity and be distracting to others. A
reasonable standard is to limit personal calls during work time to no more than one per day as needed.
Team members are therefore asked to make any other personal calls on non-work time and to ensure that
friends and family members are aware of the company's policy. Flexibility will be provided in
circumstances demanding immediate attention.
The company will not be liable for the loss of personal cellular phones brought into the workplace.
NOTICE.
Page 17
PROFESSIONAL STANDARDS
AND BUSINESS CONDUCT
The Company expects that Staff members will conduct themselves ethically and in accordance with what
are generally accepted as “standard business practices.” The increasingly complex relationships that have
evolved between the Company and the numerous individuals, companies, and other groups, with which it
deals, require that persons representing the Company exercise a high degree of personal responsibility,
integrity, and sound judgment. It is also expected that Staff members shall not engage in any illegal
activities or any activities, which are in violation of the rules and regulations governing the industries in
which the Company operates its business. Any such violations, whether found by a court or not, shall be
grounds for immediate dismissal.
When any The Company team member is on a job there should be no un-ethical conduct, which includes
no, propositioning or dating of any male or female clientele.
The Company has issued policies and procedures designed to provide guidance to team members
concerning team member code of conduct and business ethical issues. It is hoped that by clearly setting
forth the standards of behavior that the Company expects from its team members, any misunderstandings
will be minimized, and any questionable situation can be brought to the attention of the Company’s
Administrator and resolved.
Specific areas of focus include:
 Company assets and resources
 Software piracy
 Conflicts of interest
 Supplemental employment/outside activities
 Gifts and entertainment
 Fraud/embezzlement
Software Duplication
It is the policy of the Company to respect the proprietary rights of owners of computer software and to
expect that team members will refrain from actions that constitute an infringement of the copyright or
other proprietary right attached to software. Team members are required to determine permitted uses of
software in their possession, such as the right to make copies, and to obtain appropriate permission when
necessary.
Activities that infringe upon proprietary rights will not be considered to have occurred in the course of
employment since they are expressly prohibited. The Company reserves the right to refuse to defend team
member named in a lawsuit arising out of alleged infringement activity, and to refuse to pay any damages
awarded by a court of law against any such person. Infringement activities in the course of Company-
related programs may constitute grounds for disciplinary action.
Users are to take precautions to prevent the unauthorized use of their access codes (passwords).
Access codes are not to be shared with others and their confidentiality is to be strictly maintained.
In choosing access codes, users are to avoid the use of common words, proper names, nicknames or
initials, and any other letter and/or number sequences that might easily be guessed. Users will be
NOTICE.
Page 18
held accountable for all actions performed under their access codes, including those performed by
other individuals as a result of user negligence in protecting the codes. Users are responsible for
monitoring access on their accounts and for changing access codes on a regular basis. If access
codes become compromised, users are to change them immediately. No one is to use another
individual's account either with or without permission, and active sessions are not to be left
unattended. The provision of false or misleading information in order to gain access to
technological and information resources is prohibited. Users are not to test or attempt to
compromise internal controls, even for purposes of systems improvement.
Personal software is not to be loaded and/or used on Company owned equipment. As such, this software
and/or data can be removed without authorization from any and all Company resources.
Written Information Security Program (WISP)

The Company respects and appreciates the absolute need for proper security and safeguarding of personal
information contained in both paper and electronic records. We are in support of and fully compliant
with Massachusetts' Standards for The Protection of Personal Information [201 CMR 17.00], the latest in
state regulations.
NOTICE.
Page 19
BUSINESS EXPENSE REIMBURSEMENT
Travel/Entertainment/Meals
Ordinary travel between home and work is not compensable working time. However, if an employee
who regularly works at a fixed location is required, for the convenience of the employer, to report to a
location other than his or her regular work site, the employee will be compensated for all travel time in
excess of their ordinary travel time between home and work.
An employee will be compensated for all travel time if required or directed to travel from one place to
another after the beginning of or before the close of the work day.
Employees can utilize a tax-deductible option for any business expenses that are not reimbursed by the
Company.
When there is an overnight type of seminar or business related purpose, which has been pre-approved by
management, the employee will be reimbursed accordingly. Each case will be reviewed individually.
Clinic Purchases
Any items to be purchased for Clinic use including decorations or other must be pre-approved by
management. The employee will be given a check for the approved amount in advance, money can be
taken from the cashbox, or employee will be reimbursed. Receipts are required.
Petty Cash
Money in the cashbox is for business use only - for making change for customers.
Money taken for other business uses, such as buying supplies, must be pre-approved by the Clinic
Manager. Receipts are required.
Money in the cashbox is not for personal use.
Parking Spaces
On-street parking is available as well as the parking lot.
NOTICE.
Page 20
BENEFITS
Insert Name of Dental Program reserves the right, at their discretion, to amend or terminate any of these
programs or to require or increase employee premium contributions toward any benefits. This right may
be exercised in the absence of financial necessity.
Health Insurance Benefits

Regular, Full time exempt and non-exempt employees are eligible immediately upon date of hire for the
following: Health Insurance Benefits currently provided at: 28% Employee paid and 72% Employer
paid.
Part-time employees are eligible to participate in the company’s Health Insurance plan – employee is
responsible for the full premium.
Aflac Insurance
Aflac Insurance for various types of coverage are available at 100% Employee paid. All employees are
eligible to participate immediately upon date of hire.
Paid Holidays
Eligibility begins after the employee’s Introductory period (first three months of continuous
employment).
Regular, Full time exempt and non-exempt employees are eligible for full eight (8) hours of pay per
holiday. Part-Time employees who are hired for 24 or more hours per week are eligible for four (4)
hours of paid holiday time. Part-Time hours are based upon hired hours, not actual hours worked.
The Ten (10) paid holidays when the Clinic is closed varies from year to year, but generally are as
follows:
President’s Day Independence Day Veteran’s Day Christmas Day
Patriot’s Day Labor Day Thanksgiving Day
Memorial Day Columbus Day Day after Thanksgiving
In order to be paid for the holiday, the employee cannot be out sick the scheduled day before and the
scheduled day after the holiday. This doesn’t apply if vacation time was pre-approved surrounding the
holiday.
If you observe a religious holiday, which is not among those observed by Oral Health Clinic, you may
take the time as a vacation or personal day, or you may observe the holiday and make arrangements with
management to make up the missed hours at a mutually agreeable time.
NOTICE.
Page 21
Sick Time Policy
employment).
Regular, Full time exempt and non-exempt employees are eligible for Sick Time Benefits of five (5) sick
days per calendar year (pro-rated based on start date of employment).
Part-Time employees who are hired for 24 or more hours per week are eligible for a total of 20 hours of
(equivalent to five (5) 4 hours per day) sick time per calendar year (pro-rated based on start date of
employment). Part-Time hours are based upon hired hours, not actual hours worked.
Sick time accrues with additional service and continues to accrue from year to year without limit. Longer
service employees accordingly have greater income protection in case of serious disability or sickness.
Insert Name of Dental Program expects that employees will use no more than five sick days per year.
Sick time in excess of this or any other abuse of the sick time benefit may result in disciplinary action up
to and including termination.
If you are sick but have used up all your sick days, unused vacation time will be used if you have accrued
time.
If a Regular, full-time exempt employee leaves work due to illness within their first 4 hours of their shift,
it will be treated as one full sick day. If a Regular, full-time exempt employee leaves work due to illness
after the first 4 hours of their scheduled shift, it will be treated as 1/2 of a sick day.
Insert Name of Dental Program reserves the right to require the employee to submit a doctor's note that
verifies illness or other medical condition. If an employee will be out for three or more consecutive days
due to illness, a doctor's note is required (prior to returning to work), stating illness and when the
employee is expected to return to work. Additional information may be required to determine whether
essential functions of the job can be performed or reasonable accommodations may be necessary.
For Sick Time, no benefits are payable if the illness or injury is attributable to work done on behalf of
another employer.
Absenteeism or Tardiness
Unexcused absenteeism or tardiness and/or excessive absenteeism or tardiness are cause for disciplinary
action that can range from a verbal warning to immediate discharge, depending on the severity of the
offense, and the circumstances of each individual case. Excessive absenteeism or tardiness is defined as
follows:
 3 absences or 3 tardies in any rolling 30-day period
 4 absences or 4 tardies in any rolling 90-day period
NOTICE.
Page 22
Vacation Time Policy
employment).
Regular, Full time exempt and non-exempt employees are eligible for Vacation Benefits of 3 weeks paid
vacation per calendar year (pro-rated based on start date of employment).
Part-Time employees who are hired for 24 or more hours per week are eligible for a total of sixty (60)
hours of (equivalent to three (3) weeks of 4 hours per day) paid vacation time per calendar year (pro-rated
based on start date of employment). Part-Time hours are based upon hired hours, not actual hours
worked.
Employees must provide one weeks’ notice of intent to take time off. Management must approve your
vacation requests in accordance with the Organization and Clinic schedules and the requests of co-
workers on the basis of seniority. Two or more employees, (whether full-time or part-time) will not be
approved for the same time off/special request.
Vacation days may not be carried over from one year to the next. All unused vacation days will be lost on
the next calendar year.
Employees may not take unpaid time off in lieu of vacation time. Under no circumstances will payments
be made in lieu of taking vacation. A terminated employee will be paid for all accrued but unused
vacation time at the time of termination. Note that vacation time earned but lost will not be paid out at
the time of termination.
Because of the size of the organization and requirements of the organization, employees will not be
entitled to take vacation during times when management is on vacation. Advanced notice of eligible
times for vacation will be provided. Each case will be reviewed individually.
In the event that a paid holiday, as defined under the Paid Holiday Benefit, falls within your vacation
period, that holiday will not be counted as a vacation day taken.
Massachusetts Maternity/Paternity Leave

Female employees who have worked for the Organization for at least three months are entitled under
Massachusetts law to up to eight weeks of unpaid maternity leave for the purpose of giving birth or for
adopting a child under the age of 18 (or under the age of 23 if the child is mentally or physically
disabled).
To be entitled to such leave, an employee must notify management at least two weeks in advance of her
expected departure date and whether she intends to return to work. If this notice is given, the employee
will, at the completion of the leave, be reinstated to her original job with the status, pay, length of
service, and seniority that she would have had as of the date of reinstatement from maternity leave,
otherwise, she will be employed in a substantially similar position unless other employees of equal length
of service and status in the same or similar position have been laid off due to economic conditions or
changes in operating conditions. Any female employee who is not reinstated after her maternity leave for
these reasons will be placed on a preferential hiring list for another position.
Male team members: Because state and federal law prohibit sex discrimination in employment, male
team members may have a right to take the same 8 weeks of unpaid leave a female team member is
entitled to take at the adoption of a baby, and to take a certain amount of unpaid leave at the birth of a
child.
NOTICE.
Page 23
Jury Duty Leave
All classifications of employees are eligible for Jury Leave and are paid regular wages for the first three
(3) days as long as a copy of your summons is submitted to the Clinic Manager. Insert Name of Dental
Program will not attempt to have your service on a jury postponed except where a critical business
condition necessitates such action.
Military Leave
If you are a member of the ready reserve of the armed forces and you are required to participate in
military training, you are entitled to leave of absence for up to seventeen days per calendar year. You are
required to provide reasonable advance notice to your supervisor of the date of departure and date of
return. Upon immediate return and after providing documentation of satisfactory completion of the
training, you generally will be restored to your previous position, or a similar position with the same
status, pay and seniority.
In addition, federal law provides broad protection and rights for you if you leave your employment for
the purpose of entering uniformed services for extended periods. “Uniformed Services” refers to the
Armed Services (including the Coast Guard), the Army National Guard and Air National Guard (when
engaged in active or inactive duty for training, or full-time duty), and the commissioner corps of the
Public Health Service. The period of protection extends ordinarily for up to five years. If you interrupt
your career for uniformed service, you generally must give advance notice to the Company of the
impending service, and must report for work in a timely fashion after the period of uniformed service has
ended.
The Company provides military leave to eligible team members consistent with the requirements of state
and federal law including, but not limited to, the Uniformed Services Employment and Re-Employment
Rights Act (USERRA) 38 U.S.C. Section 4301 et. seq.
Insofar as issues arise that are not addressed in this policy, the Company will abide by USERRA and any
controlling state law. The Clinic Manager should be consulted whenever a team member requests or
prepares to return from military leave. All regular, full-time and part-time team members are eligible for
military leave.
Bereavement Leave
In the case of death of a member of the immediately family, defined as husband, wife, father, mother,
son, daughter, sister, brother, step or half son or daughter, grandmother or grandfather, father-in-law or
mother-in-law, or domestic partner, all employees are eligible to take up to three paid days.
Continuation or Conversion of Group Health Insurance

Through provisions of COBRA (Consolidated Omnibus Budget Reconciliation Act), if you resign, are
terminated, or if your work hours are reduced, rendering you ineligible to participate in one of our group
health plans, you and your dependents may have the right to continue to participate at your own (or your
dependents) expense for up to 18 months, or up to 29 months if you are determined to be disabled under
the Social Security Act guidelines at the time your termination or reduction of hours occurs. Your
eligible dependents may also extend coverage, at their expense, for up to 36 months in our group health
insurance plans in the event of your death, divorce, legal separation or entitlement to Medicare benefits,
or when a child ceases to be eligible for coverage as a dependent under the terms of the plan.
In the event of your termination or resignation, the COBRA notification form will be sent to you directly
to your home address. You will then have 60 days to elect coverage under COBRA. While on
continuation coverage, you and/or your dependents are responsible for contacting the insurance company
NOTICE.
Page 24
in any of the following events: your divorce; legal separation; one of your dependents becomes ineligible
for coverage; you or your qualified beneficiary becomes eligible for Social Security disability benefits.
NOTICE.
Page 25
BLOODBORNE PATHOGENS
Whenever there is an employee, patient, guest or vendor accident that may involve blood or other
potentially infectious materials, please call the Clinic Manager or 911 immediately. Do not attempt to
administer first aid if you have not been trained to do so. Employees must wear personal protective
equipment before administering first aid. Personal protective equipment is also required in the daily
job.
WORK-RELATED INJURIES OR ILLNESS

In the event that you suffer a work related injury or illness (i.e., Worker's Compensation), you must
report it to the Worker’s Compensation Administrator, the Clinic Manager, within 24 hours of
occurrence. You may make this report by telephone, in person, or in writing. (See also Workers'
Compensation).
Medical expenses incurred in connection with work-related injuries or illnesses are paid in full. Partial
salary payments are provided beginning with the sixth consecutive day of your absence from work. If you
miss 21 or more days of work, you will receive partial salary benefits retroactive to the first day of
missed work. The Organization will pay the difference between your weekly workers' compensation
benefit, as determined by our Worker's Compensation Insurance Carrier, and your weekly salary until
such time as your accrued sick time benefit is exhausted.
NOTICE.
Page 26
NOTICE OF PRIVACY PRACTICES FOR PROTECTED
HEALTH INFORMATION
At Insert Name of Dental Program, we respect the confidentiality of your health information and will
protect your information in a responsible and professional manner. We are required by law to maintain
the privacy of your health information and to provide you with this notice.
This notice explains how we use information about you and when we can share that information with
others. It also informs you about your rights with respect to your health information and how you can
exercise these rights.
When we talk about “information” or “health information” in this notice, we mean the following:
 We may share your information with others who help us conduct our business operations, such as
insurance brokers. We will not share your information with these outside groups unless they
agree to keep it protected.
 We may share your information for certain types of public health or disaster relief efforts.
 We may use or share your information to share information with an employee benefit plan
through which you received health benefits. We will not share detailed health information
with your benefit plan unless they promise to keep it protected.
There are also state and federal laws that may require us to release your health information to others. We
may be required to provide information for the following reasons:
 We may report information to state and federal agencies that regulate us.
 We may share information for public health activities.
 We may report information to public health agencies if we believe there is a serious health or
safety threat.
 We may provide information to a court of administrative agency (for example, pursuant to a
court order, search warrant or subpoena).
 We may report information for law enforcement purposes. For example, we may give
information to a law enforcement official for purposes of identifying or locating a suspect,
fugitive, material witness or missing person.
 We may report information to a government authority regarding child abuse, neglect or domestic
violence.
 We may share information with a coroner or medical examiner to identify a deceased person,
determine a cause of death, or as authorized by law.
 We may share information relative to specialized government functions, such as military and
veteran activities, national security and intelligence activities, and the protective services for the
President and others.
 We may report information on job-related injuries because of requirements of your state worker
compensation laws.
 We may share information in our capacity as an employer such as employee census for
insurance quoting purposes, disability claims, or doctor’s back-to-work notes.
NOTICE.
Page 27
If any of the above reasons do not apply, we must get your written permission to use or disclose your
health information. If you give us written permission and change your mind, you may revoke your
written permission at any time. Once you give us authorization to release your health information, we
cannot guarantee that the person to whom the information is provided will not disclose the information.
Privacy Officer
There are two Privacy Officers of Insert Name of Dental Program: the first Privacy Officer is the Clinic
Manager. The second Privacy Officer is. The primary duty of a Privacy Officer is to oversee all
ongoing activities related to the development, implementation, maintenance, and adherence to the
organization’s policies and procedures covering the privacy, access, and patient health information in
compliance with Federal and state laws and the healthcare organization’s information privacy practices.
A complete Privacy Officer Position Description is on file and available for review upon request.
What are your Rights
 You have the right to ask us to restrict how we use or disclose your information for treatment,
payment, or health care operations. You also have the right to ask us to restrict information that
we have been asked to give to family members or to others who are involved in your health care
or payment for your health care. Please note that while we will try to honor your request, we
are not required to agree to these restrictions.
 You have the right to ask to receive confidential communications of information. For example,
if you believe that you would be harmed if we send your information to your current mailing
address (e.g., in situations involved domestic disputes or violence), you can ask us to send the
information by an alternative means to an alternative address. We will accommodate reasonable
requests by you as explained above.
- Alternative means could be by fax, internal mail, email, PO box.
 You have the right to inspect and obtain a copy of information that we maintain about you in
your medical file. However, you do not have the right to access certain types of information and
we may decide not to provide you with copies of the following information:
- Compiled in reasonable anticipation of, or for use in a civil, criminal, or administrative
action or proceeding; and
- Subject to certain federal laws governing biological products and clinical laboratories.
- Additionally, in certain other situations, we may deny your request to inspect or obtain a
copy of your information. If we deny your request, we will notify you in writing and
may provide you with a right to have the denial reviewed.
 You have the right to ask us to amend information we maintain about you in your designated
record set. We may require that your request be in writing and that you provide a reason for
your request. We will respond to your request no later than 60 days after we receive it. If we
are unable to act within 60 days, we may extend that time by no more than an additional 30
days. If we need to extend this time, we will notify you of the delay and the date by which we
will complete action on your request.
If we make the amendment, we will notify you that it was made. In addition, we will provide the
amendment to any person that we know has received your health information. We will also provide the
amendment to other persons identified by you.
If we deny your request to amend, we will notify you in writing of the reason for the denial. The denial
will explain your right to file a written statement of disagreement. We have a right to rebut your
NOTICE.
Page 28
statement. However, you have the right to request that your written request, our written denial and your
statement of disagreement be included with your information for any future disclosures.
 You have the right to receive an accounting of certain disclosures of your information made by us
during the six years prior to your request. Please note that we are not required to provide you with
an accounting of the following information:
 Any information collected prior to April 14, 2004
 Information disclosed or used for treatment, payment, and health care operations
purposes.
 Information disclosed to you or pursuant to your authorization.
 Information that is incident to a use of disclosure otherwise permitted.
 Information disclosed for a facility’s directory or to persons involved in your care or
other notification purposes.
 Information disclosed for national security or intelligence purposes.
 Information disclosed to correctional institutions, law enforcement officials or health
oversight agencies.
 Information that was disclosed or used as part of a limited data set for research, public
health, or health care operations purposes.
We may require that your request be in writing. We will act on your request for an accounting
within 60 days. We may need additional time to act on your request, and therefore may take up
to an additional 30 days. Your first accounting will be free, and we will continue to provide you
one free accounting upon request every 12 months. However, if you request an additional
accounting within 12 months of receiving your free accounting, we may charge you a fee. We
will inform you in advance of the fee and provide you with an opportunity to withdraw or modify
your request.
Exercising Your Rights
 You have a right to receive a copy of this notice upon request at any time. Should any of our privacy
practices change, we reserve the right to change the terms of this notice and to make the new notice
effective for all protected health information we maintain. Once revised, we will provide the new
notice to you by internal mail.
 If you have any questions, about this notice or about how we use or share information, please contact
your Privacy Officer, at.
If you believe your privacy rights have been violated, you may file a complaint in writing addressed to
Clinic Manager, or email to. You may also file a complaint in writing addressed to the second Privacy
Officer …You may also notify the Secretary of the U.S. Department of Health and Human Services of
your complaints. We will not take any action against you for filing a complaint.
NOTICE.
Page 29

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INSERT NAME OF DENTAL

Revised September, 2015

No part of this document may be reproduced in any

All Rights Reserved

WHO IS COVERED BY THIS HANDBOOK..........................................................................................................3

AND BUSINESS CONDUCT....................................................................................................................................19

WORK-RELATED INJURIES OR ILLNESS........................................................................................................27

Notice of Privacy Practices for Protected Health Information...................................................................................28

To provide excellent affordable dental care, in a friendly, comfortable environment to people of

Insert history of company

This Handbook covers all Insert Name of Dental Program employees.

Equal Employment Opportunity Commission (EEOC)

Evaluations and Compensation Review

Employee Substandard Performance and Termination Procedure

Complaint Resolution Procedure

HIPAA Privacy Requirement

Social Media Policy

If contacted by the media, refer them to the Clinic Manager.

Overtime Eligibility Status (Non-Exempt/Exempt)

New Employee Procedures

Schedules and Time Off Requests

Sick and Tardiness Calls

Recording of Work Hours

Snow Day, Planned Business Closings, and Other Emergency Closings

Clinic Meeting Compensation Policy

 Violation of established safety regulations

 Violation of established Practice Standards

 Insubordination or refusal to complete an assignment

 Professional misconduct including speaking ill of fellow workers or others

 Disorderly conduct (including fighting), use of profanity, rude to patients

 Unexplained or excessive absenteeism or tardiness

 Falsification of company documents and records (including personnel matters)

 Failure to accurately record your time

 Leaving the Clinic unattended

 Opening the Clinic late

 Providing confidential information of patients, other employees, business related, or other

 Destruction or waste of Company property or material or another personal property or material

 Sale, possession, distribution or use of weapons of any kind unless props

 Gambling on company property

 Violation of Workplace Violence Policy

 Violation of Harassment and discrimination policies

 Violation of Smoking Policy

 Violation of HIPAA Privacy Policy and Practices

Children and Pets

Telephone Usage, Systems Usage and Privacy Policy

Press Policy and Dissemination of Information

Policy on Drugs, Alcohol and Weapons

Electronic Communications Policy

Personal Cellular Phones

Written Information Security Program (WISP)

Health Insurance Benefits

Massachusetts Maternity/Paternity Leave

Continuation or Conversion of Group Health Insurance

WORK-RELATED INJURIES OR ILLNESS

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